Foot Compartment Syndrome

Overview

  • Follows crush injury, calcaneal fractures and Lisfranc injuries
  • Up to nine compartments described
  • Calcaneal compartment most often involved after hindfoot fractures
  • Severe pain out of proportion and a tense swollen foot
  • Pressure measurement when the picture is unclear
  • Fasciotomy versus observation and later claw toe reconstruction is debated

Western Health Orthopaedic Registrar presentation – Foot Compartment Syndrome by Dr Amy Gibbens

Anatomy

  • Nine compartments commonly described, medial, lateral, superficial central, calcaneal, adductor and four interosseous
  • Calcaneal compartment communicates with the deep posterior compartment of the leg

Aetiology

  • Crush injury is the commonest cause
  • Calcaneal fractures, Lisfranc injuries and multiple metatarsal fractures
  • Reperfusion after vascular repair

Clinical Features

  • Pain out of proportion and a tense swollen foot
  • Pain on passive toe dorsiflexion is unreliable
  • Altered plantar sensation is a late sign
  • Pulses and capillary refill are usually preserved

Investigations

Foot Compartment Syndrome, fasciotomy for compartment syndrome
Fasciotomy for compartment syndrome. Image by آرمین, Wikimedia Commons, CC BY-SA 3.0.
  • Pressure monitoring in uncertain cases, obtunded patients and children
  • Measure several compartments, including the calcaneal
  • Fasciotomy indicated when diastolic minus compartment pressure is under 30 mmHg

Management

  • Two dorsal incisions, medial to the second and lateral to the fourth metatarsal
  • Dorsal incisions reach interosseous, adductor and central compartments
  • Medial Henry incision along abductor hallucis decompresses medial, superficial central, calcaneal and lateral compartments
  • Wounds left open for delayed closure or split skin graft
  • Non-operative care accepting late deformity is advocated by some, but most guidelines favour fasciotomy

Complications

  • Claw and hammer toes from intrinsic and long flexor contracture
  • Cavus, stiffness and neuropathic pain
  • Fasciotomy wound infection
  • Late deformity treated with flexor tenotomy, tendon transfer or arthrodesis

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.