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At least 19 recordsLinked to original sources
PubMed1986

Reconstruction of foot injuries.

Foot injuries constitute a spectrum of problems that can be classified by severity. The development of successful techniques for the treatment of lower leg injuries has made the severity of a concomitant foot injury a key factor in determining the overall salvageability of the leg. A more complete classification of foot injuries is therefore needed and has been proposed. Preoperative assessment of foot injuries differs in the acute versus the delayed presentation. The acute case requires evaluation of wound conditions, exposed structures, and associated proximal injuries. The chronic injury requires gait analysis, study of weight-bearing patterns by Harris mat prints, skeletal evaluation, mapping of plantar sensation, and, in some cases, angiography. Thorough knowledge of foot anatomy is essential for developing a rational plan for treatment. The significance and course of the medial calcaneal nerve and the anatomy of the plantar nerves have not been fully appreciated in most reports on the treatment of foot injuries. The recognition of the proximal plantar subcutaneous plexus blood supply has modified the understanding of plantar flap design. It has simplified and improved the safety of dissection of sensate plantar flaps. A plethora of both local and distant flap options exist for the treatment of foot injuries. The foot is divided into four major areas based on different requirements for reconstruction and the types of flaps available. These areas are the proximal plantar area; the malleoli, Achilles tendon, and posterior (non-weight-bearing) heel area; the distal plantar area; and the dorsum. The options for coverage have been discussed in detail, and a summary of the reconstructive strategy by area has been presented in Table 3. Complex (type III) injuries are special injuries owing to their severity and multiple components. They require a careful initial evaluation for both feasibility and advisability of extremity salvage. Treatment of these injuries consists of bony stabilization and soft-tissue debridement followed by flap coverage.

Debridement↗
PubMedDate not supplied

[Ambulation training with bilateral limited weight bearing after foot injuries].

AIM: Bilateral foot injuries are not uncommon. Operative treatment usually requires partial weight bearing over several weeks. This is a challenge for physiotherapy especially for ambulation training. We describe a new rehabilitation aid allowing for bilateral limited weight bearing during ambulation. METHODS: Ambulation training was initiated in the early postoperative period using the Regensburg ambulation aid. A lift system allows for exact limitation of weight bearing on both sides controlled by balances integrated into the floor. Using a rail system a 15 m free walking distance is available. This study included 10 patients with bilateral foot fractures. The functional outcome was assessed using the AOFAS score and quality of life with the SF-36 score. Plain X-rays were used to evaluate loss of correction. The control group consisted of 20 patients where ambulation training was discontinued for at least 6 weeks postoperatively. RESULTS: The system is very safe, during the entire period no complication was recorded. Acceptance among the patients was extremely high. Worries about unwanted weight bearing could be reduced. Patients mobilized with early ambulation training showed a better compensation of gait if compared to the control group. Secondary problems in the knee, hip or spine, as well as muscular deficiencies had a significantly lower incidence. No loss of correction could be seen in either of the two groups. CONCLUSION: The presented ambulation aid is a significant contribution to the physiotherapy of bilateral foot injuries.

Equipment Design↗
PubMed2002

Functional outcome of multiply injured patients with associated foot injury.

Fourteen polytrauma patients with foot injuries were compared to 14 polytrauma patients without foot injury in this review. The patients were selected from our institution's trauma registry. Criteria for selection included a minimum Injury Severity Score of 12 and a minimum follow-up of 12 months. The AAOS lower limb and foot and ankle outcomes data collection questionnaires were used to evaluate a patient's perception of the results. Marked differences were noted in the patients' physical function (80.7 vs. 38.9), role physical (87.5 vs. 41.1), bodily pain (81.9 vs. 50.6), social function (96.6 vs. 67.9), physical health and pain (83.3 vs. 43.5), satisfaction with symptoms (4.0 vs. 1.5), global foot and ankle (100 vs. 57.6), and shoe comfort scores (100 vs. 18.9) in foot injured vs. control patients, respectively. Although it is intuitively obvious that a patient with a foot injury vs. one without a foot injury who has suffered polytrauma may have a worse outcome, the profound differences in the above scores draw attention to the importance of the proper management of patients with musculoskeletal injuries who survive polytrauma injuries.

Adult↗
PubMed2002

[Quality of life after foot injuries].

OBJECTIVE: Assessment of quality of life after foot injuries. METHODS: All patients with foot injuries treated operatively from July 1995 to December 1999 were asked to complete the SF-36 health survey. Values of four subgroups (male with foot injuries without any other injury, multiple injured male with foot injuries, male without any other injury and both calcaneus fractures or other injuries) were compared with the standardized German population (Mann-Whitney-U-Test, alpha = 0.05). RESULTS: 110 of 201 patients completed the questionnaire (follow-up 54.7 %). Values of most of the subscales showed significant differences in comparison with the standardized population for three of four groups. Men with calcaneus fractures revealed the highest disabilities especially for the pain subscale. Quality of life in multiple injured patients is dominantly influenced by foot injuries. CONCLUSIONS: Foot injuries cause a strong limitation of quality of life. The SF-36 health survey provides a very suitable outcome measurement for foot injuries.

Adolescent↗
PubMed2000

Emergency department evaluation and treatment of ankle and foot injuries.

Ankle and foot injuries are among the most common sports injuries and extremity complaints presenting to the emergency department. Although generally benign, some of these injuries have prolonged morbidity. This article reviews the anatomy of the foot and ankle and examines the approach and therapy for common types of injuries.

Ankle Injuries↗
PubMed2001

Outcome of foot injuries in multiply injured patients.

In the past, foot injuries in patients with multiple trauma were thought to be of lesser importance than fractures of long bones. In one prospective study from the authors' institutions, however, multiple-trauma patients with foot injuries were shown to have a poorer functional outcome compared with matched controls. To address these concerns, this article has two parts. The first part is an overview of general principles in the treatment of foot injuries in polytrauma patients. The treatment of specific injuries is beyond the scope of this article, but an approach is highlighted that can be remembered when decisions are made regarding these severely injured patients. The second part reviews the findings from the authors' study, focusing on functional outcomes of multiple-trauma patients with foot injuries.

Calcaneus↗
PubMed1999

Do foot injuries significantly affect the functional outcome of multiply injured patients?

OBJECTIVE: To assess the functional outcome of multiply injured trauma patients with foot injuries and to determine which outcome measures are most appropriate for this assessment. DESIGN: Prospective, matched pair analysis. SETTING: University-affiliated Level I trauma center with a prospectively entered trauma database. PATIENTS: Twenty-eight multiply injured patients with foot injuries were randomly identified in our prospective trauma database (Group 1). The patients in Group 1 were randomly matched in a blinded fashion to twenty-eight multiply injured patients without foot injuries who were selected from the entire group of patients in our trauma database (Group 2). The patients were matched by age, sex, length of follow-up, and Injury Severity Score. MAIN OUTCOME MEASURES: Three outcome tools were used: the Short Form 36 (SF-36), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the modified Boston Children's Hospital Grading System. RESULTS: The outcome of multiply injured patients with foot injuries was significantly worse than that of patients without foot injuries when using any of the three outcome measures (SF-36, p = 0.008; WOMAC, p = 0.00007; modified Boston Children's score, p = 0.001). The outcome of patients with foot injuries was worse than that of those without foot injuries in five of the eight components of the SF-36 score (physical functioning, p = 0.0004; role physical, p = 0.01; bodily pain, p = 0.01; social functioning, p = 0.01; role emotional, p = 0.006). The outcome of patients with foot injuries was worse than that of patients without foot injuries in all three components of the WOMAC (pain score, p = 0.0004; stiffness score, p = 0.007; physical function score, p = 0.00006). For the patients with foot injuries, there was strong correlation across all three scales (SF-36 vs. WOMAC, r = 0.84; SF-36 vs. modified Boston Children's Hospital, r = 0.88; WOMAC vs. modified Boston Children's Hospital, r = 0.78). CONCLUSIONS: The SF-36, WOMAC, and modified Boston Children's Hospital Grading System are all useful in assessing the outcome of multiply injured patients with foot injuries. The outcome of these patients is poor when using any of these measures. Foot injuries cause significant disability to multiply injured patients. More attention should be given to these injuries, and more aggressive management should be considered to improve the outcome of this group of multiply injured patients.

Adolescent↗
PubMed2004

Prevalence and patterns of foot injuries following motorcycle trauma.

OBJECTIVES: To determine the prevalence and patterns of foot injuries following motorcycle trauma. DESIGN: Prospective. SETTING: Yorkshire Region Trauma Units (Level 1 trauma centers with trauma research). PATIENTS: Individuals injured in motorcycle road traffic accidents between January 1993 and December 1999. OUTCOME MEASUREMENTS: Patient demographics, protective devices (helmet) use, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), clinical details, therapeutic interventions, resuscitation requirements, duration of hospital stay, mortality, and type of foot injuries sustained. RESULTS: The parent population of 1239 contained 53 (4.3%) foot-injured motorcyclists (49 men) with a mean age of 31.7 years (range 18-79 years). Fifty-two were drivers and one was a rear-seat passenger. Mean ISS was 6.9 (range 4-33), significantly lower than the parent population mean of 34.98 (range 9-75) (P = 0.001). Mean GCS was 14.7 (range 13-15). The motorcyclists' injuries included 26 metatarsal fractures (49.1%), 14 talar fractures (26.4%), 7 os calcis fractures (13.2%), and 6 toe fractures (11.3%). Associated foot injuries included three partial foot amputations, four Lisfranc dislocations, three cases of foot compartment syndrome (two crush injuries with no fracture, one open fourth metatarsal fracture with associated Lisfranc dislocation). Forty-six motorcyclists had more than one foot injury. Associated injuries included 22 ankle fractures (41.5%), 15 tibial fractures (28.3%), 6 femoral fractures (11.3%), 5 pelvic ring fractures (9.4%), 23 upper limb injuries (43.4%), and 3 cases of chest trauma (5.7%). No one sustained abdominal trauma or head injury compared with the parent population. All patients required operative stabilization of foot fractures, including their associated injuries. Mean hospital stay was 10.9 days (range 1-35 days). In the parent population, there were 71 deaths (6.0%), whereas there was only 1 death (1.9%) in the foot-injured group (with fractures including open book pelvic, T6-8, unilateral open femur, tibial, ankle, and metatarsal) with an ISS 33, who died of multiorgan dysfunction syndrome. At final follow-up, all patients underwent radiologic and clinical assessment of foot injuries. Forty-three patients returned to their previous occupation and level of mobility. Ten of the more significantly injured patients had to modify their occupation from manual to sedentary-type jobs due to their foot injuries. We noted a pattern of complex ipsilateral foot and limb injury in nine patients, which we postulate was due to the actual mechanism of contact with the road surface. CONCLUSION: Motorcycle accidents continue to be a source of severe injury, especially to the foot. The most common foot injury is a metatarsal fracture; however, there must be a high index of suspicion for associated injuries. Although these injuries are associated with a low mortality rate, they require prompt assessment and treatment to limit long-term morbidity and disability. The difference in foot injury pattern and mortality between the parent population and our series, among other factors, potentially may be influenced by the actual mechanism of contact with the road surface and the modifying action of the foot during the accident.

Accidents, Traffic↗
PubMed1995

Lower leg and foot injuries in tennis and other racquet sports.

Injuries to the lower extremity are common in racquet sports. These can be either acute or chronic. Although acute injuries usually respond to treatment, chronic injuries are often less amenable to treatment. The occurrence of both kinds of injuries, however, can often be prevented by proper training techniques including stretching and strengthening exercises. These exercises are also important components of a proper rehabilitation program.

Achilles Tendon↗
PubMed2005

[Foot injuries in the polytraumatized patient].

Foot injuries in polytraumatized patients are not critical for survival but for the later quality of life. Closed fractures or dislocations of the foot are frequently overlooked or misinterpreted in association with polytrauma, which leads to severe functional impairment in those patients who survive. Repeated clinical examinations and early radiographic examinations are essential in the unconscious patient after resuscitation. Emergent indications for surgery even in the presence of multiple injuries are open injuries, incarcerated soft tissues, manifest compartment syndrome of the foot, and neurovascular injury. The decision on limb salvage or amputation has to be individualized with respect to the patient's overall condition and the severity of local trauma to the foot. The "life before limb" principle has to be respected. Emergent reduction of fracture dislocations of the talus, calcaneus, Chopart's and Lisfranc's joints via direct approaches and temporary transfixation with K-wires should be attempted in a first step whenever possible. Additional external fixation facilitates wound care and prevents soft tissue contractions until definite internal fixation becomes feasible. Early soft tissue coverage is always sought in order to avoid infection.

Amputation, Surgical↗
PubMedDate not supplied

The importance of proper shoe gear and safety stirrups in the prevention of equestrian foot injuries.

The aim of this study was to compile specific foot injuries occurring in pediatric patients that result from equestrian sports and to highlight the importance of wearing adequate riding boots to protect the feet. During a 12-year period, 258 children were admitted to Children's Hospital of Geneva for injuries resulting from horseback riding. Amongst these children, 8 sustained foot lesions that required hospital admission. Four children had compression-type fractures of the cuboid (nutcracker fracture of the cuboid) associated with other complex midfoot fractures, 2 had Lisfranc fracture dislocations, 1 had a fracture of the talus with associated intern malleolar fracture, and the last had a fracture of the 5 metatarsals with lateral displacement. All the noted lesions complied with the same traumatic mechanisms. The horse fell on the patient, and the child's foot, entrapped in the stirrup, was caught in between the animal and the ground. The forefoot was bent by indirect violence in abduction by the stirrup, which acted as a fulcrum. Serious foot injuries may occur in children during equestrian activities. These lesions may be very disabling. Therefore, it is important for doctors, instructors, and parents to promote the use of appropriate safety equipment, including strengthened riding boots and safety stirrups.

Adolescent↗
PubMed2000

Foot injuries and arthroscopy in sport.

Arthroscopy of the foot and ankle is a valuable tool for treating athletic foot injuries. The ability to evaluate and treat injuries without an extensive open approach is very important when dealing with the athletic population, allowing a much quicker rehabilitation and return to sport. The diagnostic and therapeutic indications for foot and ankle arthroscopy have increased significantly over recent years. Techniques and instrumentation have become more advanced and more readily available to the orthopaedist. This article defines the conditions in which arthroscopy is appropriate and presents current techniques for treatment.

Ankle Injuries↗