CHRONIC COMPARTMENT SYNDROME OF THE FOOT - A CASE-REPORT

Purpose of the study The aim of this paper is to present an unusual lo calization of a chronic compartment syndrome concerning the medial com partment of the foot. It emphasizes surgical treatment, using a fascio tomy procedure. Material and methods A thirty year old man was examine d for a painfull right foot. Pain was situated on the medial plantar a spect of the foot. It appeared following 15 minutes of physical effort , especially after walking and running. it usually disappeared after a few minutes of rest and then, foot and lower leg examination were nor mal. The patient had comparative tissue pressure measurements at rest and after running, using a digital hand-held monitor (Stryker(R)). A r est, the pressure was about 4 mmhg on both sides and it increased to 5 5 mmhg against 45 mmhg at the opposite side after exercice. It require d more than 7 minutes vs. 30 seconds to return to their preexercise re sting values. Thus a fasciotomy of the medial compartment was performe d, using a medial approach. Results The patient had a good result at t hree months follow-up, recovering normal physical activity without any pain. Discussion The foot localization of an acute compartment syndro me has been recently described and it concerned only post-traumatic ca ses. The compartmental structure of the foot has been previously repor t. The chronic compartment syndrome of the lower leg was the reason fo r a pressure measurement study, at rest and following physical exercic e; thus surgical fasciotomy was indicate when intracompartmental press ure rose above 30 mmHg in the presence of normal diastolic blood press ure, and particularly if delayed normalization of the pressure was gre ater than 5 minutes. The publications of foot pressure measurement are uncommon and they concerned only pressure at rest. In our observation , the profile of pressure of the patient and the result of fasciotomy, are in favour of chronic compartment syndrome. Conclusion Chronic com partment syndromes require dynamic pressure measurements for an accura te diagnosis. Surgical fasciotomy may be sufficient to restore muscle function. We think this syndrome could happen in all anatomical compar tmental structure when there is intensive use of muscles.