Compartment Syndrome

Summary

  • There are 9 foot compartments.
  • Prolonged ischemia due to unidentified compartment syndrome may lead to irreversible destruction of tissue.
  • Usually associated with calcaneal fracture or major midfoot fracture.

Diagnostic tips

  1. Intense pain and swelling.
  2. Associated traumatic injury is usually present.
  3. Decreased sensation to the toes.
  4. Movement of toes causes more pain.
  5. Absent pulse or complete anaesthesia are late signs of compartment syndrome.

Tests and Imaging

  1. X-ray and MRI will demonstrate associated underlying injury but will not be able to specifically diagnose compartment syndrome.
  2.  Compartment pressure monitoring is used to diagnose compartment syndrome.
  3. Pressure monitoring within the compartment less than diastolic blood pressure (less than 20-25 mmHg is suggestive of compartment syndrome)

Immediate Treatment

  1. Refer to Emergency Department.
  2. Avoid activity in the area.
  3. Elevation of the lower extremity to the level or above the heart to lower mean arterial pressure reducing oxygen perfusion.
  4. Pneumatic intermittent impulse compression device to decrease interstitial pressure, improve venous return, and enhance arterial flow increasing osmotic resorption of the interstitial fluid.

Possible Referral

  1. Emergency surgery for release or fasciotomy.

btn

Back