Diagnosis and Treatment of Acute Compartment Syndrome

The onset of acute compartment syndrome is something of great concern to the emergency room physician, trauma surgeon, and podiatric foot and ankle surgeon.  It is something that is routinely screened for an any lower extremity trauma.

The muscles of the foot and leg are divided into compartments, each of which is separated by a layer of fascia.  This dividing fascia is tough and restricting, and does not allow for much expansion of the tissues within the compartment.  Normally this is a good thing, as it helps separate and organize the muscle compartments of the foot and leg.  However, when the volume of the compartment expands following injury, these bands of tissue help to restrict the fluid, creating an increase in the compartmental pressure.  This increase in pressure can cause damage to the muscles, nerves, and vessels within the compartment, and can lead to tissue death if not addressed properly. 

Signs and symptoms of acute compartment pressure include intense pain out of proportion for the given injury, numbness or tingling in the toes, loss of function of the toes or an inability to move them, and coolness to touch caused by decreased blood flow.  Later in the development of compartment syndrome, pulses may be absent and the toes may turn white in color. 

The diagnosis of compartment syndrome is largely based on the history and physical findings, but a device called a wick catheter may be used to confirm the diagnosis.  This is an instrument that is mainly composed of a needle attached to a pressure gauge, which acts to measure the compartmental pressure.  The normal pressure reading for a muscular compartment should be between 0 and 10 mmHg.  Pressures between 10-20mmHg are closely monitored, as they may continue to increase.  Pressures above 30mmHg are considered diagnostic of compartment syndrome in most cases. 

Once the diagnosis of compartment syndrome is made, the patient must be taken to surgery right away.  A delay in surgical treatment may result in irreversible muscle and tissue damage.  Surgery for compartment syndrome involves releasing the fascia between compartments to relieve the pressure.  This procedure is known as a fasciotomy. 

There are four muscle compartments in the leg to release; the superficial and deep posterior compartments, the lateral compartment, and the anterior compartment.  In the foot, there are also four main compartments; the medial, lateral, central, and interosseous.  Some references will divide the central compartment into a superficial, deep, and calcaneal compartment, and also consider each of the interosseous compartments their own separate compartment.  When acute compartment syndrome is diagnosed, both the leg and foot compartments will oftentimes be opened together. 

The incision sites are kept open, and local wound care is performed to keep the sites clean and prevent infection.  Compartment syndrome will generally keep a patient in the hospital for at least several days, while their condition can be monitored.  Any other injuries must also be addressed.  

Central Florida Foot & Ankle Center, LLC 
101 6th Street N.W. Winter Haven, FL 33881 
Phone: 863-299-4551 
www.FLFootandAnkle.com