Reconstructive Surgery after Compartment Syndrome of the Lower Leg and Foot

Compartment syndrome at the lower extremity, if overlooked or treated inadequately in polytraumatized and multiply injured patients, regularly leads to progressive foot deformities and severe loss of function in the affected patients. The sequelae of compartment syndrome directly result from muscle contracture, necrosis and scarring and are further affected over time by gravity and posture (especially the sleeping position with the foot in equinus and inversion). While overlooked compartment syndrome of the lower leg leads to deformities of the whole foot, most frequently equinovarus, compartment syndrome of the foot results in painful toe deformities, mostly hammer or claw toes. Treatment aims at functional rehabilitation of the foot and ankle. Flexible deformities are treated with tendon lengthening or tendon transfer based on a thorough clinical evaluation of the remaining muscle force. Progressive contractures are subject to tenotomy, extensive capsular release and excision of scarred tissue. Corrective fusions should be reserved for long-standing deformities with symptomatic arthritis. They are combined with soft-tissue procedures as indicated.