Management of major forefoot trauma

Clinicians treating foot trauma should be familiar with the basic principles of wound management, such as debridement, fasciectomy, primary versus delayed wound closure, and the prevention and treatment of gas gangrene (1,2,4-6). Treatment modalities vary, depending on training and personal experience. In severe cases of foot trauma, such as crush injuries and open fractures involving skin, underlying soft tissue, and bone, the authors advocate staging of treatment with frequent assessment of the wounds. Furthermore, we recommend judicious preservation of bone and soft tissue in the initial management of such cases. Four cases have been presented to illustrate these principles.