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40-50 degrees of plantar flexion
2%
34/1877
10-20 degrees of ankle dorsiflexion
1%
27/1877
Neutral to 30 degrees of plantar flexion
73%
1369/1877
Neutral to 10 degrees of dorsiflexion
13%
248/1877
Ankle position has no effect on calf compartment pressure
10%
190/1877
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Agitation, anxiety, and increasing analgesic requirements are the "3 A's" of pediatric compartment syndrome. Weiner et al measured intramuscular compartment pressure in the anterior and deep posterior compartments of the leg in seven healthy adults who had long leg casts placed. They found that in a casted leg the intramuscular pressure in the anterior compartment was lowest with the ankle in neutral, and the deep posterior compartments was lowest when the ankle joint was in the resting position to approximately 37 degrees of plantar flexion. Based on this, they concluded that the safest ankle casting position regarding compartment pressure is between 0 and 37 degrees of plantar flexion. After the cast was bivalved, they noted a significant decrease in intramuscular pressure of 47 percent in the anterior compartment and of 33 percent in the deep posterior compartment. Constrictive casts and abberant ankle positioning can exacerbate pain/symptoms. Loosening of the cast by bivalving, spreading, and cutting underlying stockinette/softroll should always be the first step in management of possible compartment syndrome.
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