Compartment syndrome of the foot: an experimental approach to pressure measurement and release.

INTRODUCTION: Using a cadaver model and multiple continuous compartment pressure measurement, we sought to determine the pressure distribution in different osseofascial spaces of the foot and determine the quickest and most effective technique of pressure release.

MATERIALS AND METHODS: The compartment pressures were measured (in mmHg) in five different osseofascial spaces of each foot. In stepwise manner, warmed saline was injected only into the central compartment only. Three experimental approaches to fasciotomy were studied.

RESULTS: We recognized a simultaneous exponential increase of all foot compartments in all experimental models. With a medial fasciotomy technique first, a flexor brevis compartment incision was necessary to release pressures in the central compartments. Following this procedure, pressure was released in the tarsal tunnel and in the intermetatarsal area immediately. Pressure reduction in the central flexor space and in the tarsal tunnel was less effective with a dorsal fasciotomy technique.

CONCLUSIONS: There is no pressure increase of a "single" osseofascial space in case of a foot compartment syndrome. If immediate pressure release is required, a medial fasciotomy technique including the central flexors should be favoured.