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Compartment Syndrome

INCIDENCE & AETIOLOGY

Compartment syndrome of the foot occurs in 10% of calcaneal fractures & 41% of crush injuries.

PLANTAR COMPARTMENTS

the 9 compartments of the foot can be placed into 4 groups

Interosseous Compartment: 4 intrinsic muscles between the 1st and 5th metatarsals

Medial Compartment:  abductor hallucis; FHB

Calcaneal / Central Compartment: FDB; Quadratus plantae; Adductor Hallucis

Lateral Compartment: Flexor digiti minimi brevis; abductor digiti minimi

DIAGNOSIS

HIGH INDEX OF SUSPICION

Unlike its counterpart in the leg or forearm, there are no classic signs in the foot. Pain on passive stretch, dysesthesias, and diminished pulses are not consistent findings. 

Tense swelling may be suggestive. 

Pressure measurement of all major compartments is required. Absolute pressures >30mmHg requires decompression, or less than 20mmHg below the diastolic blood pressure.

SURGICAL FASCIOTOMY 

2 dorsal incisions over the medial aspect of the 2nd MT & lateral aspect of the 4th MT.

one 6cm medial incision - releasing the medial, calcaneal & lateral compartments.



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