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The pathogenesis of the muscle contracture includes prolonged ischemia, myonecrosis, fibroblastic proliferation, contraction of the cicatrix, and myotendinous adhesion formation. Resultant shortening or overpull of involved muscles leads to stiffness and deformity. Simultaneously, nerve injury from initial ischemia or subsequent soft tissue fibrotic compression leads to muscle paresis or paralysis of the involved compartment and of those muscles more distally innervated. The resultant deformity is thus a combination of varying degrees of contracture and weakness depending on which muscles and nerves are affected. Deformity and functional impairment in the foot and ankle secondary to ischemia are determined by many factors, including: (1) which leg compartment, if any, has been affected and to what degree extrinsic flexor or extensor overpull is exhibited, (2) degree of nerve injury sustained causing weakness or paralysis of extrinsic or intrinsic foot and ankle muscles, (3) which foot compartment, if any, has been affected and to what degree intrinsic overpull is exhibited, and (4) degree of sensory nerve injury leading to anesthesia, hypoesthesia, or hyperesthesia of the foot. Therefore, a variety of clinical presentations can be encountered following compartment syndrome of the leg and foot. Treatment is based on an appreciation of the patho-anatomy of the deformity. Nonoperative therapy is aimed at obtaining or preserving joint mobility, increasing strength, and providing corrective bracing and accom-modative footwear. Operative management is usually reserved for treatment of residual nerve compression or severe and problematic deformities. Established surgical protocols are performed in a stepwise fashion, to include: (1) release of residual or secondary nerve compression, (2) release of fixed contractures, using infarct excision, myotendinous lengthening, muscle recession, or tenotomy, (3) tendon transfers or arthrodesis to increase function, and (4) ostectomy or amputation for severe, refractory deformities.<\/jats:p>","DOI":"10.1177\/107110079501600610","type":"journal-article","created":{"date-parts":[[2013,3,3]],"date-time":"2013-03-03T03:31:12Z","timestamp":1362281472000},"page":"368-377","source":"Crossref","is-referenced-by-count":46,"title":["Volkmann's Ischemic Contracture of the Foot and Ankle: Evaluation and Treatment of Established Deformity"],"prefix":"10.1177","volume":"16","author":[{"given":"Mark D.","family":"Santi","sequence":"first","affiliation":[{"name":"Foot and Ankle Surgery Fellow, Department of Orthopaedic Surgery, University of California, San Diego Medical Center, and Veteran's Affairs Medical Center, San Diego, California."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Botte","sequence":"additional","affiliation":[{"name":"Associate Professor of Orthopaedic Surgery and Chief, Foot and Ankle Surgery Service, Department of Orthopaedic Surgery, University of California, San Diego Medical Center, and Chief, Rehabilitation Medicine Service, Veteran's Affairs Medical Center, San Diego, California."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[1995,6]]},"reference":[{"key":"e_1_3_1_2_1","doi-asserted-by":"publisher","DOI":"10.3109\/03008207709152607"},{"key":"e_1_3_1_3_1","doi-asserted-by":"publisher","DOI":"10.3233\/BIR-1980-171-212"},{"key":"e_1_3_1_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-197306000-00039"},{"key":"e_1_3_1_5_1","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1097\/00003086-198706000-00006","article-title":"Effects of immobilization on joints.","volume":"219","author":"Akeson W.J.","year":"1987","unstructured":"4. 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