Crush Injury in the Foot

Foot crush injury and compartment syndrome are diagnosed and treated by the Podiatry Division of Premier Medical Group.

What is a foot crush injury?

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A foot crush injury is a severe type of broken foot condition. In this injury, the foot is compressed between two hard surfaces, resulting in a “crushing” of bones, soft tissue, and nerves. This often occurs in transportation or occupational accidents, such as if a heavy object falls on the foot, if the foot is run over by heavy machinery, or if the individual is in a car accident.

Foot crush injuries are often more extensive than typical foot breaks. These injuries are typically very severe, including several broken bones and soft tissue damage. As a result, treating a foot crush injury can be exceptionally difficult, often involving podiatrists, orthopedic surgeons, and physical therapists. While minor crush injuries, such as those that do not involve bone fractures, can heal on their own, be sure to make an appointment with your doctor immediately after the injury. This condition responds well to quick treatment, so seeing a medical professional soon after the accident can make a big difference in the injury’s lasting effects.

What is crush injury compartment syndrome?

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Crush injury compartment syndrome is a condition that results from bleeding or swelling after an injury. The acute syndrome occurs when pressure builds up inside an enclosed muscle space within the body, like the compartments of the foot. This high pressure is dangerous, and it can impede blood flow to and from affected tissues. In many cases, crush injury compartment syndrome will require emergency surgery to prevent permanent injury, which can include severe tissue damage, loss of body function, or even death.

While acute compartment syndrome most commonly occurs during bone breaks and foot crush injuries, there are several types of compartment syndrome. The chronic form of this condition develops over days or weeks, and it may be caused by vigorous, regular exercise. This typically affects the lower leg, buttock, or thigh. By contrast, abdominal compartment syndrome also develops after a severe injury, surgery, or during critical illness, and it can affect the liver, bowels, kidneys, and other organs.

Around 75 percent of the time, crush injury compartment syndrome is caused by a broken bone, but burns, crush injuries, too-tight bandaging, surgery to blood vessels, blood clots, and prolonged limb compression (such as that experienced while unconscious) can also cause the condition. Crush injury compartment syndrome can develop rapidly over the course of hours or days. There are many symptoms, but the most common are listed below:

  • Swelling, tightness, and bruising
  • Pain that feels more intense than what you might expect for the injury
  • Numbness, pins-and-needles, or electricity-like sensations
  • A new but persistent and deep ache in the affected area.

A physical exam is typically needed to diagnose crush injury compartment syndrome. In many cases, the doctor will need to measure the pressure inside the affected body part. This typically involves inserting a needle, which is attached to a pressure monitor, into the suspected area. Plastic catheters may also be placed to continuously monitor the pressure.

Importantly, compartment syndrome symptoms often have a delayed presentation. One study found that patients did not experience symptoms for the first 6 hours after the injury-causing accident. However, they were admitted in the operating room approximately 24 hours after the initial injury with signs of foot crush compartment syndrome. Your physician will be aware of the possibility of developing compartment syndrome after the initial trauma, but keep an eye on the injury. You may be discharged from the hospital within hours with instructions to return if symptoms begin to present.

If you are diagnosed with crush injury compartment syndrome, you may require immediate surgery to reduce the compartment pressure. Other treatments typically include providing fluids intravenously, providing oxygen through the nose or mouth, taking pain medications, and/or keeping the body part below the level of the heart, which will improve blood flow.

What are the symptoms with foot injury and trauma?

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While a foot crush injury may sound like an easy condition to diagnose, your doctor will need to identify several symptoms before providing a definitive diagnosis. Each accident and injury cause is different, which means there is wide variety of symptom experiences. That said, the most common foot crush injury symptoms are listed below.

  • Fractures
  • Lacerations
  • Pain
  • Bruising
  • Swelling
  • Numbness

If the injury is left untreated, there are several, more severe symptoms and attendant conditions you may experience. This can include any of the following.

  • Compartment Syndrome, which occurs when pressure inside the body compartment builds to dangerously high levels, often when muscle is deprived of blood for too long.
  • Necrosis, which happens when the tissue dies as a result of blood deprivation.
  • Rhabdomyolysis, which is a rare condition that occurs when dead muscle contents are released into the bloodstream. It can cause kidney failure.
  • Infection, which is the most common. The risk of developing an infection is higher in crush injuries than in other types of wounds, as the breaks and trauma are often widespread and not clean.

If you experience any of the above symptoms, even if they are not especially severe, make an appointment with the doctor. Compartment syndrome has a delayed presentation, and most foot crush injury symptoms will only become more dangerous and severe with time.

What are the different types of foot crush injuries?

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Foot crush injuries follow a certain classification system. Using a very thorough physical exam and history review, the doctor will assess the severity of the injury. This part of the diagnosis is important, as foot crush injuries are very serious, sometimes leading to potential for intensive surgery or amputation. In understanding the type of force applied to the foot, the doctor can better determine the type of injury you have. The different types of foot crush injuries are listed below.

Type I – This type of foot crush injury occurs when the crushing object is heavy and large and has contact with the foot for a long period of time. This causes a gradual tissue and/or bone crush, and the soft tissues may eventually burst.

Type II – This type involves the experience described above, but lacerations are present, causing a mangling of tissues. This is most often associated with open or compound fractures.

Type III – This type of foot crush injury is shear, often involving a degloving from a tangential type force. It typically occurs when the top layers of skin and tissue are ripped from underlying muscle, the connective tissue, or bone. This is often life-threatening.

In addition to determining the type of foot crush injury, the physician will look for signs of compartment syndrome. Using these observations, the zone of injury, and the type of foot crush injury you’ve sustained, the doctor will begin to plan treatments.

What is the treatment for crush injuries of the foot?

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The foot crush injury treatment your doctor recommends will depend on the type, severity, location, and cause of the condition. The most minor crush injuries, such as those that result from dropping moderately heavy objects, like books, should be able to heal on their own. In these cases, only superficial soft tissue is damaged, and that damage is extremely minor, often resulting in a bruise. Ice and compression should help to minimize any swelling and pain. Still, you should see a doctor to understand the extent of the injury.

If your foot crush injury has excessive swelling, pain, or bleeding, you will need to see a doctor for treatment. The physician will perform a physical examination and take X-rays to check for fractured bones. Using this information, the doctor will determine your treatment options. This can include a range of casts and splints.

In the least severe cases, some broken bones in the foot can be treated with crutches and flat-bottom shoes. When combined with close monitoring, this can allow the foot to heal on its own. If the broken bones are not aligned, your doctor may need to realign them. This may result in the need for a fiberglass or plaster cast.

In severe cases, foot reconstruction surgery will be recommended, especially if there are several bone breaks and extensive soft tissue injury. In the most extreme cases, the doctor may recommend amputation, but this is only an option if the foot is mangled beyond repair.

If your doctor suspects you have compartment syndrome, or if your foot crush injury puts you at a higher risk for development, your doctor will not place a cast, splint, or anything that causes more pressure. In all cases, it is important to remember that crush injuries should be inspected by a doctor as soon as possible. Time is an important factor in treating a foot crush injury treatment, which means visiting a physician can significantly reduce the severity and complications that arise from the condition.

Do I need to see a doctor for my crushed foot injury?

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If you have a crushed foot injury, you should see a doctor immediately. These injuries only become more dangerous with time, and infections, necrosis, and other severe conditions are likely to develop without medical intervention. What’s more, acute compartment syndrome occurs primarily after foot injuries, and it can be difficult to diagnose without a physician. That said, this condition is a medical emergency and should not be taken lightly. Even if you are unsure whether a bone has broken or soft tissue is damaged, see a medical professional immediately.

Some foot crush injuries may not seem like a big deal, such as if you drop a heavy object in your home and notice a large bruise forming. Even if you’re not at serious risk of compartment syndrome, you should still seek medical attention. It can be difficult for the average person to understand the difference between a bad bruise and a broken bone. Trying to self-diagnose an injury can put a person at risk of developing an infection from a hidden internal injury. When in doubt, make that doctor’s appointment.