Working Diagnosis:
Peroneus Brevis tear, intramuscular hematoma, with impending Lateral Compartment Syndrome.

Treatment:
The patient was admitted to the hospital and was able to sleep through the night. In the early morning he had increased pain, numbness on the top of his right foot, and increased difficulty with active eversion. Pain with combined passive inversion and plantarflexion was mild and the lateral compartment remained firm with persistent swelling. Patient was taken to the OR for an emergent fasciotomy.

Outcome:
In the OR, injury to the proximal muscle belly of the peroneus brevis with tearing, intramuscular clot, and hemorrhage were noted. The muscle belly of peroneus longus at the musculotendinous junction along with proximal peroneus brevis appeared mildy dusky. Decreased contraction response to Bovie stimulation was also noted. Following fascial compartment release, the dusky region improved in color. The peroneus longus muscle belly was pink and had good contraction to Bovie stimulation. Anterior compartment was normal. A loose rubber band temporary closure of the skin was performed. The next day patient reported nearly complete pain resolution. Motor exam was normal. Active and passive ROM was full and without pain. The numbness on top of the foot had largely resolved. Patient returned to the OR for washout and primary closure of the incision. Patient was then discharged home.

Editor's Comments:
Compartment syndrome is a surgical emergency, and failure to recognize and delay in diagnosis can lead to significant morbidity. Early fasciotomy is the treatment of choice. This case highlights the utility of ultrasound imaging as a diagnostic tool in providing urgent assessment, and ultimately appropriate treatment in a timely manner.

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