INDUSTRIAL INJURIES TO THE FOOT AND ANKLE

Michael J. Shereff, M.D.

INCIDENCEBureau of Labor StatisticsUS Department of Labor 12 million work – related

injuries occur each year = 20% of all injuries sustained in the United States.

7.2 million involve the musculoskeletal system.

.

INCIDENCE Foot and Ankle injuries

= 9.9% of all injuries. Most common age = 25

to 30years Males:Females = 2-3:1 Most common in

technical,sales,and administrative support positions.

ANKLE Service jobs = 25% Manufacturing =

17% Retail = 17% Construction = 13%

FOOT Manufacturing =

25% Service & Retail =

18% Construction = 15%

TOES Decreasing Order of

Frequency: Manufacturing Construction Retail Service

Construction Industry 83% Foot and Ankle

injuries occur in men.

Mean age = 34years.

More frequent in summer.

Construction Industry

Rate of return to work = 1.5 times higher for men than for women.

Rate of return to work = 20% less for each 10 year increase in age.

ETIOLOGYFoot and Ankle Injuries

Sprains/Strains = 42%

Contusions = 9% Lacerations = 8% Fractures = 6% Other causes = 35%

ANKLE Sprains & Strains =

70% Fractures = 15% Contusions = 5% Cuts, punctures,

burns & amputations = less common.

FOOT Contusions = 30% Fractures = 20% Sprains & Strains =

15% Cuts & Punctures =

less common.

TOES Fractures = 47% Bruises = 23 % Remaining causes =

less common.

ETIOLOGY Ontario Construction

Industry Puncture wounds=6.3% Fractures=19.6% Sprains=34.3%

Most Common Mechanism of Injury Contact with an

object Falls Exposure to a

harmful force – vehicles & machinery.

Mechanism of InjuryWork – related injuries to the foot and

ankle due to repetitive trauma are VERY UNCOMMON.

IMPACTMedian number of days missed from

work = 5.

IMPACTNational Safety Council (U.S.) 600 million dollars paid in

compensation for work related injuries to the foot and ankle.

NATIONAL ACADEMY OF SOCIAL INSURANCE Total costs to employers for Workers

Compensation have increased.Costs per covered employee has

declined.

DECREASED COST PER EMPLOYEE Increased workplace safety.Medical care cost reforms.Return to work programs = good cost

containment.Reduction of length of disability.Tightening of eligibility for benefits.

SITE OF INJURY (USBLS 1999)Ankle = 82,884 reported injuries =

51.63%Foot = 59,782 reported injuries =

37.24%Toes = 17,867 reported injuries =

11.13%TOTAL = 160,533 reported injuries

SITE OF INJURYAmerican National Standards InstituteSole=30%Midfoot=23%Toes=22%

SITE OF INJURY Canadian Injury

Survey Ankle=32% Metatarsal

Area=31% Toes=25% Heel=6% Sole=6%

SITE OF INJURY Ontario Construction

Industry Ankle=50.1% Metatarsal

Area=32% Toes=7.3% Heel=5.4% Sole=3.9%

PREDISPOSING FACTORS Increased in young

inexperienced workers

55% < 30 years 65% < 5 years

experience

PREDISPOSING FACTORS Most common on

Mondays Decreases rest of week Increases before lunch Increases late in

afternoon Least common = Friday

AM

OCCUPATIONAL INJURIES Phalangeal Area Metatarsal Region Sole Heel Ankle

PHALANGEAL AREA Mechanism=direct

blow Phalangeal

Fractures Contusion-severe

crush

FOREFOOT FRACTURES 50% = hallux and 1st

metatarsal Most common sites

= distal metatarsal and phalanx Great Toe

25% = 5th ray 25% = digits 2,3,&4.

FOREFOOT FRACTURESTREATMENT External Fixation Internal Fixation

METATARSAL REGIONMECHANISM Direct = foot trapped

or impacted beneath heavy object.

Indirect = plantar flexion & inversion injury

METATARSAL REGIONTYPES OF INJURIES Contusion Traumatic synovitis

extensor tendons Fracture metatarsal

bones Lis Franc fracture-

dislocation Compartment

Syndrome

METATARSAL REGIONTREATMENT Soft Tissue Injury:

Contusion Traumatic Synovitis Rx: Protected

mobilization = Boot/Post-op Shoe &

Crutches –NWB –PWB-FWB

METATARSAL REGIONTREATMENT METATARSAL

FRACTURES Nondisplaced =

SLC-NWB Displaced = closed

or open reduction (+/-) internal fixation

METATARSAL REGIONTREATMENT FRACTURE –

DISLOCATION Closed or open

reduction (+/-) internal fixation.

COMPARTMENT SYNDROMES Treatment =

Fasciotomy

SOLE Lacerations Puncture Wounds Treatment =

Tetanus, Antibiotics, Debridement,

HEEL Traumatic heel pad

disruption – inserts. Plantar fascia tear –

Early =rest,NWB,ice Late = inserts

Fractures - nondisplaced = cast displaced = ORIF

ANKLE #1 most common

site of industrial trauma

Mechanism Direct = blunt trauma Indirect = inversion injury

ANKLE INJURIES Sprain ligaments Strain or rupture

tendons Fractures =less

common

ANKLE SPRAIN Tear LCL Rx: Protected

Mobilization

ANKLE FRACTURES Lateral Malleolus Medial Malleolus Bimalleolar Pilon Fractures Rx: Non – displaced

=SLC – NWB Rx: Displaced =

ORIF

INJURIES BY OCCUPATION Aviators Astragalus Fracture of the neck

of the talus. Sudden impact of

foot against floorboard.

Rx: ORIF

FIREFIGHTERS,ROOFERS,& PAINTERS Mechanism = Fall

from height Injury = Fracture

calcaneus Rx: ORIF

WELDERS Mechanism = burns

from metal fragments

Rx: Debridement and local wound care.

INDUSTRIAL CLEANING Mechanism =

scalding water burns Rx: Debridement

and local wound care.

PIPELINE WORK Mechanism =

Frostbite Rx: Local wound

care

ELECTRICAL WORK Mechanism = high

voltage burns Rx: Debridement

plastic surgical reconstruction.

INDUSTRIAL SHOEWEAR Z41 Committee of

ANSI (American National Safety Institute)

Mandates Safety Shoe standards.

INDUSTRIAL SHOEWEAR Must protect from

exposure to specific hazards on the job.

Constuction = safety toe shoes & puncture resistant soles.

Electrical = nonconductive soles.

THANK YOU !