Foot Injury From a Road Traffic Accident (degloving injury)

Background

This patient sustained a foot injury in a road traffic accident (RTA). The skin on her foot was torn away, requiring skin grafting. Although she had received some physiotherapy before our first appointment, she had not received any specialist scar treatment. The first photograph was taken on the first appointment, one year after her injury.

Presenting Problem

The patient reported pain and distress about the appearance of her foot, which left her self-conscious about her footwear choices. Her foot was swollen which limited her shoe wear choice. She could walk only about 20 minutes with a stick, limited by pain and discomfort.

Clinical Assessment

On examination the scar was inflamed and vascular (red), and extremely adherent (stuck to underlying tissue). The skin-grafted area was also concave (sunken below the surrounding surface). The lateral border (along the side of her toe) was very raised and thickened.

Treatment Provided

The treatment given was LPG (mechanical massage for tissue mobilisation), manual scar massage, and use of an Otoform silicone mould to soften and reshape the scar.

Outcome

Progress photographs show clear improvements. The scar became less textured and inflamed, more evenly contoured (“plump”), and much more pliable (flexible and soft). The patient’s pain improved significantly. At her last appointment she had just returned from travelling, walking 10,000 steps per day without needing a stick.

Tips

• What to Look Out for When Examining Before-and-After Photos

  • Check for time effects: Look for how long has passed between the “before” and “after” photos — scars generally improve naturally during the maturation period (up to around 2 years post-injury). Time alone may explain some changes rather than the treatments used. (In this case, the injury was already one year old and the treatment period was short — the improvements seen are due to the therapy provided, not simply time.)

  • Ask about all treatments: Confirm whether other interventions occurred between the “before” and “after” photos that could explain the change. (This patient had no other treatment during the photo series — only scar physiotherapy with me.)

  • Look for consistency: Lighting, angles and positioning should be similar in before-and-after photos to fairly show progress. (These photos could have been more consistent — but even so, the difference cannot be explained by photography alone.)

• Seek Early Expert Opinion

  • Specialist scar assessment soon after injury can help guide treatment and improve long-term outcomes.