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Effectiveness of foot fasciotomies in foot and ankle trauma
  1. Katherine M Bedigrew1,
  2. D J Stinner1,3,
  3. J F Kragh Jr3,
  4. B K Potter2,
  5. S B Shawen2 and
  6. J R Hsu1,3
  1. 1Department of Orthopaedics, San Antonio Military Medical Center, Ft. Sam Houston, Texas, USA
  2. 2Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
  3. 3Extremity Trauma and Regenerative Medicine, United States Army Institute of Surgical Research, Ft. Sam Houston, Texas, USA
  1. Correspondence to Dr Daniel J Stinner, Extremity Trauma and Regenerative Medicine, United States Army Institute of Surgical Research, 3698 Chambers Road, San Antonio, TX 78234, USA; Daniel.stinner{at}gmail.com

Abstract

Background Foot compartment syndrome (FCS) has been reported to cause neuropathic pain, claw or hammer toes, and motor and sensory disturbances. The optimal treatment of FCS is controversial. The purpose of this study was to determine if foot fasciotomies improve patient outcomes in high-energy, combat-related lower extremity trauma.

Methods Medical records of patients with documented FCS from May 2007 to January 2009 were retrospectively reviewed. Consecutive, matched control patients were identified based on similar hindfoot, mid-foot and/or forefoot injuries who did not undergo foot fasciotomy during the same period. The primary outcomes analysed were the development of claw or hammer toes and neuropathic pain.

Results 19 patients with foot fasctiotomies were identified and matched with 19 controls. Median follow-up was 19.5 months (range, 3.5–47.5 months) for the combined cohorts. The most common mechanism of injury was an explosive blast. Nine fasciotomy and nine control patients sustained open foot fractures. Significantly more patients with foot fasciotomies developed claw toes (50% vs 17%, p=0.03). There were no significant differences in the development of neuropathic pain, sensory deficits, motor deficits, chronic pain, stiffness or infection. The fasciotomy patients underwent an average of 5.5 surgeries per patient versus 4 surgeries per patient in the control group.

Conclusions Fasciotomy of the foot did not prevent neuropathic pain and deformities in patients with FCS in this study.

  • foot compartment syndrome
  • foot fasciotomy
  • claw toes

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Footnotes

  • Contributors KMB and DJS contributed equally to this paper in data collection, analysis and manuscript preparation. JFK, BKP and SBS assisted with data analysis and manuscript review. JRH participated in study design, data analysis and manuscript review.

  • Competing interests None declared.

  • Ethics approval US Army Medical Research and Material Command IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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