SLR - December 2012 - Pentek

Injury Patterns Causing Isolated Foot Compartment Syndrome

Reference: Thakur NA, McDonnell M, Got CJ, Arcand N, Spratt KF, DiGiovanni CW. Injury Patterns Causing Isolated Foot Compartment Syndrome. J Bone Joint Surg Am. 2012 Jun 6;94(11):1030-5.

Scientific Literature Review

Reviewed by: Jeffrey R. Pentek, DPM
Residency Program: Botsford General Hospital, Farmington Hills, MI

Podiatric Relevance:
Compartment syndrome of the foot is a serious disorder which can lead to significant long-term pain and disability unless promptly recognized and a proper fasciotomy has been performed. Thus, the ability of physicians to anticipate the development of this condition would be advantageous in allowing earlier recognition, leading to quicker treatment and overall prevention of future complications. The aim of this study was to gain an appreciation of the overall incidence of compartment syndrome within the foot as it pertains to the frequency and anatomic location of various foot injuries. This would allow a baseline for physicians to draw conclusions on its potential development in specific traumatic situations.

Methods:
Researchers retrospectively searched the National Trauma Data Bank for patients that had suffered from isolated foot injuries or fractures that ultimately required a fasciotomy of the foot for the presumed treatment of compartment syndrome from 2002-2008. This population was compared to patients with similar injury patterns not resulting in a fasciotomy during this time period in order to determine the underlying incidence based on the specific injury patterns.

Results:
364 cases were found to have undergone a fasciotomy of the foot from 18,676 reported isolated foot injuries (two percent overall incidence). Of all categories of injury that were statistically significant, the incidence of foot compartment syndrome was highest in crush and forefoot injuries (19 of 106, 17.9 percent of cases leading to fasciotomy), followed by isolated crush injuries regardless of location – forefoot, midfoot, and hindfoot (23 of 162, 14.2 percent). Combining the number of anatomic locations of injury did not appear to result in higher rates of compartment syndrome. Only one percent of isolated calcaneal fractures underwent fasciotomy for a presumed foot compartment syndrome, which was much less than the 10 percent as previously stated in scientific literature.

Conclusion:
As compartment syndrome of the foot can be a debilitating condition if not promptly recognized and treated, an understanding of its incidence following traumatic situations is needed. Physicians need to be aware that injuries specifically involving a crush mechanism, either with a forefoot injury or by itself, should cause concern as it appears to be an important predisposing factor in the development of compartment syndrome of the foot.

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