Compartment Syndrome of the Foot: Difference between revisions
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Acute compartment syndromes can be produced by many different events. Crush injuries cover the majority of compartment syndromes of the foot<ref name="BRON 3" />, next to this fact one notices snake bites, burns, metatarsal fractures, talus or calcaneus fractures, dislocation of the Chopart and/or Lisfranc joints etc.<ref name="BRON 3" /> <ref name="BRON 2" /> | Acute compartment syndromes can be produced by many different events. Crush injuries cover the majority of compartment syndromes of the foot<ref name="BRON 3" />, next to this fact one notices snake bites, burns, metatarsal fractures, talus or calcaneus fractures, dislocation of the Chopart and/or Lisfranc joints etc.<ref name="BRON 3" /> <ref name="BRON 2" /> | ||
Steroids: Using steroids or creatine makes the muscles increase in volume. <ref name="BRON 7">Tucker Alicia K. Chronic exertional compartment syndrome of the leg. Current Reviews in Musculoskeletal Medicine. 2 September 2010 http://ukpmc.ac.uk/articles/PMC2941579//reload=0;jsessionid=7B73BD6FF505810518B89305640B4C33.jvm4 (accessed on november/december 2010)</ref> | Steroids: Using steroids or creatine makes the muscles increase in volume. <ref name="BRON 7">Tucker Alicia K. Chronic exertional compartment syndrome of the leg. Current Reviews in Musculoskeletal Medicine. 2 September 2010 http://ukpmc.ac.uk/articles/PMC2941579//reload=0;jsessionid=7B73BD6FF505810518B89305640B4C33.jvm4 (accessed on november/december 2010)</ref> | ||
Bandages: If a tape, bandage or cast is too tight fitted, it may lead to a compartment syndrome. | Bandages: If a tape, bandage or cast is too tight fitted, it may lead to a compartment syndrome. | ||
The connective tissue of a compartment is not able to stretch, so when there appears a bleeding or a swelling of the muscles within the compartment, the pressure rises likely. | The connective tissue of a compartment is not able to stretch, so when there appears a bleeding or a swelling of the muscles within the compartment, the pressure rises likely.<ref name="BRON 8">Kirsten G B, Elliot A, J Johnstone. Diagnosing acute compartment syndrome. The journal of bone and joint surgery, Vol. 85, N°5, July 2003 http://web.jbjs.org.uk/cgi/reprint/85-B/5/625.pdf (accessed on november/december 2010)</ref> <ref name="BRON 9">Galanakos S, Sakellariou V I, Kkotoulas H, Sofianos I P. Acute Compartment Syndrome: The significance of immediate diagnosis and the consequences from delayed treatment. E.E.X.O.T, Vol 60: 127-133, 2009</ref><br>Normally a non-contracting muscle contains a pressure near zero, nevertheless if the pressure rises up to 30 mmHg, the vessels will be compressed resulting into pain and a reduction of blood flow. Also the lymphatic drainage will activate to prevent the increasing interstitial fluid pressure<ref name="BRON 1" /> , when this reached to its maximum; the pressure between the compartments will cause physiological defects such as a nerve dysfunction and deformation. A hemorrhage of an edema causes the interstitial pressures within the soft tissues to increase, creating possible ischemia by loss of capillary refill.<ref name="BRON 7" /><br>Ischemia starts when the local blood flow can’t fulfill the metabolic demands of the tissues. When a body part is not provided with blood for more than eight hours, the damage is irreversible and may lead to the death of the concerning tissues.<ref name="BRON 2" /> | ||
== Characteristics/Clinical Presentation == | == Characteristics/Clinical Presentation == | ||
Revision as of 19:33, 14 January 2011
Original Editors - Jessie Tourwe
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Search Strategy [edit | edit source]
Databases searched: Pubmed, PEDro, eMedicine, Medscape
Keywords searched: compartment syndrome foot, lower leg, loge syndrome, crush injuries, treatment compartment syndrome,…
Definition/Description[edit | edit source]
This syndrome is a condition that can appear in many parts of the body: foot, leg, thigh, forearm, hand, buttocks etc.[1] A compartment syndrome occurs when the muscles along with nerves and blood vessels are compressed in a compartment.
The developing of swelling and/or a hematoma causes the pressure to increase and because the fascia – made of inelastic connective tissue – can’t extend, the blood flow is disrupted. Tissue death can take place if the concentration of oxygen drops too low for too long.[2]
Clinically Relevant Anatomy[edit | edit source]
Anatomical studies of muscles and tendons show that the foot is divided into 4 large compartments (interosseous, medial, lateral, central) each including muscles, nerves and arteries. Early researches identified 9 compartments. However, it is very impractical to divide the foot into more than four compartments. That’s why most of the recent studies still refer to the foot as a whole of four compartments.[3]
| -Interosseous compartment: Dorsal interossei muscles Plantar interossei muscles Plantar lateral artery, vein and nerve
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- Medial compartment: Abductor hallucis Flexor hallucis brevis Tendon of flexor hallucis longus Medial plantar arteries, veins and nerves
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| - Lateral compartment: Abductor digiti minimi Flexor digiti minimi Opponens digiti minimi Branches of the lateral plantar artery vein and nerve
|
- Central compartment (3 levels): First level: Adductor hallucis Second level: Quadratus plantae Lumbrical muscles Tendons of flexor digitorum longus Third level: Flexor digitorum brevis All levels of the central compartment contain (deep) branches of the plantar lateral artery, vein and nerve |
Epidemiology /Etiology [edit | edit source]
Chronic (exertional) compartment syndromes take place when athletes make too many efforts during a sport causing an overuse injury. The muscles get tired and irritated resulting in an inflammation and swelling. Sports like soccer, biking, running, tennis, gymnastics can be risk factors.[5]
It is possible that athletes don’t have the appropriate training program so that they overstrain their muscles. Use of inappropriate footwear.[6] Other causes can be biomechanical faults in a person’s anatomy.[5] Limb length differences, muscle weakness, tightness in specific joints etc
Acute compartment syndromes can be produced by many different events. Crush injuries cover the majority of compartment syndromes of the foot[3], next to this fact one notices snake bites, burns, metatarsal fractures, talus or calcaneus fractures, dislocation of the Chopart and/or Lisfranc joints etc.[3] [2]
Steroids: Using steroids or creatine makes the muscles increase in volume. [7]
Bandages: If a tape, bandage or cast is too tight fitted, it may lead to a compartment syndrome.
The connective tissue of a compartment is not able to stretch, so when there appears a bleeding or a swelling of the muscles within the compartment, the pressure rises likely.[8] [9]
Normally a non-contracting muscle contains a pressure near zero, nevertheless if the pressure rises up to 30 mmHg, the vessels will be compressed resulting into pain and a reduction of blood flow. Also the lymphatic drainage will activate to prevent the increasing interstitial fluid pressure[1] , when this reached to its maximum; the pressure between the compartments will cause physiological defects such as a nerve dysfunction and deformation. A hemorrhage of an edema causes the interstitial pressures within the soft tissues to increase, creating possible ischemia by loss of capillary refill.[7]
Ischemia starts when the local blood flow can’t fulfill the metabolic demands of the tissues. When a body part is not provided with blood for more than eight hours, the damage is irreversible and may lead to the death of the concerning tissues.[2]
Characteristics/Clinical Presentation[edit | edit source]
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References[edit | edit source]
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- ↑ 1.0 1.1 Abraham T Rasul Jr. Compartment syndrome. eMedicine. 11 March 2009 http://emedicine.medscape.com/article/307668-overview (accessed on november/december 2010)
- ↑ 2.0 2.1 2.2 Frink M, Hildebrand F, Krettek C, Brand J, Hankemeier S. Compartment syndrome of the lower leg and foot. The Association of bone and joint surgeons. 27 may 2009 http://emedicine.medscape.com/article/140002-overview (accessed november/december 2010)
- ↑ 3.0 3.1 3.2 Haddad S L, Managing risk: compartment syndromes of the foot. American Academy of Orthopaedics Surgeons, Jan/Feb 2007 http://www.aaos.org/news/bulletin/janfeb07/clinical1.asp (accessed on november/december 2010)
- ↑ Schünke M, Schulte E, Schumacher U, Voll M, Wesker K. Prometheus. Bohn Stafleu Van Loghum, Houten 2005. Pg 463
- ↑ 5.0 5.1 http://www.physioadvisor.com.au/10513350/compartment-syndrome-chronic-compartment-syndrom.htm
- ↑ http://orthoinfo.aaos.org/topic.cfm?topic=a00204
- ↑ 7.0 7.1 Tucker Alicia K. Chronic exertional compartment syndrome of the leg. Current Reviews in Musculoskeletal Medicine. 2 September 2010 http://ukpmc.ac.uk/articles/PMC2941579//reload=0;jsessionid=7B73BD6FF505810518B89305640B4C33.jvm4 (accessed on november/december 2010)
- ↑ Kirsten G B, Elliot A, J Johnstone. Diagnosing acute compartment syndrome. The journal of bone and joint surgery, Vol. 85, N°5, July 2003 http://web.jbjs.org.uk/cgi/reprint/85-B/5/625.pdf (accessed on november/december 2010)
- ↑ Galanakos S, Sakellariou V I, Kkotoulas H, Sofianos I P. Acute Compartment Syndrome: The significance of immediate diagnosis and the consequences from delayed treatment. E.E.X.O.T, Vol 60: 127-133, 2009
