Background: Plantar sensation is considered to be a critical factor
in the evaluation of limb-threatening lower extremity trauma. The present
study was designed to determine the long-term outcomes following the treatment
of severe lower extremity injuries in patients who had had absent plantar
sensation at the time of the initial presentation.
Methods: We examined the outcomes for a subset of fifty-five
subjects who had had an insensate extremity at the time of presentation. The
patients were divided into two groups on the basis of the treatment in the
hospital: an insensate amputation group (twenty-six patients) and an insensate
salvage group (twenty-nine patients), the latter of which was the group of
primary interest. In addition, a control group was constructed from the parent
cohort so that the patients in the study groups could be compared with
patients in whom plantar sensation was present and in whom the limb was
reconstructed. Patient and injury characteristics as well as functional and
health-related quality-of-life outcomes at twelve and twenty-four months after
the injury were compared between the subjects in the insensate salvage group
and those in the other two groups.
Results: The patients in the insensate salvage group did not report
or demonstrate significantly worse outcomes at twelve or twenty-four months
after the injury compared with subjects in the insensate amputation or sensate
control groups. Among the patients in whom the limb was salvaged (that is,
those in the insensate salvage and sensate control groups), an equal
proportion (approximately 55%) had normal plantar sensation at two years after
the injury, regardless of whether plantar sensation had been reported to be
intact at the time of admission. No significant differences were noted among
the three groups with regard to the overall, physical, or psychosocial scores.
At two years after the injury, only one patient in the insensate salvage group
had absent plantar sensation.
Conclusions: Outcome was not adversely affected by limb salvage,
despite the presence of an insensate foot at the time of presentation. More
than one-half of the patients who had presented with an insensate foot that
was treated with limb reconstruction ultimately regained sensation at two
years. Initial plantar sensation is not prognostic of long-term plantar
sensory status or functional outcomes and should not be a component of a
limb-salvage decision algorithm.
Level of Evidence: Prognostic Level I. See Instructions
to Authors for a complete description of levels of evidence.