The Pathogenesis of Anterior Tibial Syndrome

Paton, David F.

doi:10.1302/0301-620x.50b2.383

Cited by 23 publications

(4 citation statements)

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“…Conversely, isolated ischemic or compressive injury to the superficial peroneal nerve may result in peroneal muscle weakness, with potential loss of eversion or creation of varus deformity. These muscles, in general, rarely seem to be involved in causing ischemic foot 60,61,67 …”

Section: Abduction And/or Eversionmentioning

confidence: 99%

Volkmann's Ischemic Contracture of the Foot and Ankle: Evaluation and Treatment of Established Deformity

Santi

Botte

1995

Foot Ankle Int.

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Fibrotic contracture of skeletal muscle can follow weeks or months after the severe ischemic insult of compartment syndrome. Commonly known as Volkmann's ischemic contracture, the affected limb often becomes dysfunctional and painful, and may lose sensibility. The pathogenesis of the muscle contracture includes prolonged ischemia, myonecrosis, fibroblastic proliferation, contraction of the cicatrix, and myotendinous adhesion formation. Resultant shortening or overpull of involved muscles leads to stiffness and deformity. Simultaneously, nerve injury from initial ischemia or subsequent soft tissue fibrotic compression leads to muscle paresis or paralysis of the involved compartment and of those muscles more distally innervated. The resultant deformity is thus a combination of varying degrees of contracture and weakness depending on which muscles and nerves are affected. Deformity and functional impairment in the foot and ankle secondary to ischemia are determined by many factors, including: (1) which leg compartment, if any, has been affected and to what degree extrinsic flexor or extensor overpull is exhibited, (2) degree of nerve injury sustained causing weakness or paralysis of extrinsic or intrinsic foot and ankle muscles (3) which foot compartment, if any, has been affected and to what degree intrinsic overpull is exhibited, and (4) degree of sensory nerve injury leading to anesthesia, hypoesthesia, or hyperesthesia of the foot. Therefore, a variety of clinical presentations can be encountered following compartment syndrome of the leg and foot. Treatment is based on an appreciation of the pathoanatomy of the deformity. Nonoperative therapy is aimed at obtaining or preserving joint mobility, increasing strength, and providing corrective bracing and accommodative footwear. Operative management is usually reserved for treatment of residual nerve compression or severe and problematic deformities. Established surgical protocols are performed in a stepwise fashion, to include: (1) release of residual or secondary nerve compression, (2) release of fixed contractures, using infarct excision, myotendinous lengthening, muscle recession, or tenotomy, (3) tendon transfers or arthrodesis to increase function, and (4) ostectomy or amputation for severe, refractory deformities.

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Section: Abduction And/or Eversionmentioning

confidence: 99%

Volkmann's Ischemic Contracture of the Foot and Ankle: Evaluation and Treatment of Established Deformity

Santi

Botte

1995

Foot Ankle Int.

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“…As the muscles are bound by their fascial compartments, the increased pressure begins to block off intramuscular blood vessels and causes ischaemia of exertion. Increased pressure may also compress nerves to cause referred distal symptoms but rarely will cause diminished distal pulses in a healthy blood vessel (Paton, 1968;Puranen, 1974). *Devas found in his series of athletes that most tibial stress fractures occurred in the distal third of the tibia.…”

Section: Anatomymentioning

confidence: 99%

“…Freedman (1953) gives a fascinating history of the symptoms of a medical officer on the last journey of Captain Scott, Dr. Edward Wilson, who undoubtedly had an exertional anterior compartment syndrome. Paton (1968) describes the case of a man who developed anterior shin pain after an anterior compartment fascial defect was closed. Obviously, the defect was the only valve through which pressure could escape.…”

Section: Anatomymentioning

confidence: 99%

Shin splints--a literature review.

Bates¹

1985

Br J Sports Med

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"Shin splints" is not a specific diagnosis. It is merely a descriptive term that describes chronic exertional shin pain in an athlete. The evidence seems clear that shin splint pain has many different causes and this reflects the variation in the anatomy. It would be preferable to describe shin splint pain by location and aetiology, for example, lower medial tibial pain due to periostitis or upper lateral tibial pain due to elevated compartment pressure. This would aid communication between physicians and also direct therapy more accurately.

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“…In cases with a chronic compartment syndrome the intramuscular pressure is abnormally raised during and after exercise (Reneman, 1975;French & Price, 1962 (Griffiths, 1940;Horn, 1945;Hughes, 1948;Kinmonth, 1952;Freedman & Knowles, 1959) and venous (Murphy, 1914;Brooks, 1922;Leach, Hammond & Stryker, 1967;Paton, 1968) obstruction may be of importance for the development of compartment syndromes.…”

Section: Introductionmentioning

confidence: 99%

Reference values for intramuscular pressure in the lower leg in man

Qvarfordt

Eklöf

Ohlin

1982

Clinical Physiology

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Intramuscular pressures in the anterior tibial and superficial posterior compartments of the lower leg were measured by the wick catheter technique in 34 healthy individuals (17 males and 17 females, mean age 42 years). The pressures were measured at rest, during and after exercise and during venous and arterial occlusion. The pressure was 1.1 (range 0.3-3.0) kPa in the anterior tibial and 0.5 (range 0.0-2.0) kPa in the superficial posterior compartment at rest. During exercise the intramuscular pressures rose to 3.5 (range 1.0-8.0) kPa and 0.9 (range 0.1-2.8) kPa respectively. The anterior tibial compartment pressures were lower in females than in males at exercise and lower in older than in younger persons at rest. After exercise the pressures were back to the pre-exercise levels within 5 min. Venous occlusion caused an increase in the pressure which was more marked in the anterior tibial compartment than in the superficial posterior compartment. Arterial occlusion did not cause any dramatic changes in intramuscular pressures, but there was a slight elevation during the period of reactive hyperaemia.

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The Pathogenesis of Anterior Tibial Syndrome

Cited by 23 publications

References 0 publications

Volkmann's Ischemic Contracture of the Foot and Ankle: Evaluation and Treatment of Established Deformity

Volkmann's Ischemic Contracture of the Foot and Ankle: Evaluation and Treatment of Established Deformity

Shin splints--a literature review.

Reference values for intramuscular pressure in the lower leg in man

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