Only three compartments (medial, lateral, superficial) run the entire length of the foot. However, Myerson later identified four compartments and nine compartments were identified in one cadaver study (Table 2). In the late 1920s, three compartments were described, which were confirmed by Kamel and Sakla in 1961. In contrast, there is no consensus regarding the number of foot anatomical compartments. The lower leg consists of four compartments: anterior, lateral, superficial posterior, and deep posterior (Table 1). We did not evaluate study quality in those studies related to treatment. We identified no prospective randomized controlled trials. We also evaluated cited references to identify papers not identified in the original search. All studies dealing with injuries and disorders causing compartment syndrome of the lower leg or foot as well as case reports and case series were included. None of the publications evaluated long-term results.Ībstracts of all papers were independently reviewed by two authors (MF and FH). Two reviews of foot injuries describing compartment syndrome as a relevant entity following trauma were identified. When the search terms “compartment syndrome” and “foot” were combined with “outcome” only 26 publications were identified, while eight were identified as case reports. Five publications were identified as case reports, and only one study evaluated long-term results. When the search terms “compartment syndrome” and “lower leg” were combined with “outcome” only 24 items and three reviews were identified. With the additional limits of English or German language and studies on humans, we identified 130 and 157 papers, respectively. We performed a comprehensive literature search using PubMed at the National Library of Medicine using the keywords “compartment syndrome” combined with “lower leg” or “foot.” This search identified 156 and 194 publications for potential inclusion, respectively. In contrast to previously published reviews, we additionally focus on treatment and outcome of compartment syndromes of the foot and lower leg. The aim of this review is to describe (1) the anatomy of the compartments of the lower leg and foot, (2) the pathophysiology, and (3) the diagnosis of compartment syndromes of the lower leg and foot. Trauma surgeons dealing with musculoskeletal injuries must be familiar with treatment of acute compartment syndrome. ![]() In 1988, Myerson described the clinical entity and presented surgical decompression as a therapeutic intervention. While the existence and treatment of lower leg compartment syndrome was described in 1958, until recently compartment syndrome of the foot was largely unrecognized and only described in some case reports. Ischemia causes capillary wall damage and a vicious cycle of events results in permanent nerve and muscle dysfunction. The incidence of compartment syndrome of the foot is around 6% in patients with foot injuries due to motorcycle accidents, while the incidence of compartment syndrome of the lower leg seems even lower (eg, 1.2% after closed tibial diaphyseal fractures ). A few years later, the connection to elevated intracompartmental pressure was made. The long-term consequences of a compartment syndrome were already described by Richard von Volkmann at the end of the 19th century following application of casts. It is caused by bleeding or edema in a closed, nonelastic muscle compartment surrounded by fascia and bone. See Guidelines for Authors for a complete description of levels of evidence.Īcute compartment syndrome is a complication following fractures, soft tissue trauma, and reperfusion injury after acute arterial obstruction. In severe cases, amputation may be necessary. When left untreated, poor outcomes with contractures, toe deformities, paralysis, and sensory neuropathy can be expected. Surgical management does not eliminate the risk of developing nerve and muscle dysfunction. Depending on the injury, clinical examination, and compartment pressure, fasciotomy is recommended via a dorsal and/or medial plantar approach. The compartment syndrome of the foot requires thorough examination of all compartments with special focus on the calcaneal compartment. Fasciotomy of the lower leg can be performed either by one lateral incision or by medial and lateral incisions. Once the diagnosis is made, immediate fasciotomy of all compartments is required. A fasciotomy should be performed when the difference between compartment pressure and diastolic blood pressure is less than 30 mm Hg or when clinical symptoms are obvious. Clinical findings must be documented carefully. The most sensitive clinical symptom of compartment syndrome is severe pain. ![]() The diagnosis is based on clinical examination and intracompartmental pressure measurement. ![]() Compartment syndrome of the lower leg or foot, a severe complication with a low incidence, is mostly caused by high-energy deceleration trauma.
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