Health concerns of war-related ankle and foot injuries
Edited by: Dr. Hamid Shokoohi
When the Iraq-Iran War came to an end in 1988, the war against disability began for more than 10,000 veterans with war-related foot and ankle injuries. In the past 30 years, these thousands of Iranian veterans have lived with chronic disability and faced medical, social, and psychological challenges intheir day-to-day living.
In the aftermath of the war, the responsibility for treating these Iranian heroes fell squarely onto a certain group of hospitals and physicians in coordination with the Iranian Veteran Department called “Veterans and Martyrs Affairs Foundation” with a long and proud history of caring for Iranian veterans. The authors contributed to this thematic series are the core group of physicians, technicians, and administrators in the foundation who have extensively dealt with war and blast-related injuries in the past 30 years. For more than three decades, blast-related injuries including amputations, extremity deformities, sequential muscular dystrophies, and other types of devastating war related foot and ankle injuries have been managed by this group of medical specialists who are among the top experts in the field. They have effectively managed and provided comprehensive medical care including recurrent complex reconstructive surgeries, pre-prosthesis care, prosthetic fabrication and training, vocational rehabilitation, psychosocial consulting, and community integration. From my personal experience as a physician involved with the administration and care of these patients, I can attest that this has been a challenging time dealing with the unprecedented quantity, severity, and complexity of the injuries, and the need for higher levels of care and rehabilitation. However, this team has learned to treat these injuries as effectively as possible from the point of injury to rehabilitation.
Dealing with war-related foot and ankle injuries is challenging. In this specific group of victims, the veterans were among a young group of soldiers with an average age of 21 years old (at the time of injury) with long life-expectancy ahead of them, who needed to maintain an active lifestyle. This active veterans’ population was expected to have minimal downtime while maximizing their ability to return to a healthy and productive life. Furthermore, many of these victims sustained additional injuries to other body regions including spinal injuries, upper extremity amputation (a characteristic pattern of landmine injuries), and sequential poly-trauma related injuries and complications. Veterans with amputations also experienced a wide range of activity limitations that has affected their ability to return to and continue work, as well as their ability to maintain social relationships and activities.
An important basis for proper care of these patients with major foot and ankle injuries, including amputations, is an in-depth understanding of the functional outcomes of the amputation and a comprehensive assessment of the injured and their environment.
In this issue, the authors shared their knowledge and experience in managing rehabilitation and psychological aspects of care for veterans with foot and ankle injuries. The authors conducted a comprehensive study in which a multidisciplinary team of physicians and technicians provided an initial evaluation of 1129 veterans with sustained ankle-foot injuries, implemented proper care, and conducted a longitudinal follow-up on their medical care and social life over a 5-year period. I hope that by sharing the knowledge and valuable experience of our colleagues, each of us can learn the best practices for treating these conditions.
This series was published in Military Medical Research.
Hamid Shokoohi, MD, MPH, FACEP
Associate Professor of Emergency Medicine
George Washington University Medical Center