[Fractures of the forefoot]

Quality of life after fracture-related infection of the foot

BACKGROUND

Fracture related infection (FRI) of the foot is a serious hazard. Despite successful therapy, the physiological and psychological involvement seems to be high. Therefore, we aim to analyze the impact of an FRI of the foot on the quality of life after successful surgical therapy and infect eradication.

METHODS

In total, 25 patients from two German hospitals treated for FRI of the foot between March 2011 to January 2020 were retrospectively included. Quality of life was assessed by the German Short Form 36 (SF-36) and the EuroQol five-dimension three-level questionnaire (EQ-5D) as well as the ICD-10 based psychological symptom rating (ISR), and compared to a norm obtained from the general population of Germany.

RESULTS

3.0 years (range 0.7-7.9 years) following final surgery after fracture-related infection of the foot, the mean physical health component score (PCS) of the SF-36 was 35.6 ± 12.3, and the mean mental health component score (MCS) of the SF-36 reached a value of 41.3 ± 12.9. Both values were significantly lower than in the general population of Germany (p< .019). The mean scores of the ISR of the cohort crossed the threshold of mild symptom burden in total, as well as for the subscales depression and somatization. The mean EQ-5D VAS rating (62.1 ± 18.6) and the EQ-5D index value (0.66 ± 0.27) were significantly lower in comparison to a score of 72.9 ± 1.0 and 0.88 obtained from an age-matched reference population (p < .01).

CONCLUSION

FRI of the foot represents a major burden for the patient. Physical and mental well-being of affected patients is restricted albeit successful treatment in terms of infect eradication and bone union has been achieved after a mean follow-up of 3.0 years. A patient-centered treatment approach focusing on improvement of quality of life during and after treatment is therefore warranted.

[Metatarsal and toe fractures]

Metatarsal and toe fractures are the most frequent injuries of the foot skeleton. Nondislocated fractures can be conservatively treated with good success. Long-term relief and immobilization including the ankle joint are unnecessary. Metatarsal fractures close to the base are nearly always associated with Lisfranc luxation and treatment must also take the instability of the tarsometatarsal joints into consideratíon. Basal fractures of the 5th metatarsal bone require a differentiated consideration. The correct classification is necessary in order to initiate an adequate treatment. In general, intra-articular layer formation, inclination >10° and shortening between 3 mm and 5 mm, taking the position of the head of the metatarsal bone into consideration, are recommended as indications for surgery. Operative treatment of toe fractures is only rarely necessary.

[Vacuum shoe system vs.forefoot offloading shoe for the management of metatarsal fractures. A prospective, randomized trial]

BACKGROUND

Metatarsal fractures are managed using different types of forefoot offloading orthosis. Theaim of this prospective study was to evaluate the clinical and pedographic results of a vacuum shoe system in comparison to a forefoot unloading shoe.

METHOD

20 patients (14 women/6 men--age: 36.4 +/- 14.1 years) were prospectively included in the study. The patients were followed up at four different time points. Detailed clinical and radiological examinations were carried out, functional scores were measured and a pedographic assessment was performed.

RESULTS

Between the study groups no differences were seen in functional scoring. A complete bony healing was achieved within the 3 months of followup in all patients. The heelstrike to heelstrike time was without significant differences in the pedographic analysis. Adequate forefoot unloading was achieved with both orthosis. The load sharing between fore-, mid- and hindfoot showed no significant differences in the pedographic analysis. Patients' satisfaction was rated with higher values for the vacuum shoe system, but without significance.

CONCLUSION

Both shoe systems show an adequate unloading of the forefoot. Therefore both orthosis may be used for the treatment of metatarsal fractures.