Lower-limb injuries common place in U.S. soldiers in Iraq

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A study released in advance of the American Podiatric Medical Association's (APMA) 95th Annual Meeting in Philadelphia reveals nearly 68 percent of all U.S. soldiers wounded in the Iraq and Afghanistan conflicts are a result of extremity injuries and nearly 22 percent of those injuries involve the foot and/or ankle.

To meet the war's demands of lower-limb injuries, podiatric physicians are on the surgical front lines for the first time ever. No longer relegated to non-critical cases, podiatric physicians have seen their role expanded to match their medical and surgical training.

Army Lt. Col. Michael Neary, a podiatric physician and surgeon stationed at Landstuhl Regional Medical Center (LRMC) in Germany, conducted the study reviewing 42 months of retrospective records of U.S. troops admitted to the podiatric service unit at LRMC. After assessing more than 350 patient records from March 2003 to September 2006, Neary concluded that podiatric physicians were critical to the overall LRMC medical mission. LRMC is the only U.S. military medical facility outside the United States to treat severely injured American soldiers fighting in Iraq and Afghanistan.

"The study's findings confirm the fundamental role that podiatric physicians are playing in the ongoing conflicts," said Neary, originally from Willow Grove, Pennsylvania. "This study was a way to validate podiatrists' role in the war and educate civilians and the U.S. Army about the extent of injuries the podiatric staff is seeing and treating."

Neary, who will present his findings at the APMA Annual Meeting on Saturday, August 18, found that 10 percent of all cases at LRMC involve injuries treated by the podiatric staff. The most common injuries were to the soft tissue or bone and usually resulted from an improvised explosive device (IED) or gunshot wound.

On average, the podiatric staff at LRMC admitted four soldiers per week to the inpatient unit, where the average stay was four days. Additionally, they saw 15 to 20 outpatient injuries per week. For less severe injuries, soldiers were treated and sent back to active duty. The severely wounded, were debrided (cleaned) and stabilized for transfer to one of three military medical facilities in the United States. Those patients requiring a potential amputation are sent to an amputee center for further evaluation.

Generally, amputations are not performed at LRMC. Instead soldiers with severe lower limb wounds are sent to high-level U.S. military medical facilities. There they receive input from surgeons, a prosthetist, family members and other amputees before deciding if an amputation is necessary. Of the 30,000 troops seen by the orthopedic/podiatry division at LRMC in the past four years, only ten amputations have been performed onsite.

Neary summed up his four years of service at LRMC with one word -- rewarding. "I've been given the unique opportunity to make a difference in soldiers' lives."

Listen to Dr. Neary's entire interview here: http://feeds.feedburner.com/thefootfile (podcast).

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