Accuracy of medial foot compartment pressure testing: A comparison of two techniques

Background: Foot compartment syndrome is diagnosed with intracompartmental pressure measurements. The purpose of this study was to determine the ability of two techniques to accurately place a needle tip within the medial foot compartment and to compare the proximity of the needle tip to the medial foot compartment neurovascular structures between the two techniques. Materials and Methods: This was a laboratory study using ten unembalmed cadaveric ankle-foot specimens. Two 18-gauge side-ported needles were placed into the medial foot compartments of each cadaveric specimen utilizing two separate techniques (Mollica and Reach techniques). Ultrasound was used to confirm needle tip placement within the medial foot compartment and needle proximity to the neurovascular structures. Results: Both needle placement techniques accurately placed the needle tip within the medial foot compartment. However, the distance between the needle tip and the neurovascular structures of the medial foot compartment was significantly closer (p = 0.037) using the Mollica technique (mean = 3.9 mm ± 2.2 mm) than the Reach technique (mean = 10.9 mm ± 5.2 mm). Neither needle placement technique perforated the medial foot neurovascular structures. Conclusion: While both medial foot compartment pressure techniques accurately placed the needle tip within the medial foot compartment, the needle tip was significantly further from the medial foot neurovascular structures using the Reach technique than the Mollica technique. The Reach technique involves inserting the needle 6 cm below the distal tip of the medial malleolus, and advancing it 1 cm in a medial to lateral direction.