Compartment Syndromes of the Foot
The foot anatomically consists of multiple
small compartments. These compartments are filled with muscles, nerves
and tendons and are lined by a tight membrane (the fascia). These
are anatomically distinct compartments. When injury to the foot occurs,
there is commonly some bleeding which occurs in the muscles. This
is what causes swelling of the foot. What is often not understood,
however, is that when swelling gets severe, the muscle starts to expand.
The lining membrane (the fascia) of each of these small compartments
has a limited capacity to expand. If the muscle and fluid swelling
inside the compartment become significant, they may exceed the capacity
of blood flow in and out of the small compartments. If this occurs,
we call this a compartment syndrome. This can be a very serious problem.
If the pressure inside the compartment increases too much, the nerves
and muscles start to get squeezed and stop functioning properly.
Compartment syndromes of the foot typically occur after fairly significant
industrial, agricultural and motor vehicle accidents in which crushing
of the foot occurs. There is usually some very heavy object that either
runs over the foot, crushes it or impacts on the foot in a significant
way. Swelling of the foot begins to occur and is followed by severe
pain.
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This foot was crushed by a forklift.
There was a serious problem with compartment syndrome in this
patient. |
The diagnosis of compartment syndrome is made
by inserting a needle into the compartments and measuring the pressure
elevation inside each compartment. If the pressure is high, surgical
treatment is required to relieve the pressure. This operation is called
a fasciotomy. The presence of compartment syndrome is a medical and
surgical emergency and a fasciotomy must be done soon after the injury.
Once the cuts are made on the foot (fasciotomy), the pressure is released.
Although the foot stays quite swollen for a while, healing eventually
does occur. Commonly, small skin grafts are applied to the incisions
to speed up the healing process.
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Cuts have been made on the top of this
foot (fasciotomy) to decrease the pressure which was building
up inside the foot from the compartment syndrome. The blood
clot pops out of the foot just like popping a balloon. |
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This foot was crushed in a car
accident. A fasciotomy was performed, and the holes in
the top of the foot covered with small skin grafts one
week later. This patient now has absolutely normal function
of the foot. |
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