Tibiofibular joint Superior tibiofibular joint.Tibiocalcaneal part (Medial ligament Deltoid ligament).Superior fibular retinaculum Superior peroneal retinaculum.Superficial part of posterior compartment of leg.Superficial fibular nerve Superficial peroneal nerve.Small saphenous vein Short saphenous vein. ![]() Profunda femoris vein Deep vein of thigh.Posterior tibiotalar part (Medial ligament Deltoid ligament).Posterior talocrural region Posterior ankle region.Posterior cutaneous nerve of thigh Posterior femoral cutaneous nerve.Medial border of foot Tibial border of foot.Lateral cutaneous nerve of thigh Lateral femoral cutaneous nerve.Lateral compartment of leg Fibular compartment of leg Peroneal compartment of leg.Lateral border of foot Fibular border of foot Peroneal border of foot.Intermediate cuneiform Middle cuneiform.Inferior fibular retinaculum Inferior peroneal retinaculum.Deep part of posterior compartment of leg.Deep fibular nerve Deep peroneal nerve.Anteromedial intermuscular septum Subsartorial fascia.Anterior tibiotalar part (Medial ligament Deltoid ligament).Anterior talocrural region Anterior ankle region. ![]() Figure 2: Incisions on the top (dorsum) of the foot used to release these muscle compartments of the foot.Ĭlaw toe or hammer toe correction surgeries may be recommended if these deformities cause dysfunction and interfere with wearing shoes in this group of patients. In severe cases the foot may be dysfunctional if widespread death of the muscles of the foot has occurred. If this does occur, then over time the toes will become clawed. However, it is relatively common for compartment syndrome of the foot to develop without being identified. Releasing the strong fibrous tissue that encases the muscle compartments on time will allow blood to flow to the compartment to maintain the tissue circulation and oxygenation. This involves opening up the various compartments of the foot through a series of 3 or 4 incisions (2 on the top, 1 on the side as necessary) to release the swollen compartments (Figure 2). If compartment syndrome is diagnosed, surgical release may be required. If compartment syndrome does result in muscle death overtime, the resulting sequelae will be significant clawing of the lesser toes, and possibly pain and dysfunction in the foot. It is always difficult to know the extent to which they are involved. Specific treatment for compartment syndrome is controversial. Once suspected, the initial treatment should include removing all restrictive dressings. Typical signs and symptoms may be absent, especially if there are distracting injuries or the patient has an altered level of consciousness. It is best to suspect a diagnosis of acute compartment syndrome of the foot in any patient with high-energy trauma. Pressure monitoring that demonstrates pressures within the compartment that are less than 20-25 mm of mercury less than the lowest aspect of the blood pressure (diastolic pressure) is suggestive of compartment syndrome. ![]() X-rays will demonstrate the associated underlying foot injury, but will not be able to specifically diagnose the compartment syndrome.ĭiagnosis is usually made after an accurate clinical evaluation combined with compartmental pressure monitoring. Movement of the toes will create significant pain in the foot for conscious patients. In severe cases, there may also be a decrease in sensation to the toes. ![]() An associated traumatic injury to the foot is usually present. On examination, the foot is usually markedly swollen and the muscles are tense (Figure 1). When compartment syndrome of the foot does occur, it is common for many, or all, of these compartments to be involved. If this is not treated in time eventually muscle death can occur. This can result in increased pressure in the muscle tissue – and subsequently a lack of blood supply and oxygenation to these tissues. Significant swelling of the muscles of the foot and may be restricted by the dense fibrous tissue (fascia) that surrounds each “compartment” of muscles. Numbness and tingling or pins and needle feeling is not uncommon. Patients with compartment syndrome of the foot report intense pain, bruising (ecchymosis), and swelling. This condition is also common in calcaneal fractures of the foot as a result of a fall from a height. Many studies link this condition to high energy trauma as a result of a motor vehicle accident (MVA) causing serious injury like Lisfranc fractures. It is usually associated with fractures of the foot or a midfoot fracture-dislocation. Edited by Hossein Pakzad, MD, FRCSC, FAAOSĬrushing injuries are the leading cause of compartment syndrome of the foot.
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