Compartment syndrome of the foot after calcaneal fractures.

BACKGROUND

A compartment syndrome is a condition in which high pressure within a closed fascial space causes reduced blood flow with nerve and muscle ischaemia. Untreated compartment syndrome leads to ischaemia with necrosis, contractures, myofibrosis and irreversible functional impairment in the involved part of the limb. Calcaneal fractures and other kinds of foot trauma may cause acute compartment syndrome of the foot. This condition may lead to foot deformities, including clawing of the toes, weakness of the foot muscles and, ultimately, a gait disorder.

MATERIAL AND METHOD: We studied 13 patients with unilateral calcaneal bone fractures. The healthy feet were examined as a control group. Data were derived from histories, physical examinations and measurements of intracompartmental pressure in three muscle compartments of the foot.

RESULTS

Pressure in the foot with a calcaneal fracture was significantly higher than that on the healthy side, with pressures of 68.6 mmHg vs. 18.8 mmHg (p=0.0002) in the calcaneal (central) compartment, 49.0 mmHg vs. 14.4 mmHg (p=0.0003) in the lateral compartment, and 45.9 mmHg vs. 11.8 mmHg (p=0.0003) in the medial compartment. The pressures correlated with pain intensity rated by patients on a 10-point scale.

CONCLUSIONS

Calcaneal fractures are accompanied by elevated intracompartmental pressure and symptoms of compartment syndrome. Acute compartment syndrome of the foot is very rarely diagnosed in Poland and only exceptionally treated by compartmental decompression. If left untreated, combined with deformities directly related to the fracture, it may lead to disability.