Outcome after complex trauma of the foot

In 1997, H. Zwipp. proposed a 5-point scoring system for the classification of complex trauma of the foot. However, outcome and quality of life after this type of injury have not been studied systematically.

Seventy-four patients with a complex injury of the foot were treated between 2001 and 2007. Fifty patients met the inclusion criteria for a prospective cross-sectional study. American Foot and Ankle Society score, the Short Form 12, and the Visual Analogue Scale-Foot and Ankle Score were recorded. All patients were examined by an experienced orthopedic surgeon and a certified pedorthist. Functional assessment was completed by dynamic baropedography.

Primary amputation was necessary in 11, secondary amputation in 7 patients. A compartment syndrome was diagnosed in 29 patients. Soft tissue coverage was achieved in eight patients using a free vascular flap. The complication rate was 32%. Mean follow-up was 4 years (1-7 years). At that time, the American Foot and Ankle Society score was 66.2, the Short Form 12 score 38.2 (physical health component scale), and the Visual Analogue Scale-Foot and Ankle score was 51.9. Orthopedic shoes were necessary in 44% of the patients; however, compliance was low, and 52% of the orthopedic devices were insufficient. Pedographic evaluation demonstrated changes in gait in 82% of the patients.

Early outcome after complex trauma of the foot was essentially determined by soft tissue injury, whereas long-term outcome was determined more by the trauma of the bones and joints. Objective measurements such as dynamic pedography helped to better understand patients' limitations. Orthotic supply could be improved in a reasonable number of the patients.