[Anatomically and biomechanically based treatment algorithm for foot and ankle soft tissue reconstruction.]

INTRODUCTION: Successful soft tissue foot and ankle reconstruction is still challenging and needs subdivision into different, interdependent zones due to the limited amount of surrounding skin and soft tissue and the specific functional and anatomic requirements. Interdisciplinary support is often needed if composite defects (skin, soft tissue, bone) are present. However, there is still no coherent concept for treatment in cases of severe skin and soft tissue damage at the foot that meets the aforementioned requirements. METHOD: Using common data of pedobarographic gait analysis for assessment of plantar pressure distribution, we ascertained zones of different load profiles. Based on these data we propose a functional and anatomic subdivision of the foot and ankle region with regard to pressure distribution, soft tissue quality, shear zones between thick and thin skin regions and underlying vital structures. Because of these zones of different anatomic and functional needs, we developed a treatment algorithm that includes the common and well established local, regional and microsurgical reconstructive options. RESULTS: We demonstrate the need for subdividing anatomically and functionally based areas at the foot and ankle region and the practicability of the proposed treatment algorithm. Two clinical cases are discussed with an update on the present literature. CONCLUSION: Skin and soft tissue reconstruction of the foot and ankle should incorporate the specific functional and anatomic needs of the regions and should be accurately timed. The aim of plastic surgeons is the restoration of sensibility, motor function and aesthetic aspects. The proposed treatment algorithm can help by using the most effective operative technique for reconstruction of defects of varying size and localisation.