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[Chronic compartment syndrome of the foot. A case report].

PURPOSE OF THE STUDY
The aim of this paper is to present an unusual localization of a chronic compartment syndrome concerning the medial compartment of the foot. It emphasizes surgical treatment, using a fasciotomy procedure.


MATERIAL AND METHODS
A thirty year old man was examined for a painful right foot. Pain was situated on the medial plantar aspect 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 normal. The patient had comparative tissue pressure measurements at rest and after running, using a digital hand-held monitor (Stryker). A rest, the pressure was about 4 mmhg on both sides and it increased to 55 mmhg against 45 mmhg at the opposite side after exercise. It required more than 7 minutes vs. 30 seconds to return to their preexercise resting values. Thus a fasciotomy of the medial compartment was performed, using a medial approach.


RESULTS
The patient had a good result at three months follow-up, recovering normal physical activity without any pain.


DISCUSSION
The foot localization of an acute compartment syndrome has been recently described and it concerned only post-traumatic cases. The compartmental structure of the foot has been previously report. The chronic compartment syndrome of the lower leg was the reason for a pressure measurement study, at rest and following physical exercise; thus surgical fasciotomy was indicate when intracompartmental pressure rose above 30 mmHg in the presence of normal diastolic blood pressure, and particularly if delayed normalization of the pressure was greater 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 compartment syndromes require dynamic pressure measurements for an accurate diagnosis. Surgical fasciotomy may be sufficient to restore muscle function. We think this syndrome could happen in all anatomical compartmental structure when there is intensive use of muscles.