Can Compartment Syndrome Occur in the Feet?
Yes, compartment syndrome absolutely occurs in the feet, though it is uncommon and frequently missed due to less reliable clinical signs compared to other anatomical locations. 1, 2
Anatomical Considerations
The foot contains nine distinct anatomical compartments that can develop elevated pressures, making diagnosis and treatment more complex than compartment syndrome in other body regions. 1, 3, 4 These multiple compartments necessitate multi-stick needle catheterization when measuring compartment pressures, as a single measurement site is insufficient. 1, 4
High-Risk Mechanisms for Foot Compartment Syndrome
Foot compartment syndrome (FCS) typically results from:
- High-energy fractures of the forefoot, midfoot, or calcaneus 2, 4
- Crush injuries to the foot 1, 3, 4
- Vascular injuries 1
- Post-surgical complications 1
Critical Diagnostic Challenges Specific to the Foot
The classical clinical signs of compartment syndrome are LESS reliable in the foot than elsewhere in the body, making diagnosis particularly challenging. 2, 4
Why Foot Compartment Syndrome is Harder to Diagnose:
- Pain with passive stretch of involved muscles is less helpful diagnostically in the foot compared to leg compartments 4
- Nerve dysfunction signs are less reliable indicators 4
- Tense swelling may raise suspicion but is not definitive 4
- Pain out of proportion to injury remains the earliest warning sign, though interpretation can be confounded by the severity of foot injuries 5, 3
Recommended Diagnostic Approach:
Maintain an extremely low threshold for measuring compartment pressures in foot injuries, particularly with crush mechanisms or fractures. 1, 3 Direct pressure measurement via multi-stick catheterization of all nine compartments is the most reliable diagnostic method. 1, 4
Pressure Thresholds for Fasciotomy
Fasciotomy is indicated when:
- Compartment pressure ≥30 mmHg 5, 1
- Differential pressure (diastolic blood pressure minus compartment pressure) ≤30 mmHg 5, 6
- Compartment pressure is 10-30 mmHg below diastolic pressure 1
Surgical Management
Emergent fasciotomy of all involved compartments is the definitive treatment when foot compartment syndrome is diagnosed. 5, 2
Standard Surgical Approaches:
- Two dorsal incisions for access to forefoot compartments 1
- One medial incision for decompression of the calcaneal, medial, superficial, and lateral compartments 1
Devastating Consequences of Missed Diagnosis
Long-term sequelae of untreated foot compartment syndrome include:
- Claw-toe deformity (the primary late complication) 4
- Contractures and deformity 1, 2
- Weakness and paralysis 1
- Sensory neuropathy 1
- Chronic pain 2
These complications are poorly tolerated and often necessitate multiple reconstructive procedures. 1
Critical Pitfall to Avoid
Never rely solely on clinical examination to rule out foot compartment syndrome in high-risk injuries. 2, 4 The threshold for performing compartment pressure measurements must be extremely low given the unreliability of physical findings and the devastating consequences of missed diagnosis. 1, 3 When in doubt, measure pressures in all nine compartments rather than risk permanent disability. 1, 4
Special Consideration: Foot-Leg Connection
A communication exists between the calcaneal compartment of the foot and the deep posterior compartment of the leg, meaning a foot injury alone can cause deep posterior compartment syndrome in the leg. 4 Monitor both regions when foot compartment syndrome is suspected. 4