Compartment syndromes of the foot: current concepts

The foot has been mentioned as a site for the development of a compartment syndrome for approximately 9 years. Despite this, very little information exists in the literature containing specifics on the nature of the disorder. Very recent work has shown that crush injuries, forefoot and midfoot fractures and dislocations, and calcaneal fractures are prone to the development of foot compartment syndromes (FCS). The classical clinical signs of pain with passive stretch of the involved muscles, and dysfunction of the nerves that pass through the involved compartments are less helpful in the diagnosis of the syndrome in the foot than elsewhere. Tense swelling of the foot may be of some help in arousing suspicion that a FCS has developed, but the diagnosis is best made by invasive catheterization of the foot compartments. Since recent work has discovered that at least nine foot compartments exist, multi-stick catheterization is recommended. Fasciotomy should be performed when the pressures are significantly elevated, to prevent the development of late contractures. A communication exists between a newly-found compartment of the foot, the calcaneal compartment, and the deep posterior compartment of the leg. A combined pattern of FCS and deep posterior compartment syndromes of the leg exists, and should be remembered by the clinician treating injuries of the foot or leg. Also, a foot injury alone may cause a deep posterior compartment syndrome in the leg. Claw-toe deformity seems to be the primary late sequela of FCS. Local procedures may be of only temporary benefit.