All severe midfoot trauma has a spectrum of soft-tissue injuries. Rest, elevation, and in some cases, intermittent compression devices will help in resolving the soft-tissue swelling. Non-weight bearing 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 sides. 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.
Appropriate bone and joint reduction allow for quicker recovery of the soft tissues. Therefore immediate insertion of external fixators, Steinmann pins, or K-wires on the medial and lateral sides creates a temporary reduction of both the medial and lateral rays. It provides stability for the skeletal component of the injury and prevents further bony and soft-tissue injury. Stability usually decreases pain, but if the degree of pain escalates after the temporary reduction, one must think of a compartment syndrome. Elevation of the leg, compression, and icing will help decrease the swelling.
Severe soft-tissue injury, vascular injury, or both, may necessitate immediate amputation at the appropriate level.