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Don't Forget About the Foot​

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Foot injuries in polytrauma patients are often overlooked because life-threatening injuries take priority. A recent retrospective registry analysis conducted at Tampere University Hospital from 2016 to 2023 assessed the frequency and timing of foot injuries in polytrauma patients and identified factors that lead to delays in diagnosis. The methods involved included:

 

• Selecting polytrauma patients with NISS of 16 or higher

• Screening for specific types of foot fractures, such as Lisfranc injuries and Chopart injuries

 

Key findings from the study revealed:

 

• Foot injuries were present in 4.1% of patients (54/1327).

• 215 foot injuries, mostly fractures, were recorded.

• Diagnoses were delayed (more than 24 hours after submission) in 43% of patients and 37% of the injuries.

• The most delayed diagnoses were midfoot and metatarsal fractures.

 

Risk factors for delay

 

Several risk factors for delayed diagnosis include:

 

• More foot injuries

• Lower GCS score

• Concomitant facial injuries

 

Bottom line

 

Delayed diagnosis of foot injuries is common. The foot and ankle team can help by emphasizing extremity screening in trauma protocols after rendering acute life-saving care. 

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Ankle Osteoarthritis and Joint Replacement: Does Injury Cause Matter?

by Vince Vacketta, DPM

 

Does injury type influence how well total ankle replacement restores function? Researchers conducted a biomechanical gait analysis comparing patients with post-fracture arthritis to those with post-sprain arthritis, measuring ankle motion, walking forces, and step patterns.

 

What the study found

 

Both groups experienced pain relief and improved PROMS. However, biomechanical outcomes differed:



• Post-fracture arthritis patients showed limited ankle range of motion (ROM) and reduced push-off power during walking. Their gait patterns remained abnormal.

• Post-sprain arthritis patients had better ROM restoration and more normal walking mechanics.

 

Clinical significance

 

Osteoarthritis etiology matters. Pain relief from surgery does not guarantee normal walking mechanics. The underlying cause of arthritis influences how completely joint replacement restores function. 

 

Practical implication

 

Surgeons should counsel post-fracture ankle arthritis patients to expect pain improvement but not gait normalization. Symptom relief does not equal full biomechanical recovery.

 

 

Subtler Arthritis After Pilon

 

Pilon fractures frequently lead to ankle arthritis. However, the risk and severity of posttraumatic subtalar arthritis is not well documented. This is relevant considering the evolving trend of acute of tibiotalocalcaneal (TTC) arthrodesis as a treatment option.

 

Study design

 

To better understand subtalar arthritis after pilon fractures, researchers conducted a retrospective review of 473 patients with pilon fractures treated by open reduction internal fixation. Patients were grouped based on time since injury to final imaging (1-12, 12–24, 25–48, 48+ months) and subtalar arthritis was graded using Kellgren-Lawrence (K-L), NSS (None, Some, Severe), and CT Ankle Osteoarthritis (CTAO) systems. 

 

Key findings

 

The study found that:

 

• Subtalar arthritis worsened over time after injury.

• More severe arthritis was associated with older age, smoking, steroid use, higher comorbidity burden (CCI), and more severe fracture patterns (AO/OTA).

• Patients imaged 25+ months post-injury had significantly worse arthritis than those examined earlier.

• CTAO scores correlated with patient age at injury and imaging.

 

Takeaway

 

Subtalar arthritis after pilon fracture progresses over time and is largely driven by patient characteristics and injury factors. These findings suggest acute TTC nailing may have a role for a defined subset of tibial pilon fractures.