Atraumatic Exertional Compartment Syndrome of the Medial Foot: Case Report

Introduction: Acute compartment syndrome is a surgical emergency that is mainly diagnosed clinically. Acute exertional compartment syndrome of the medial compartment of the foot is a rare condition most often result from strenuous exercise. Early diagnosis is most often a clinical examination, however, laboratory and magnetic resonance imaging (MRI) can assist in the diagnosis if clinician uncertainty persists. We present a case report of acute exertional compartment syndrome of the medial compartment of the foot after physical activity.

Case report: A 28-year-old male presents to the emergency department the day after playing basketball, with severe atraumatic medial foot pain. Clinical examination demonstrated tenderness and swelling over the medial arch of the foot. Creatine phosphokinase (CPK) results at 9500 international units. MRI demonstrated fusiform edema of the abductor hallucis. Subsequent fasciotomy revealed protruding muscle during fascial incision and relieved the patient of their pain. Return to surgery 48 h after initial fasciotomy revealed gray discoloration and lack of contractility of the muscle tissue. The patient was recovering well at the first post-operative visit, however, was lost to follow-up thereafter.

Conclusion: Acute exertional compartment syndrome of the medial compartment of the foot is a rarely reported diagnosis, likely due to a combination of missed diagnosis and underreporting. Laboratory tests for CPK may be elevated, and MRI may be helpful in the diagnosis of this condition. Fasciotomy of the medial compartment of the foot relieved the patient's symptoms, and to our knowledge had a good outcome.