Fasciotomy of the Foot: An Anatomical Study with Special Reference to Release of the Calcaneal Compartment

Abstract

Three patients with calcaneal fractures developed clawing of the lesser toes as a late sequela. Believing that this complication may be the result of contractures from an occult compartment syndrome of the foot, an investigation of the anatomical compartments of the foot was performed. The various compartments of 17 unembalmed adult lower limb specimens were injected with dyed gelatin in a controlled fashion. After freezing, the feet were sectioned either transversely or sagittally. The distribution of the dyed gelatin was then studied. Nine compartments were identified. These were the (1) medial, (2) superficial, (3) lateral, (4) adductor, (5-8) four interossei, and (9) calcaneal. The contents of each compartment was then studied as was the compartment's location in the foot and its position relative to other compartments. We identified a new, separate compartment which lies deep to the superficial compartment in the hindfoot area only. This compartment contains the quadratus plantae muscle. We have named it the "calcaneal" compartment to emphasize its hindfoot location. In addition, a communication was demonstrated between the calcaneal compartment and the deep posterior compartment of the leg through the retinaculum behind the medial malleolus, following the neurovascular and tendinous structures. Claw toe deformity following calcaneus fracture appears to be due to late contracture of the quadratus plantae muscle in the calcaneal compartment. A surgical technique for release of all of the foot compartments is described.

Anatomic compartments of the foot: A 3‐Tesla magnetic resonance imaging study

“…The lateral plantar nerve and vessels as well as the nerve to the abductor digiti minimi muscle pass through this compartment. This compartment extends to the insertion of the quadratus plantae muscle onto the flexor digitorum longus tendon (Manoli and Weber, 1990) (Figs. 3 and 4).…”

“…Although compartment syndrome has been well described in a variety of anatomic locations, the compartments of the foot have proven to be a contentious anatomic entity. From Grodinsky's (1929) classic description of four foot anatomic compartments, to Manoli and Weber's (1990) more recent description of nine foot compartments, the foot has been described as having three (Kamel and Sakla, 1961;Goldman et al, 1990;Smith, 1990;Ledermann et al, 2002), four (Wood-Jones, 1949;Myerson, 1988Myerson, , 1990Starosta et al, 1988;Shereff, 1990;Lower and Kenzora, 1994;Lee et al, 1995;Rauwerda, 2000), five (Loeffler and Ballard, 1980;Adelaar, 2001), eight (Ascer et al, 1989;Sarrafian, 1990;Guyton et al, 2001), or nine (Manoli and Weber, 1990;Myerson and Manoli, 1993;Silas et al, 1995;Botte et al, 1996;Bibbo et al, 2000;Perry and Manoli, 2001;Stiegelmar et al, 2001;Fulkerson et al, 2003) fascial compartments. A review of the literature also suggests a tenth potential compartment: the skin.…”

Acute compartment syndrome of the foot after an ankle sprain: a case report

“…Acute compartment syndrome usually occurs after fracture, major soft tissue injury, or vascular trauma 3 . The foot is a rare site for compartment syndrome, with a prevalence of 5% 4 . The result may be devastating without surgical management including severe nerve injuries, ischemic contractures, gangrene, and tissue necrosis that may eventually lead to amputation 5 .…”

“…The goal of surgical treatment is the dissection of the fascia that surrounds the swollen muscle allowing venous circulation to recover 4 . Proposed surgical approaches for an acute foot compartment syndrome include the double dorsal incision and/or an additional medial incision 4 . In our case a double-dorsal incision technique was performed to reduce intracompartment pressure and prevent muscular necrosis and other complications.…”

Compartment syndrome of the foot

“…Its later complication is the ischemic contracture of the small flexor muscles of the foot (Manoli and Weber, 1990;Manoli et al, 1993). Clinically this complication causes a deformity of the foot such as hammer toe or claw toe (Echtermeyer, 1985;Fakhouri and Manoli, 1992;Zwipp et al, 1989).…”