Over the last several weeks we’ve talked about some injuries to the lower extremities that are suffered under high-energy mechanisms (calcaneal fractures and 5th met base fractures), meaning a large force on the body has created the injury. We’ve talked about what to do when you suspect an injury, including early evaluation by your Podiatrist. Aside from an improved outcome through receiving early treatment and immobilization with either casting or surgical means, as Foot and Ankle specialists we are always on the lookout for Compartment Syndrome.
Well, what is that? Compartment syndrome, also known as neurovascular compromise (neuro = nerves; vascular = blood supply) needs to be ruled out every time an injury to the lower extremity occurs. When swelling occurs post-injury, pressure can build-up within the compartments of the leg or foot and can inhibit the function of both the nerve structures and the blood vessels within that same area. If function of those structures is inhibited for too long of a time period, permanent damage and impaired function can result, with possible loss of portions of the foot that have been compromised.
First and foremost, it is important that you be evaluated as soon as possible when you’ve suffered a lower extremity injury, especially those suffered via high-energy mechanisms. Prompt evaluation by a Podiatrist can recognize early indicators of compartment syndrome in addition to early intervention for relief of compartment pressure to free up those impinged structures.
When you present to the Emergency Room, you should expect the area of injury to be examined, but there are a few specific signs/symptoms we will be looking for to help us rule out compartment syndrome. Palpating your foot for pulses, the temperature of the foot and how quickly your toes “pink up” after pressure (capillary refill time) will give us a lot of information about compromise of blood vessels. Next, evaluation of the nerves to your foot and leg will be conducted where feeling on the injured foot will be compared with feeling on the non-injured foot. Several tools, such as a cotton-swab or a small piece of fishing-line will help with the comparison.
If all points of the examination are within normal limits compartment syndrome can be ruled out and standard evaluation and treatment of your injury will ensue. If there are several red flags in the examination, there is an additional evaluation with a Wick’s Catheter that can be conducted. The Wick’s can take a measurement of the pressure within the compartments of the leg and foot to determine if increased pressures are present and thus confirming a diagnosis of compartment syndrome. If the diagnosis is confirmed, immediate relief of the compartment pressure must take place to prevent long-term complications to the nerves and blood vessels significantly decreasing the risk of loss of portions of the foot secondary to compromise.
The “Gold Standard” for treatment of compartment syndrome is fasciotomy. Basically, what that means is that several small incisions will be made over the areas of concern for increased pressures, essentially relieving the pressure within the compartments of the foot and decreasing the risk of “neurovascular compromise.”
Compartment syndrome as a sequelae of high-energy injuries is rare, but can occur, thus early evaluation of your lower extremity injury is imperative to early recognition and prevention of long-term complications. Most often, evaluation will rule out compartment syndrome and early treatment of your injury can begin. In those rare instances where compartment syndrome is a real threat, you’ll be happy that prompt intervention took place, because even though the road to recovery will be long, function, sensation and blood flow to your leg and foot will be restored preventing the risk of long term disability!