ORIGINAL ARTICLE Return to Duty and Disability After Combat-Related Hindfoot Injury

Objectives: To characterize the return-to-duty (RTD) rates and disability outcomes for soldiers who sustained combat-related hind-foot injuries that were treated with either reconstruction or transtibial amputation (TTA). Design: Retrospective cohort series. Setting: Tertiary trauma center. Patients/Participants: All patients treated for combat-related hindfoot injuries between May 2005 and July 2011. Intervention: TTA or hindfoot reconstruction/ankle fusion. Main Outcome Measurements: Age, RTD rate, combined disability, and associated disabling conditions. Results: One hundred twenty-two patients underwent treatment for combat-related hindfoot injuries. Fifty-seven patients were treated with amputation, and 65 patients were treated with hindfoot reconstruction or ankle fusion. The overall RTD rate was 20%. Amputees had a RTD rate of 12%, which was lower than those who had a fusion or hindfoot repair [26 % (P, 0.06)]. The disability ratings of amputees were significantly higher than those patients undergoing either ankle fusion or primary hindfoot repair [75% and 62%, respectively (P, 0.006)]. Discussion: While RTD rates were higher for hindfoot reconstruc-tion or ankle fusion compared with TTA, psychiatric conditions were more common among these patients. Although there were clear differences between both groups, the relationship between true functional outcomes and disability ratings remains unclear and both treatment groups seem to do poorly in terms of returning to active duty