Management of compartment syndromes of the foot

Twelve patients with isolated extremity injuries had 14 compartment syndromes of the feet. An interstitial pressure of more than 30 mm of mercury in either the central or interosseous compartment was considered pathologic and was treated by fasciotomy, performed dorsally in nine feet and medially in five. Open reduction of fractures amenable to internal fixation (eight tarsometatarsal, three calcaneus, and one metatarsal) was performed after completion of the fasciotomies. The fasciotomy wounds were covered by primary split-thickness skin excision (three), delayed split-thickness skin grafting (eight), and delayed primary wound closure (three). Patients were evaluated at a mean of 22 months (range, 17-36 months) after injury, and the examination was directed specifically toward symptoms and signs of myoneural ischemia. Absolute compartment pressure measurements are more accurate than clinical findings in the diagnosis of a compartment syndrome of the foot. Fasciotomy may be performed medially or dorsally, depending on the configuration of the pattern of fracture or dislocation. To ensure satisfactory results, all compartments should be decompressed, and the pressures remeasured after the completion of fasciotomy.