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Updated: Mar 7, 2026

Evaluating the Function of the Foot Core System in the Elderly
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Complex trauma of the foot.

H Zwipp1, C Dahlen1, T Randt1

  • 1Klinik und Poliklinik für Unfall- und Wiederherstellungschirurgie, Technische Universität Dresden, Germany.

Der Orthopade
|March 2, 2017
PubMed
Summary

Complex foot trauma in multiply-injured patients requires careful management. Early diagnosis and radical debridement are crucial for limb salvage, with amputation considered for severe crush injuries.

Keywords:
Key words Complex trauma • Foot injury • Talus fractures • Calcaneus fractures • Chopart- and Lisfranc dislocation-fractures

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Area of Science:

  • Orthopedic Surgery
  • Trauma Surgery
  • Foot and Ankle Reconstruction

Background:

  • Complex foot injuries occur in up to 52% of multiply-injured patients.
  • The primary goal is restoring a painless, stable, plantigrade foot to prevent long-term disability.

Purpose of the Study:

  • To outline management strategies for complex foot trauma in multiply-injured patients.
  • To define indications for primary amputation versus limb salvage.
  • To detail surgical interventions for various foot injury types.

Main Methods:

  • Radical debridement and assessment during a 'second look' within 24-48 hours for limb salvage.
  • Early free tissue transfer when necessary.
  • Immediate dorsal fasciotomy for compartment syndrome.
  • Temporary stabilization with K-wires, external fixators, or tibiotarsal transfixation.
  • Open reduction and internal fixation (ORIF) using screws or K-wires.
  • Radiographic diagnosis in three standard projections.

Main Results:

  • Primary amputation is indicated for severe crush injuries (PTS 3-4).
  • Limb salvage (PTS 1-2) depends on intraoperative findings and radical debridement.
  • Specific techniques are detailed for talus, calcaneus, Chopart's, and Lisfranc's joint injuries.
  • Delayed primary closure may be necessary to avoid soft tissue damage.

Conclusions:

  • Exact diagnosis of foot trauma is essential despite life-threatening injuries.
  • Timely surgical intervention, including fasciotomy and appropriate fixation, is critical.
  • Adherence to these principles minimizes long-term disability from foot trauma.