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Compartment Syndromes (Acute & Chronic)

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Foot and Ankle Sports Orthopaedics

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Abstract

Compartment syndrome of the lower leg or foot is usually seen in the setting of high-energy trauma. However, chronic exertional compartment syndrome (CECS) is most frequently seen in athletes. The diagnosis is largely based on clinical examination, and the most sensitive clinical symptom of compartment syndrome is severe pain. Intracompartmental pressure measurements can be obtained to confirm diagnosis. Once the diagnosis is made, immediate fasciotomy of all involved compartments is required. Fasciotomy of the lower leg can be performed by one lateral incision or by medial and lateral incisions. Endoscopic fasciotomy is also described in cases of CECS. Foot compartment syndrome requires thorough examination of all compartments with special focus on the calcaneal compartment. Depending on the injury, clinical examination, and compartment pressure, fasciotomy is recommended via a dorsal and/or medial plantar approach. Surgical intervention does not eliminate the risk of developing nerve and muscle dysfunction. If left untreated, poor outcomes characterized by sensory deficits, weakness, paralysis, contractures, and toe deformities can be expected.

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References

  1. French EB, Price WH. Anterior tibial pain. BMJ. 1962;2:1290–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Reneman RS. The anterior and the lateral compartment syndrome of the leg due to intensive use of muscles. Clin Orthop Rel Res. 1975;113:69–80.

    Article  Google Scholar 

  3. Clanton TO, Solcher BW. Chronic leg pain in the athlete. Clin Sports Med. 1994;4:743–59.

    Google Scholar 

  4. Qvarfordt P, Christenson JT, Eklof B, et al. Intramuscular pressure, muscle blood flow, and skeletal muscle metabolism in chronic anterior tibial compartment syndrome. Clin Orthop Relat Res. 1983;179:284–90.

    Article  Google Scholar 

  5. Styf JR, Korner LM. Chronic exertional compartment syndrome of the leg: results of treatment by fasciotomy. J Bone Joint Surg Am. 1986;68A:1338–47.

    Article  Google Scholar 

  6. Arciero RA, Shishido NS, Parr TJ. Acute anterolateral compartment syndrome secondary to rupture of the peroneus longus muscle. Am J Sports Med. 1984;12:366–7.

    Article  CAS  PubMed  Google Scholar 

  7. Jarolem KL, Wolinsky PR, Savenor A, et al. Tennis leg leading to acute compartment syndrome. Orthopedics. 1994;17:721–3.

    CAS  PubMed  Google Scholar 

  8. McHale KM, Prahinski JR. Acute exertional compartment syndrome occurring after performance of the army physical fitness test. Orthop Rev. 1994;23:749–53.

    CAS  PubMed  Google Scholar 

  9. McKee MD, Jupiter JB. Acute exercise-induced bilateral anterolateral leg compartment syndrome in a healthy young man. Am J Orthop. 1995;24:862–4.

    CAS  PubMed  Google Scholar 

  10. Nicholson P, Devitt A, Stevens M, et al. Acute exertional peroneal compartmental syndrome following prolonged horse riding. Injury. 1998;29:643–4.

    Article  CAS  PubMed  Google Scholar 

  11. Johnson J, Becker J. Bilateral acute compartment syndrome in a football player: a case report. Curr Sports Med Rep. 2012;6:287–9.

    Article  Google Scholar 

  12. Assenmacher JA, Hunter RE. Acute nonexertional lateral compartment syndrome from snowboarding. A case report. Am J Sports Med. 2002;5:754–6.

    Google Scholar 

  13. Stollsteimer GT, Shelton WR. Acute atraumatic compartment syndrome in an athlete: a case report. J Athl Train. 1997;3:248–50.

    Google Scholar 

  14. Mavor GE. The anterior tibial syndrome. J Bone Joint Surg Br. 1956;38B:513–7.

    Google Scholar 

  15. Edmundsson D, Toolanen G. Chronic exertional compartment syndrome in diabetes mellitus. Diabet Med. 2011;28:81–5.

    Article  CAS  PubMed  Google Scholar 

  16. Hallock GG. An endoscopic technique for decompressive fasciotomy. Ann Plast Surg. 1999;43:668–70.

    Article  CAS  PubMed  Google Scholar 

  17. Rorabeck CH, Castle GS, Hardie R, et al. Compartment pressure measurements: an experimental investigation using the slit catheter. J Trauma. 1981;21:446–9.

    CAS  PubMed  Google Scholar 

  18. Kutz JE, Singer R, Linday M. Chronic exertional compartment syndrome of the forearm: a case report. J Hand Surg Am. 1985;10:302–4.

    Article  CAS  PubMed  Google Scholar 

  19. Manoli 2nd A, Weber TG. Fasciotomy of the foot: an anatomical study with special reference to release of the calcaneal compartment. Foot Ankle. 1990;10:267–75.

    Article  PubMed  Google Scholar 

  20. Cortina J, Amat C, Selga J, Corona PS. Isolated medial foot compartment syndrome after ankle sprain. Foot Ankle Surg. 2014;20:e1–2. doi:10.1016/j.fas.2013.08.006.

    Article  PubMed  Google Scholar 

  21. Mollica MB, Duyshart SC. Analysis of pre- and postexercise compartment pressures in the medial compartment of the foot. Am J Sports Med. 2002;30:268–71.

    PubMed  Google Scholar 

  22. Muller GP, Masquelet AC. Chronic compartment syndrome of the foot. A case report]. Rev Chir Orthop Reparatrice Appar Mot. 1995;81:549–52.

    CAS  PubMed  Google Scholar 

  23. Seiler R, Guziec G. Chronic compartment syndrome of the feet. A case report. J Am Podiatr Med Assoc. 1994;84:91–4.

    Article  CAS  PubMed  Google Scholar 

  24. Lokiec F, Siev-Ner I, Pritsch M. Chronic compartment syndrome of both feet. J Bone Joint Surg Br. 1991;73:178–9.

    CAS  PubMed  Google Scholar 

  25. Jowett A, Birks C, Blackney M. Chronic exertional compartment syndrome in the medial compartment of the foot. Foot Ankle Int. 2008;29:838–41.

    Article  PubMed  Google Scholar 

  26. Chambers L, Hame SL, Levine B. Acute exertional medial compartment syndrome of the foot after playing basketball. Skeletal Radiol. 2011;40:931–5. doi:10.1007/s00256-011-1157-8.

    Article  PubMed  Google Scholar 

  27. Davey JR, Rorabeck CH, Fowler PJ. The tibialis posterior muscle compartment. An unrecognized cause of exertional compartment syndrome. Am J Sports Med. 1984;12:391–7.

    Article  CAS  PubMed  Google Scholar 

  28. Hislop M, Tierney P, Murray P, et al. Chronic exertional compartment syndrome: the controversial “fifth” compartment of the leg. Am J Sports Med. 2003;31:770–6.

    PubMed  Google Scholar 

  29. Myerson MS. Management of compartment syndromes of the foot. Clin Orthop Relat Res. 1991;271:239–48.

    Google Scholar 

  30. Manoli 2nd A, Fakhouri AJ, Weber TG. Concurrent compartment syndromes of the foot and leg. Foot Ankle. 1993;14:339.

    Article  PubMed  Google Scholar 

  31. Ling ZX, Kumar VP. The myofascial compartments of the foot: a cadaver study. J Bone Joint Surg Br. 2008;90:1114–8. doi:10.1302/0301-620X.90B8.20836.

    Article  CAS  PubMed  Google Scholar 

  32. Myerson M, Manoli A. Compartment syndromes of the foot after calcaneal fractures. Clin Orthop Relat Res. 1993;290:142–50.

    Google Scholar 

  33. Kalsi R, Dempsey A, Bunney EB. Compartment syndrome of the foot after calcaneal fracture. J Emerg Med. 2012;43:e101–6. doi:10.1016/j.jemermed.2009.08.059.

    Article  PubMed  Google Scholar 

  34. Olson SA, Glasgow RR. Acute compartment syndrome in lower extremity musculoskeletal trauma. J Am Acad Orthop Surg. 2005;13:436–44.

    Article  PubMed  Google Scholar 

  35. Lundvall J, Mellander S, Westling H, et al. Fluid transfer between blood and tissues during exercise. Acta Physiol Scand. 1972;2:258–69.

    Article  Google Scholar 

  36. Fronek J, Mubarak SJ, Hargens AR, et al. Management of chronic exertional compartment syndrome of the lower extremity. Clin Orthop Relat Res. 1987;220:217–27.

    Google Scholar 

  37. Styf JR, Korner LM. Microcapillary infusion technique for measurement of intramuscular pressure during exercise. Clin Orthop Rel Res. 1986;207:253–62.

    Google Scholar 

  38. Edmundsson D, Toolanen G, Thornell L, et al. Evidence for low muscle capillary supply as a pathogenic factor in chronic compartment syndrome. Scand J Med Sci Sports. 2010;6:805–13.

    Article  Google Scholar 

  39. Haddad S L, Managing risk: compartment syndromes of the foot. American Academy of Orthopaedics Surgeons Now. 2007. http://www.aaos.org/news/bulletin/janfeb07/clinical1.asp.

  40. Pedowitz RA, Hargens AR, Mubarak SJ, et al. Modified criteria for the objective diagnosis of chronic compartment syndrome of the leg. Am J Sports Med. 1990;18:35–40.

    Article  CAS  PubMed  Google Scholar 

  41. Awbrey BJ, Sienkiewicz PS, Mankin HJ. Chronic exercise-induced compartment pressure elevation measured with a miniaturized fluid-pressure monitor. A laboratory and clinical study. Am J Sports Med. 1988;16:610–5.

    Article  CAS  PubMed  Google Scholar 

  42. Brace RA, Guyton AC, Taylor AE. Reevaluation of the needle method for measuring interstitial fluid pressure. Am J Physiol. 1976;229:603–7.

    Google Scholar 

  43. McDermott AG, Marble AE, Yabsley RH, Phillips MB. Monitoring dynamic anterior compartment pressures during exercise: a new technique using the STIC catheter. Am J Sports Med. 1982;10:83–9.

    Article  CAS  PubMed  Google Scholar 

  44. Murabak SJ, Hargens AR, Owen CA, et al. The wick catheter technique for measurement of intramuscular pressure: a new research and clinical tool. J Bone Joint Surg Am. 1976;58A:1016–20.

    Google Scholar 

  45. Van den Brand JGH, Verleisdonk EJMM, van der Werken C. Near infrared spectroscopy in the diagnosis of chronic exertional compartment syndrome. Am J Sports Med. 2004;32:452–6.

    Article  PubMed  Google Scholar 

  46. Rajasekaran S, Beavis C, Aly AR, Leswick D. The utility of ultrasound in detecting anterior compartment thickness changes in chronic exertional compartment syndrome: a pilot study. Clin J Sports Med. 2013;4:305–11.

    Article  Google Scholar 

  47. Wittstein J, Moorman CT, Levin LS. Endoscopic compartment release for chronic exertional compartment syndrome. Am J Sports Med. 2010;8:1661–6.

    Article  Google Scholar 

  48. Zobrist R, Aponte R, Levin LS. Endoscopic access to the extremities: the principle of fascial clefts. J Orthop Trauma. 2002;16:264–71.

    Article  PubMed  Google Scholar 

  49. Fulkerson E, Razi A, Tejwani N. Review: acute compartment syndrome of the foot. Foot Ankle Int. 2003;24:180–7.

    Article  PubMed  Google Scholar 

  50. Fakhouri AJ, Manoli 2nd A. Acute foot compartment syndromes. J Orthop Trauma. 1992;6:223–8.

    Article  CAS  PubMed  Google Scholar 

  51. Myerson MS. Experimental decompression of the fascial compartments of the foot--the basis for fasciotomy in acute compartment syndromes. Foot Ankle. 1988;8:308–14.

    Article  CAS  PubMed  Google Scholar 

  52. Izadi FE, Richie Jr DH. Exertional compartment syndrome of the medial foot compartment--diagnosis and treatment: a case report. J Am Podiatr Med Assoc. 2014;4:417–21. doi:10.7547/0003-0538-104.4.417.

    Article  Google Scholar 

  53. Miozzari HH, Gerard R, Stern R, Toman J, Assal M. Acute, exertional medial compartment syndrome of the foot in a high-level athlete: a case report. Am J Sports Med. 2008;36:983–6.

    Article  PubMed  Google Scholar 

  54. Detmer DE, Sharpe K, Sufit RL, et al. Chronic compartment syndrome: diagnosis, management, and outcomes. Am J Sports Med. 1985;13:162–70.

    Article  CAS  PubMed  Google Scholar 

  55. Rorabeck CH, Bourne RB, Fowler PJ. The surgical treatment of exertional compartment syndrome in athletes. J Bone Joint Surg Am. 1983;65A:1245–51.

    Article  Google Scholar 

  56. Rorabeck CH, Fowler PJ, Nott L. The results of fasciotomy in the management of chronic exertional compartment syndrome. Am J Sports Med. 1988;16:224–7.

    Article  CAS  PubMed  Google Scholar 

  57. Schepsis AA, Martini D, Corbett M. Surgical management of exertional compartment syndrome of the lower leg: long term follow up. Am J Sports Med. 1993;21:811–7.

    Article  CAS  PubMed  Google Scholar 

  58. Schepsis AA, Fitzgerald M, Nicoletta R. Revision surgery for exertional compartment syndrome of the lower leg. Am J Sports Med. 2005;33:1040–7.

    Article  PubMed  Google Scholar 

  59. Slimmon D, Bennell K, Brunker P, et al. Long-term outcome of fasciotomy with partial fasciectomy for chronic exertional compartment syndrome of the lower leg. Am J Sports Med. 2002;30:581–8.

    PubMed  Google Scholar 

  60. Frink M, Hildebrand F, Krettek C, Brand J, Hankemeier S. Compartment syndrome of the lower leg and foot. Clin Orthop Relat Res. 2010;468:940–50. doi:10.1007/s11999-009-0891-x.

    Article  PubMed  Google Scholar 

  61. Ojike NI, Roberts CS, Giannoudis PV. Foot compartment syndrome: a systematic review of the literature. Acta Orthop Belg. 2009;75:573–80.

    PubMed  Google Scholar 

  62. McCallum JR, Cook JB, Hines AC, Shaha JS, Jex JW, Orchowski JR. Return to duty after elective fasciotomy for chronic exertional compartment syndrome. Foot Ankle Int. 2014;9:871–5.

    Article  Google Scholar 

  63. Waterman B, Laughlin M, Kilcoyne K, Cameron K, Owens B. Surgical treatment of chronic exertional compartment syndrome of the leg: Failure rates and postoperative disability in an active patient population. J Bone Joint Surg Am. 2013;95:592–6.

    Article  PubMed  Google Scholar 

  64. Packer JD, Day MS, Nguyen JT, Hobart SJ, Hannafin JA, Metzl JD. Functional outcomes and patient satisfaction after fasciotomy for chronic exertional compartment syndrome. Am J Sports Med. 2013;2:430–6.

    Article  Google Scholar 

  65. Han F, Daruwalla ZJ, Shen L, Kumar VP. A prospective study of surgical outcomes and quality of life in severe foot trauma and associated compartment syndrome after fasciotomy. J Foot Ankle Surg. 2014;14:S1067–2516. doi:10.1053/j.jfas.2014.09.015.

    Google Scholar 

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Authors and Affiliations

  1. Duke University Medical Center, Department of Orthopaedic Surgery, Duke Sports Science Institute, Durham, NC, 27710, USA

    Jonathan A. Godin MD, MBA, Travis J. Dekker MD & C. T. Moorman III MD

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  1. Jonathan A. Godin MD, MBA
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  2. Travis J. Dekker MD
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  3. C. T. Moorman III MD
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Correspondence to C. T. Moorman III MD .

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Editors and Affiliations

  1. Swiss Medical Network Basel, Orthopaedic Department SWISS ORTHO CENTER Schmerzklinik Basel, Basel Stadt, Switzerland

    Victor Valderrabano

  2. Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA

    Mark Easley

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Godin, J.A., Dekker, T.J., Moorman, C.T. (2016). Compartment Syndromes (Acute & Chronic). In: Valderrabano, V., Easley, M. (eds) Foot and Ankle Sports Orthopaedics. Springer, Cham. https://doi.org/10.1007/978-3-319-15735-1_18

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  • DOI: https://doi.org/10.1007/978-3-319-15735-1_18

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