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Compartment syndrome of the lower leg or foot, a severe complication with a low incidence, is mostly caused by high-energy deceleration trauma. The diagnosis is based on clinical examination and intracompartmental pressure measurement. The most sensitive clinical symptom of compartment syndrome is severe pain.

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Clinical findings must be documented carefully. A fasciotomy should be performed when the difference between compartment pressure and diastolic blood pressure is less than 30 mm Hg or when clinical symptoms are obvious. Once the diagnosis is made, immediate fasciotomy of all compartments is required. Fasciotomy of the lower leg can be performed either by one lateral incision or by medial and lateral incisions. The compartment syndrome of the foot requires thorough examination of all compartments with special focus on the calcaneal compartment.

Depending on the injury, clinical examination, and compartment pressure, fasciotomy is recommended via a dorsal and/or medial plantar approach. Surgical management does not eliminate the risk of developing nerve and muscle dysfunction. When left untreated, poor outcomes with contractures, toe deformities, paralysis, and sensory neuropathy can be expected. In severe cases, amputation may be necessary.

Level of Evidence: Level III. See Guidelines for Authors for a complete description of levels of evidence. Introduction Acute compartment syndrome is a complication following fractures, soft tissue trauma, and reperfusion injury after acute arterial obstruction [,,,, ]. It is caused by bleeding or edema in a closed, nonelastic muscle compartment surrounded by fascia and bone []. The long-term consequences of a compartment syndrome were already described by Richard von Volkmann at the end of the 19th century following application of casts [].

A few years later, the connection to elevated intracompartmental pressure was made []. The incidence of compartment syndrome of the foot is around 6% in patients with foot injuries due to motorcycle accidents [], while the incidence of compartment syndrome of the lower leg seems even lower (eg, 1.2% after closed tibial diaphyseal fractures []). Ischemia causes capillary wall damage and a vicious cycle of events results in permanent nerve and muscle dysfunction [,, ]. While the existence and treatment of lower leg compartment syndrome was described in 1958 [], until recently compartment syndrome of the foot was largely unrecognized and only described in some case reports [,, ]. In 1988, Myerson described the clinical entity and presented surgical decompression as a therapeutic intervention []. Trauma surgeons dealing with musculoskeletal injuries must be familiar with treatment of acute compartment syndrome []. The aim of this review is to describe (1) the anatomy of the compartments of the lower leg and foot, (2) the pathophysiology, and (3) the diagnosis of compartment syndromes of the lower leg and foot.

In contrast to previously published reviews [,, ], we additionally focus on treatment and outcome of compartment syndromes of the foot and lower leg. Search Strategy and Criteria We performed a comprehensive literature search using PubMed at the National Library of Medicine using the keywords “compartment syndrome” combined with “lower leg” or “foot.” This search identified 156 and 194 publications for potential inclusion, respectively.

With the additional limits of English or German language and studies on humans, we identified 130 and 157 papers, respectively. When the search terms “compartment syndrome” and “lower leg” were combined with “outcome” only 24 items and three reviews were identified.