summary Foot Compartment Syndrome is a devastating lower extremity condition where the osseofascial compartment pressure rises to a level that decreases perfusion to the foot and may lead to irreversible muscle and neurovascular damage. Diagnosis is made with the presence of severe and progressive foot pain that worsens with the passive motion of the toes. Firmness and decreased compressibility of the compartments is often present. Needle compartment pressures are diagnostic in cases of inconclusive physical exam findings and in sedated patients. Treatment is usually emergent fasciotomies. Epidemiology Anatomic location May occur anywhere that skeletal muscle is surrounded by fascia, but most commonly leg forearm hand foot (details below) thigh buttock shoulder paraspinous muscles Etiology Pathophysiology local trauma and soft tissue destruction> bleeding and edema > increased interstitial pressure > vascular occlusion > myoneural ischemia Causes trauma fractures (69% of cases) login to view 1 more bullet crush injuries severe ankle sprains gunshot wounds tight casts, dressings, or external wrappings burns postischemic swelling bleeding disorders vascular injury Anatomy 9 main compartments (controversial) medial abductor hallucis flexor hallucis brevis lateral abductor digiti minimi flexor digiti minimi brevis interosseous (x4) central (x3) superficial login to view 1 more bullet central login to view 1 more bullet deep login to view 2 more bullets Presentation Symptoms pain out of proportion to injury Physical exam pain with dorsiflexion of toes (MTPJ) places intrinsic muscles on stretch tense swollen foot loss of two-point discrimination pulses presence of pulses does not exclude diagnosis Imaging Radiographs obtain to rule-out fracture Studies Compartment pressure measurements indications polytrauma patients patient not alert/unreliable inconclusive physical exam findings relative contraindication unequivocally positive clinical findings should prompt emergent operative intervention without need for compartment measurements technique central compartment login to view 2 more bullets medial compartment login to view 1 more bullet interosseous login to view 2 more bullets lateral login to view 2 more bullets threshold for decompression within 30 mm Hg of diastolic blood pressure (delta p) login to view 2 more bullets absolute value of 30-45 mm Hg (controversial, historic) Treatment Nonoperative observation indications login to view 2 more bullets Operative emergent foot fasciotomies indications login to view 5 more bullets Technique Emergent fasciotomies of all compartments dual dorsal incisions (gold standard) approach login to view 6 more bullets technique login to view 4 more bullets post-operative login to view 1 more bullet pros login to view 2 more bullets cons login to view 1 more bullet single medial incision technique login to view 3 more bullets cons login to view 1 more bullet Complications Chronic pain and hypersensitivity difficult to manage Fixed flexion deformity of digits (claw toes) release flexor digitorum brevis and longus at level of digits