Early and Late Posttraumatic Foot Reconstruction

When complex trauma occurs in the foot, there is (1) loss of structural continuity that renders the bony architecture mechanically useless and (2) changes in the soft tissue that subject the foot to potential contractures and atrophy. The priorities of salvage of such injuries are early and accurate diagnosis, early reduction and stabilization, careful handling of soft tissues, tissue transfer to fill defects, and early motion. By these means it is possible to diminish the effects of edema, atrophy, stiffness, and osteoporosis. When initial treatment fails, salvage procedures must consider the length of disability, the expected functional outcome after salvage, and the lifestyle of the individual. Late salvage is by selective arthrodesis and realignment of mechanical relationships, followed by aggressive functional rehabilitation.