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Review Question - QID 429

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QID 429 (Type "429" in App Search)
A patient sustains a comminuted calcaneus fracture. Three months after the injury the patient complains of shoewear problems secondary to clawing of the lesser toes. What is the most likely explanation for this deformity?

Sural nerve injury

2%

35/1943

Tethering of the flexor hallucis longus by fracture fragments

8%

149/1943

Medial plantar nerve neuropathy

4%

78/1943

Weakness of the tibialis posterior

2%

43/1943

Unrecognized foot compartment syndrome

84%

1626/1943

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Contracture of the intrinsic flexor muscles of the foot can be the result of unrecognized foot compartment syndrome. Foot compartment syndrome is a known complication of calcaneus fractures.

Myerson reported 3/43 patients in his series below had chronic foot compartment syndrome. There are 9 compartments in the foot: (1) medial, (2) superficial, (3) lateral, (4) adductor, (5-8) four interossei, and (9) calcaneal. The plantar fascia limits the space available for hematoma and swelling, causing damage to the intrinsic flexors of the foot (particularly the lumbricals and interossei), resulting in clawtoes.

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