Abstract
Chronic exertional compartment syndrome of the foot is well recognised. There has been debate over the exact number and location of compartments. While the medial compartment has been consistently reported, the exact anatomy of the fasciotomy has been poorly documented in orthopaedic literature.
Over a four year period (2003–7) five patients (seven feet) with history and examination findings compatible with chronic exertional compartment syndrome affecting the medial compartment of the foot were treated in our unit. There were three female patients and two males, average age 23 (17–34).
Assessment was made using the Stryker compartment pressure monitor inserted into the compartment following exertion. The measurements were compatible with chronic exertional compartment syndrome according to the Pedowitz criteria. The patients then underwent complete surgical release of the medial compartment of the foot. This involved two small oblique incisions, over the proximal and distal ends of the muscle belly of abductor hallucis, the fascia on the superficial and deep surfaces was then released, thus releasing the distal end of the tarsal tunnel. Decompression was bilateral in one, sequential in one and unilateral in three. Three patients also had surgical treatment of chronic compartment syndrome elsewhere in their lower limbs. One patient underwent a simultaneous calcaneal osteotomy for a planovalgus foot.
Preoperative post exertional compartment pressure measurements were 67.8 (32–114) at 1 minute and 50.2 (28–97) at 5 minutes. At an average of 21 (9–57) months follow up all but one patient had significant relief of their symptoms.
We recommend that the surgical treatment of chronic exertional compartment syndrome affecting the medial compartment of the foot should involve full release of the fascia both superficial and deep to abductor hallucis. It is safe to perform this bilaterally and in association with other lower limb decompressions as required.
Correspondence should be addressed to Editorial Secretary Mr ML Costa or Assistant Editorial Secretary Mr B.J. Ollivere at BOA, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, England; Email: mattcosta@hotmail.com or ben@ollivere.co.uk
