Atraumatic presentation of compartment syndrome with post-intervention systemic inflammatory response and complex regional pain syndrome: A case report

• Published in: Foot & ankle surgery (New York, N.Y.) Vol. 1; no. 4; p. 100107
• Main Authors: Shields, John, Patel, Sachi, Gambhir, Neil, Alben, Matthew, Lucido, Jeffery V.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 2021; Elsevier
• Subjects: Atraumatic compartment syndrome; Metatarsal; Metatarsal; Atraumatic compartment syndrome
• ISSN: 2667-3967; 2667-3967
• DOI: 10.1016/j.fastrc.2021.100107

Compartment syndrome is a well-known surgical emergency within the scope of Podiatry.  However, cases can be atraumatic and present without the traditional findings of pain, pallor, paresthesia, pulselessness, paralysis, and poikilothermia. Thus, posing a diagnostic dilemma for clinicians, leading to delayed surgical intervention and poor outcomes.
We report a rare case of acute exertional compartment syndrome and include a discussion on current literature to increase awareness of atypical presentations of compartment syndrome.
A 27-year-old healthy female with no significant past medical history was treated for intractable right foot pain following an extended period of marching. Physical examination was remarkable for non-palpable pedal pulses, pain out of proportion, extensive soft tissue edema, and a warm-to-cold temperature gradient of the extremity. The diagnosis of compartment syndrome was confirmed via catheter evaluation of compartmental pressures. Emergent fasciotomy of the right foot was performed, and delayed primary closure was performed six days later. After discharge from the hospital, the patient was inconsistent in follow up visits. Later repeat imaging of the right foot revealed stress fractures and nondisplaced fractures throughout the tarsometatarsal region. At her most recent visit, the patient complained of persistent paresthesias, skin discoloration, and pain to the right foot for which she is receiving symptomatic management for.
Diagnosis in this patient was likely delayed due to strict adherence to a post-traumatic model of compartment syndrome. Broadening awareness to the variable presentations of compartment syndrome is an important step to improve patient outcomes.