Compartment Syndrome of the Foot
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
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- Central compartment (3 levels): |
Epidemiology /Etiology [edit | edit source]
Characteristics/Clinical Presentation[edit | edit source]
The most specific signs are:
- The skin appears pale and tensely swollen on the spot of tissue damage.
- Pain occurs when squeezing and/or touching the affected compartments.
- Pain when applying passive stretching to ankle, metatarsal joints and toes.
- Increased pain on dorsal flexion of the metatarsophalangeal joints.
- Muscle weakness of the intrinsic foot muscles when moving the foot in any way.
- Enlarged soreness radiating to the toes when moving them actively up and down.
Late findings are:
- It is possible the pulses are not palpable because the foot is very swollen.
- Neurological deficits: when a nerve is damaged the patient can report a decreased sensation.[3]
Considering the 5 P’s: Pain, Pallor, Paresthesia, Paralysis, Pulselessness[1]
Differential Diagnosis[edit | edit source]
Diagnostic Procedures[edit | edit source]
In order to diagnose a compartment syndrome there should be an awareness of the signs and symptoms specific to this syndrome as described above.
The only valuable test to diagnose this syndrome is an invasive measurement of the absolute compartment pressures.
- Intracompartmental pressure monitoring (ICP): [5]
When measuring the ICP using a needle, a plastic tube filled with a saline solution and air, connected to a mercury manometer.
This objective method can provide a continuous recording of pressure measurement for up to 16 to 24 hours.
The normal ICP ranges from zero to 10 mmHg. When the pressure is near a 30 mmHg below the diabolic pressure a fasciotomy is required.[1] Time is also a very significant parameter but very difficult to measure. Decompression within 6 hours will be resulted in a full recovery. If more than 12 hours pass by without any acting an inevitable disability will be identified.[6]
Outcome Measures[edit | edit source]
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Examination[edit | edit source]
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Medical Management
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Key Research[edit | edit source]
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Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ 1.0 1.1 1.2 Abraham T Rasul Jr. Compartment syndrome. eMedicine. 11 March 2009 http://emedicine.medscape.com/article/307668-overview (accessed on november/december 2010)
- ↑ 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 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
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