What is a reliable indication of compartment syndrome based on clinical evaluation?

Tenderness and decreased sensation in the foot are key indicators of compartment syndrome, which is a serious condition that occurs when swelling or bleeding in a muscle compartment increases pressure within that compartment. This pressure can impede blood flow and compromise the function of nerves and muscle tissue. The presence of tenderness indicates that tissues are under stress, while decreased sensation can signify nerve involvement due to the increased pressure.

Compartment syndrome typically presents with a characteristic set of symptoms, often referred to as the " five P's": Pain, Paresthesia (sensation changes, such as tingling), Pallor (pale skin), Pulselessness, and Paralysis. Among these, tenderness and parasthesia are particularly reliable indicators, as they represent both the pain response of the tissues and the impact of elevated pressure on nerve function.

In contrast, the presence of normal arterial pulses does not rule out compartment syndrome; circulation may still be compromised even if pulses are felt. Warmth of the extremities is also not a typical sign of compartment syndrome, as affected areas may actually feel cool due to reduced blood flow. Lastly, movement restriction without pain is not a reliable indicator since pain is a hallmark symptom of the condition, and restricted movement should always be evaluated alongside pain.