Objective To study the effect of combination of Pai acupuncture and Taohong Siwu decoction on the treatment of early acute compartment syndrome (ACS) in the foot and ankle region to provide reference for clinical practice. Methods The clinical data of 186 patients with early ACS in the foot and ankle region admitted to Yangxin County Traditional Chinese Medicine Hospital from July 2021 to May 2023 were retrospective analysis. According to different treatment methods, they were divided into the observation group (96 cases, treated with Pai acupuncture combined with Taohong Siwu decoction) and the control group (90 cases, treated with sodium aescinate). The efficacy, inflammatory cytokines [C-reactive protein (CRP), interleukin-6(IL-6) and tumor necrosis factor-α (TNF-α)] and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-posterior foot score between two groups of patients were compared. Results The overall efficacy of the observation group was better than that of the control group ( P <0.05). After 3 days of treatment, the levels of CRP, IL-6 and TNF-α in the two groups of patients were lower than those before treatment, and the levels of the inflammatory factors of the observation group were lower than those of the control group ( P <0.05). The AOFAS ankle-posterior foot scores of the two groups of patients after 3 days of treatment and 3 months after treatment were higher than those before treatment, and the score of the observation group were higher those of than the control group ( P <0.05). Conclusion Pai acupuncture combined with Taohong Siwu decoction has significant therapeutic effect on early ACS patients in the foot and ankle region, which can reduce the level of inflammatory factors and promote the recovery of foot and ankle function.