Research Paper Title

Effectiveness of foot fasciotomies in foot and ankle trauma.

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.

Reference

Bedigrew, K.M., Stinner, D.J., Kragh, J.F., Potter, B.K., Shawen, S.B. & Hsu, J.R. (2017) Effectiveness of foot fasciotomies in foot and ankle trauma. Journal of the Royal Army Medical Corps. pii: jramc-2016-000734. doi: 10.1136/jramc-2016-000734. [Epub ahead of print]