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.
Department of Orthopaedics, San Antonio Military Medical Center, Ft. Sam Houston, Texas, USA.
Katherine M
KM
Bedigrew
Department of Orthopaedics, San Antonio Military Medical Center, Ft. Sam Houston, Texas, USA.|Extremity Trauma and Regenerative Medicine, United States Army Institute of Surgical Research, Ft. Sam Houston, Texas, USA.
D J
DJ
Stinner
Extremity Trauma and Regenerative Medicine, United States Army Institute of Surgical Research, Ft. Sam Houston, Texas, USA.
J F
JF
Kragh
Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
B K
BK
Potter
Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
S B
SB
Shawen
Department of Orthopaedics, San Antonio Military Medical Center, Ft. Sam Houston, Texas, USA.|Extremity Trauma and Regenerative Medicine, United States Army Institute of Surgical Research, Ft. Sam Houston, Texas, USA.
J R
JR
Hsu
D000328:Adult; D016512:Ankle Injuries / Q000453:epidemiology / Q000601:surgery; D016022:Case-Control Studies; D000071938:Fasciotomy / Q000009:adverse effects / Q000706:statistics & numerical data; D018409:Foot Injuries / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D008889:Military Personnel; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
claw toes; foot compartment syndrome; foot fasciotomy