During exercise highly active muscles require large amounts of oxygen and glucose which require high blood flow down the arteries. This leads to “pumping up” of the muscles.
In some individuals the fascia surrounding the muscles is too tight to allow the muscle to swell during exercise. This leads to an increase in pressure inside the muscle compartment. When the pressure rises the veins become compressed because their walls are much softer.
If the pressure is not reduced, eventually muscles and nerves within the compartment are compromised, causing numbness and tingling in the feet. In severe cases, muscle death may occur, leading to permanent damage.
Fasciotomy is the splitting of the tight layer of fascia surrounding each of the involved compartments. This allows the muscles to swell during exercise allowing free flow in the blood vessels.
It usually consists of releasing either the anterior, lateral and posterior compartment or all three at the same time.
Antero-lateral release. Longitudinal incisions of about 5 cms each are made over the upper and lower aspect of the leg. The skin is undermined up and down the leg to expose the fascia of the anterior and lateral compartment. The fascia is then cut and split longitudinally and transversely with the excision of a small piece, allowing the compartment to expand.
Posterior release. A 6 cm incision is made at the midpoint of the inner side of the tibia. The fascia is released from the border of the tibia and the superficial muscles freed off the back of the tibia and the deep fascia split longitudinally with a small piece excised.
Risks
- damage to nerves and vessels
- wound infection
After
- crutches for two weeks, followed by physiotherapy
COMPLETE REST WITH LEG ELEVATION