Compartment syndrome of the foot

Compartment syndrome of the foot remains a diagnostic and therapeutic challenge, and controversy exists with almost all aspects of this condition. It can occur after calcaneus fractures, Lisfranc fracture dislocations, metatarsal/phalangeal fractures, or other high-energy trauma to the foot, ankle, and leg. The diagnosis should be based on clinical findings of pain and tense compartments and can be confirmed by compartment pressure measurements. Most authors agree that if diagnosed within 6 hours of the onset of symptoms, immediate fasciotomy of the foot compartments should be performed. Nonsurgically treated cases of foot compartment syndrome can result in permanent ischemic contracture and chronic pain. There are 9 compartments in the foot: medial, superficial, lateral, adductor, 4 interossei, and calcaneal. These are generally decompressed by 3 incisions: 2 dorsal for the adductor hallucis compartment and the 4 interosseous compartments and one medial for the medial, superficial, calcaneal, and lateral compartments. Serial debridements and gradual approximation, as well as skin grafting, are often necessary for wound management after fasciotomies.