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3Soft-tissue considerations

Soft-tissue injury

All severe midfoot trauma has a spectrum of soft-tissue injury. Rest, elevation and, in some cases, intermittent compression devices will help in resolving the soft-tissue swelling. Non-weightbearing is essential until the final treatment plan has been executed.
The amount of swelling is a good indicator of the degree of soft-tissue injury. As the swelling recedes, the skin begins to wrinkle both on the lateral and medial side. The wrinkling of the skin is a good indicator of when surgery can be undertaken. Usually, one has to delay surgery for up to 14 days or more to decrease the incidence of postoperative wound complications.
Stability of the skeleton allows for quicker recovery of the soft tissues. Therefore immediate insertion of external fixators on the medial and lateral side allows for provisional reduction of both the medial and lateral rays and provides stability for the skeletal component of the injury and prevents further bony and soft-tissue injury. Stability usually decreases pain but if after provisional reduction the degree of pain escalates, one must think of a compartment syndrome. In addition to stabilization, elevation, compression and icing help to decrease the swelling.
Severe soft-tissue and/or vascular injury may necessitate immediate amputation at the appropriate level.