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Foot Compartment Syndrome

The document discusses foot compartment syndrome, emphasizing the importance of recognizing clinical signs and understanding the anatomy of the foot's compartments. It highlights that compartment pressures above 30 mm Hg can lead to significant muscular necrosis and irreversible nerve damage if not addressed timely. Various surgical techniques for decompression are outlined, along with considerations for incision placement and aftercare, although the recommendations are based on limited evidence.

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Omar Hussain
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2 views31 pages

Foot Compartment Syndrome

The document discusses foot compartment syndrome, emphasizing the importance of recognizing clinical signs and understanding the anatomy of the foot's compartments. It highlights that compartment pressures above 30 mm Hg can lead to significant muscular necrosis and irreversible nerve damage if not addressed timely. Various surgical techniques for decompression are outlined, along with considerations for incision placement and aftercare, although the recommendations are based on limited evidence.

Uploaded by

Omar Hussain
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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FOOT COMPARTMENT

SYNDROME
Disclaimer: controversial with no
great studies.
References:
 Rockwood & Green’s 8th edition
 AAOS 2013 review article
 CORR 2010
 AO website
 most recommendations in the literature
are based on level IV and V evidence.
Compartment Syndrome
 Normal musculo-fascial
compartment pressure usually
is below 8 mm Hg

 Hargens and coworkers (JBJS


1981)
 evidence that after 8 hours of
compartmental pressure equal
to or above 30 mm Hg
significant muscular necrosis is
induced

 Peripheral nerves may


undergo irreversible
damage after 4 to 6 hours
of ischemia (AAOS 2013)
Clinical Signs
 High energy- Crush
 High energy calc fx
(10%)
 Lisfranc
 Tibial fracture via deep
posterior
communication to
calcaneal compartment
 Dorsal swelling and
pain
 Pain with movement
of the toes
Anatomy
 Originally 4 Compartments (Myerson FA
1988)
 Medial
 Lateral
 Central
Abd H.
 Interosseous FHB
QP FDMB
FDB Abd DM
Anatomy
 9 main compartments (Manoli and Weber 1990)
 medial
 abductor hallucis
 flexor hallucis brevis
 lateral
 abductor digiti minimi
 flexor digiti minimi brevis
 interosseous (x4)
 central (x3)
Abd H.
 Superficial FHB
QP FDMB
 flexor digitorum brevis
FDB Abd DM
 Central /Calcaneal
 quadratus plantae
 Deep
 adductor hallucis
 posterior tibial neurovascular bundle
 Tenth? (Reach et al)
 Bound by skin
 Ext dig brevis
 Ext Hal brevis
Medial Compartment
Superficial Compartment
Calcaneal = Central
compartment
 In calc fractures,
calcaneal
compartment most
sensitive for CS
due to bone
bleeding and
proximity to
plantar vessels.
(AO)
CORR
Anatomy: Back to 3?
 Ling & Kumar JBJS 2008
 Cadaver study
 Three vertical fibrous septae
in the hindfoot
 Bound tissue into
 Medial
 Intermediate
 Lateral
 Only the intermediate and
lateral were rigidly bound by
fascia on all sides
 Argues against superficial and
deep central compartments
Anatomy: Back to 3?
 Ling & Kumar JBJS 2008
 Cadaver study
 Three vertical fibrous
septae in the hindfoot
 Bound tissue into
 Medial
 Intermediate
 Lateral

 Case reports of isolated


medial compartment
CS….
Pressure Monitoring: AAOS
Pressure Monitoring: Rockwood
A: Before closed
reduction,
intraoperative
invasive
compartment
pressure
measurement at the
calcaneal plantar
compartment. B:
After closed reduction
and external tibio-
calcaneal-metatarsal
external fixator
application (measure
sites: yellow, lateral
plantar compartment;
red, calcaneal plantar
compartment; black,
plantar central
abductor
compartment; blue,
medial plantar
compartment). C:
Compartment
pressure
measurement of the
dorsal
intermetatarsal
compartments.
Illustration of the plantar compartments of the foot
modified from Wülker.360 1: Medial compartment. 2:
Lateral compartment. 3: Superficial central
compartment. 4: Deep (adductor) central compartment.
5: Intermediate (calcaneal) central compartment. 6:
Interosseous compartment.
Rockwood
Compartment
Three Incision Technique
Incisions

 Medial incision
 starting 4 cm anterior to the
posterior aspect of the heel
and 3 cm superior to the
plantar surface of the foot.
 incision is carried distally for
approximately 6 cm
 Release
 Medial
 Superficial central
 Deep central
 Lateral compartments
Incisions

 Medial incision
 starting 4 cm anterior to the
posterior aspect of the heel
and 3 cm superior to the
plantar surface of the foot.
 incision is carried distally for
approximately 6 cm
 Release
 Medial
 Superficial central
 Deep central
 Lateral compartments
Incisions

 Dorsal incisions
 One medial to 2nd MT
 One lateral to 4th MT
 > 3cm skin bridge
 Release
 Interossei
 Adductor compartment

 Consider pie-crusting
 Stab incision with blunt
spread to decrease need
for skin grafting
Incisions
 Dorsal incisions
 One medial to 2nd MT
 One lateral to 4th MT
 > 3cm skin bridge
 Release
 Interossei
 Adductor compartment

 Possible to decompress all?


 CORR 2010
Three Incision
Aftercare
Aftercare
For completeness, no clinical
data, Single plantar incision
 Ling & Kumar
“incision on the nonweight-
bearing instep of the foot
over the main plantar
aponeurosis commencing 5
cm from the posterior edge of
the heel and extending 5 cm
distally is used (Fig. 5).

The plantar aponeurosis should


be exposed and incised.
Through this incision the medial
septum and if present the
intermediate septum should also
be incised. The more dorsally-
located posterior tibial
neurovascular bundle is safe with
this approach.”

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