Burns to the Feet

CONTENTS I. Introduction ................................................................................................................... 288 II. Development of Modern Burn Care and the Burn Team Concept................................. 288 III. Initial Evaluation............................................................................................................ 289

A. Inhalation Injury and Associated Injuries............................................................... 289

B. Pathophysiology of the Burn Injury........................................................................ 289

C. Evaluation of the Burn Wound............................................................................... 289

1. Assessing the Extent and Depth of the Burn Wound ....................................... 289 IV. Treatment ....................................................................................................................... 291

A. Resuscitation........................................................................................................... 291

B. Escharotomy ........................................................................................................... 292

C. Initial Wound Care ................................................................................................. 292

D. Definitive Wound Coverage.................................................................................... 294

E. Hyperbaric Oxygen ................................................................................................. 296 V. Reconstruction and Rehabilitation, Hypertrophic Scars, and Contractures .................. 297

A. Classification of Contractures ................................................................................. 299

B. Treatment................................................................................................................ 300

1. External Fixators.............................................................................................. 300

2. Limb Suspension .............................................................................................. 301

3. Garments .......................................................................................................... 301

4. Orthotics........................................................................................................... 302 VI. Special Orthopedic Issues ............................................................................................... 302

A. Bone and Achilles Tendon Exposure ...................................................................... 302

B. Fractures ................................................................................................................. 302

C. Involved Joints........................................................................................................ 303 VII. Complications................................................................................................................. 303

A. Dystrophic Calcification ......................................................................................... 303

B. Osteoporosis............................................................................................................ 303

C. Pigmentation........................................................................................................... 303

D. Marjolin’s Ulcers .................................................................................................... 303 VIII. Special Types of Burns ................................................................................................... 305

A. Electrical Burns....................................................................................................... 305

B. Chemical Burns....................................................................................................... 306 IX. Prevention....................................................................................................................... 307 X. Summary ........................................................................................................................ 307

References .................................................................................................................................. 308

I. INTRODUCTION

Burns to the feet are different from burns of other areas of the body. Because of dependency and the frequent occurrence of either peripheral vascular disease or diabetic neuropathy, even small foot burns may be limb or life threatening. Burns of the feet cannot be discussed outside the context of the management of the burn patient in general. Although frequently of minor proportion to the overall extent of the burn injury, foot burns are a significant concern. The major objective in the management of patients with burned feet is to return them to normal function with unimpeded ambulation and weight-bearing on pain-free feet. The American Burn Association has defined foot burns as one of the ‘‘special’’ areas of burns that need to be referred to a regional burn center [1]. Frequently first responders, primary care and emergency department physicians do not appreciate the potential magnitude and lethality of these relatively ‘‘minor’’ injuries. This chapter addresses the initial evaluation of the burn patient in general and burns of the feet specifically. The pathophysiology of the burn injury, initial wound management, definitive wound coverage, reconstruction and rehabilitation, the long-term management of complications such as scarring and contracture, and special types of burns, including electrical and chemical burns are also discussed.