Compartment Syndrome

Compartment syndromes have been more commonly described to affect the arms and legs. Nine compartments have been identified in the foot. Compartment syndrome occurs when an elevation of tissue pressure within one of these nonyielding fascial compartments impedes vascular flow. In the foot, the cause of compartment syndrome is usually a high-energy injury associated with multiple fractures. Crush injuries are more likely to cause compartment syndrome. Compartment syndromes have been reported in association with midfoot fractures and rearfoot fractures, burns, contusions, bleeding disorders, postischemic swelling after arterial injury or thrombosis, venous obstruction, exercise, and prolonged pressure to the affected area. There have also been reports of chronic compartment syndromes due to overuse. Patients typically present with severe acute pain that is worsened on active or passive movement, swelling, paresthesias, and neurovascular deficits. The only reliable method to diagnose compartment syndrome is by obtaining intracompartmental pressures. Once the diagnosis is made, fasciotomy should be performed emergently. The sequelae of compartment syndrome range from transient neurologic compromise to complete myoneural necrosis, fibrosis, and ischemic contractures. The prognosis of compartment syndrome is directly related to the time delay in diagnosis and treatment. 3334

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