Biomechanics and Motion Analysis

Compartments of the Foot: 3-Tesla MRI Study with Clinical Correlates for Needle Pressure Testing

Principal Investigator: Kimberly K. Amrami, M.D.
Project Coordinator: John S. Reach, Jr, M.D.

Compartment syndrome is one of the few true orthopaedic emergencies. Reliable measurement of subfascial pressures represents an essential part of deciding for or against surgical faciotomy. The present non-standardized measuring techniques, poor intra-study reproducibility and reliability, dearth of clinically meaningful reports, and general disagreement on compartment number, all leads to potentially bad patient care: both missed compartment syndromes and unnecessary surgical decompression of normal compartments.

Our study provides the front-line orthopaedic surgeon a reproducible technique for measuring all 10 potential foot compartments. These are: (1) Medial, (2) Calcaneal, (3) Lateral, (4-7) Interossei, (8) Central Superficial, (9) Central Deep, and (10) Skin. Optimal needle placement and depth were identified for each compartment. These results are supported by a review of 187 articles specifically on foot compartment syndrome, 66 of these were Case Reports of actual examples of compartment syndrome. From this summary 10 clinically relevant foot compartments were distilled from the case report data. While future study is needed to ascertain the clinical significance of these compartments, it is our hope that the data presented in this study may allow a more reproducible approach to measuring foot compartment pressures.