War Wounds of the Foot and Ankle: Causes, Characteristics, and Initial Management Eric M. Bluman, MD, PhD a,b, *, James R. Ficke, MD c , Dana C. Covey, MD, MSc d The United States Armed Forces have seen continuous conflict since shortly after September 11, 2001. As of December 4, 2009, there have been 5295 warriors killed, 19,591 individuals wounded in action but returned to duty within 72 hours, and 16,590 warriors wounded in action severely enough to require evacuation from theater. 1 These casualties represent 36,181 battle injuries. The term ‘‘battle injury’’ describes those injuries that occur as a direct result of confrontation with opposing factions in armed conflict. They do not include traffic accidents, incidents related to weapons from the coalition forces, fratricide, or self-induced injuries. Although the total number of battle injuries seems staggering, most of these warriors return to their units and continue to serve. The individuals who return to the United States through the evacuation chain continue to receive treatment along the way and many return to combat as a result of the interval management. Owens and colleagues 2 evaluated a cohort of battle injuries earlier in these conflicts, 1281 soldiers sustaining 3575 extremity combat wounds. They noted that 82% of all returning evacuees had sustained at least one extremity injury. The injuries of these soldiers were also characterized. Twenty-six percent of all wounds involved the lower a Foot and Ankle Service, Department of Orthopedics, Brigham & Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA b Harvard Medical School, Boston, MA, USA c Department of Orthopaedics and Rehabilitation, Brooke Army Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA d Department of Orthopaedic Surgery, Naval Medical Center, 34800 Bob Wilson Drive, San Diego, CA 92134, USA * Corresponding author. Brigham Foot and Ankle Center at the Faulkner, 1153 Centre Street, Suite 56, Boston, MA 02130. E-mail address: ebluman@partners.org (E.M. Bluman). KEYWORDS  Battlefield injuries  Explosive weaponry  Lower extremity injuries  Negative pressure wound therapy Foot Ankle Clin N Am 15 (2010) 1–21 doi:10.1016/j.fcl.2009.11.004 foot.theclinics.com 1083-7515/10/$ – see front matter ª 2010 Elsevier Inc. All rights reserved.