Here is an article about Compartment Syndrome to help keep our patients informed on the many possible podiatric problems they may encounter:

Compartment Syndrome
Acute or Chronic?
Terence Vanderheiden, D.P.M.

Pain after an injury is not uncommon, but if the pain seems out of proportion to the injury and there is a significant amount of swelling (edema), you may have a condition called compartment syndrome. Compartment syndromes can be acute (sudden onset) or chronic (long-term problem). Learn more about compartment syndromes.
What is Compartment Syndrome?Compartment syndrome is a condition that can affect various areas of the body. For the purposes of this article, focus will be on the lower legs and feet. Four compartments are in the lower leg and nine compartments in the foot. Some of the tissues found in the compartments are muscles, nerves and blood vessels. The compartments in the lower leg and foot are divided by a fibrous band called the fascia. The fascia covers and separates the muscles and it is not very flexible.
In compartment syndrome, there is a significant increase in pressure (due to trauma, or exercise) in the compartments. This can lead to damage to the muscles, blood vessels and nerves because the fascia does not allow for expansion of the compartments. There are two types of compartment syndromes, acute and chronic. Acute compartment syndrome is usually caused by trauma. Chronic compartment syndrome is also known as exercise induced compartment syndrome. More than 200,000 people in the United States are diagnosed annually with compartment syndrome.

Causes
Acute Compartment Syndrome
Acute compartment syndrome is usually caused by trauma. Examples of trauma include crush injury, muscle tear, burn injury, bite injury (dog, insect, snake) or car accident. Acute compartment syndrome can also be caused by a cast that is too tight, drug overdose or electrocution.
Chronic Compartment Syndrome
Chronic compartment syndrome is also known as exercise induced compartment syndrome or exertional compartment syndrome. It is most often seen in the lower legs and is more common than acute compartment syndrome. When exercising, blood flow to the muscles increases and the muscles expand within the compartments. The expansion increases the pressure in the compartments and the fascia does not allow enough room for the expansion, which leads to the pain.

Signs and Symptoms
Acute Compartment Syndrome
• Decreased or abnormal sensations (numbness, tingling) in the area
• Severe swelling (edema)
• Excruciating pain
• Pain gets worse with stretching the affected muscles
• Muscle weakness
• Paleness (pallor)
• Absent pulses (no blood flow)
Chronic Compartment Syndrome
• Pain starts as dull ache
• Pain occurs within 30 minutes of starting to exercise
• Burning, cramping, aching, tightness develop if continue exercising
• Pain goes away after stopping exercise

Diagnosis
Acute Compartment Syndrome
Acute compartment syndrome is usually diagnosed based on the history (was there trauma?) and physical exam findings (extreme pain and swelling). When there is doubt about the diagnosis, the doctor will usually perform compartment pressure testing. The test involves numbing the area to be tested with a needle and local anesthesia. Once you are numb, a pressure gauge device with a needle is inserted into the chosen compartment and a pressure amount is measured. If the pressure is greater than 30 mmHg, then surgery is needed right away. It only takes about four hours before the high pressure will start to damage the muscles, nerves and blood vessels in the compartments.
Chronic Compartment Syndrome
The doctor may take x-rays of your legs or feet to make sure you do not have a stress fracture. An MRI is also sometimes used to help with the diagnosis. The gold standard (best test) for diagnosing compartment syndrome is compartment pressure testing. Compartment pressure testing is done twice, once before you exercise and once after you exercise. It is best to try and perform the exercise that brings on the pain, so bring shoes, clothes, bike, etc. so you will be able to recreate the pain. Not all compartments (4 in the leg, 9 in the foot) are usually tested, but it depends on how many places you feel pain. The actual test involves numbing the area to be tested with a needle and local anesthesia. Once you are numb, a pressure gauge device with a needle is inserted in the chosen compartment and a pressure amount is measured. The test is considered positive if you have a pressure greater than or equal to 15 mmHg before exercise or greater than or equal to 30 mmHg one minute after exercise or greater than or equal to 20 mmHg five minutes after exercise.

Treatment
Acute Compartment Syndrome
Acute compartment syndrome is a medical emergency and requires a surgical fasciotomy if the compartment pressure is greater than 30 mmHg. A fasciotomy involves making an incision in the skin to open the compartment and relieve the pressure. If acute compartment syndrome is not treated right away, you could develop deformity, paralysis, weakness and sensory nerve loss.
Chronic Compartment Syndrome
Conservative treatment for chronic compartment syndrome may include decreased exercise and then slow return to regular exercise, non-steroidal anti-inflammatory drugs (NSAIDs), orthoses, shoe gear changes, cross-training, sports massage and physical therapy. If conservative treatment does not work, then a surgical procedure called a fasciotomy is usually the next step. A fasciotomy involves making an incision in the skin to open the compartment and relieve the pressure. If more than one compartment is a problem, then more than one incision may be needed. Most studies have shown good results with 52% to 95% success rates reported. The surgery does have possible complications such as infection, delayed wound healing and nerve damage. An 11% complication rate has been reported. Chronic compartment syndrome can reoccur at a rate of 3% to 12%.