1. INDUSTRIAL INJURIES TO THE FOOT AND ANKLE
Michael J. Shereff, M.D.

2. INCIDENCE Bureau of Labor Statistics US 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. .

3. 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.

4. ANKLE Service jobs = 25% Manufacturing = 17% Retail = 17%
Construction = 13%

5. FOOT
Manufacturing = 25%
Service & Retail = 18%
Construction = 15%

6. TOES Decreasing Order of Frequency: Manufacturing Construction Retail
Service

7. Construction Industry
83% Foot and Ankle injuries occur in men.
Mean age = 34years.
More frequent in summer.

8. 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.

9. ETIOLOGY Foot and Ankle Injuries
Sprains/Strains = 42%
Contusions = 9%
Lacerations = 8%
Fractures = 6%
Other causes = 35%

10. ANKLE Sprains & Strains = 70% Fractures = 15% Contusions = 5%
Cuts, punctures, burns & amputations = less common.

11. FOOT Contusions = 30% Fractures = 20% Sprains & Strains = 15%
Cuts & Punctures = less common.

12. TOES
Fractures = 47%
Bruises = 23 %
Remaining causes = less common.

13. ETIOLOGY Ontario Construction Industry Puncture wounds=6.3%
Fractures=19.6%
Sprains=34.3%

14. Most Common Mechanism of Injury
Contact with an object
Falls
Exposure to a harmful force – vehicles & machinery.

15. Mechanism of Injury
Work – related injuries to the foot and ankle due to repetitive trauma are VERY UNCOMMON.

16. IMPACT
Median number of days missed from work = 5.

17. IMPACT National Safety Council (U.S.)
600 million dollars paid in compensation for work related injuries to the foot and ankle.

18. NATIONAL ACADEMY OF SOCIAL INSURANCE
Total costs to employers for Workers Compensation have increased.
Costs per covered employee has declined.

19. 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.

20. 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

21. SITE OF INJURY American National Standards Institute Sole=30%
Midfoot=23%
Toes=22%

22. SITE OF INJURY Canadian Injury Survey Ankle=32% Metatarsal Area=31%
Toes=25%
Heel=6%
Sole=6%

23. SITE OF INJURY Ontario Construction Industry Ankle=50.1%
Metatarsal Area=32%
Toes=7.3%
Heel=5.4%
Sole=3.9%

24. PREDISPOSING FACTORS Increased in young inexperienced workers
55% < 30 years
65% < 5 years experience

25. PREDISPOSING FACTORS Most common on Mondays Decreases rest of week
Increases before lunch
Increases late in afternoon
Least common = Friday AM

26. OCCUPATIONAL INJURIES
Phalangeal Area
Metatarsal Region
Sole
Heel
Ankle

27. PHALANGEAL AREA Mechanism=direct blow Phalangeal Fractures
Contusion-severe crush

28. FOREFOOT FRACTURES 50% = hallux and 1st metatarsal
Most common sites = distal metatarsal and phalanx Great Toe
25% = 5th ray
25% = digits 2,3,&4.

29. FOREFOOT FRACTURES TREATMENT
External Fixation
Internal Fixation

30. METATARSAL REGION MECHANISM
Direct = foot trapped or impacted beneath heavy object.
Indirect = plantar flexion & inversion injury

31. METATARSAL REGION TYPES OF INJURIES
Contusion
Traumatic synovitis extensor tendons
Fracture metatarsal bones
Lis Franc fracture-dislocation
Compartment Syndrome

32. METATARSAL REGION TREATMENT
Soft Tissue Injury:
Contusion
Traumatic Synovitis
Rx: Protected mobilization = Boot/Post-op Shoe &
Crutches –NWB –PWB-FWB

33. METATARSAL REGION TREATMENT
METATARSAL FRACTURES
Nondisplaced = SLC-NWB
Displaced = closed or open reduction (+/-) internal fixation

34. METATARSAL REGION TREATMENT
FRACTURE – DISLOCATION
Closed or open reduction (+/-) internal fixation.

35. COMPARTMENT SYNDROMES
Treatment = Fasciotomy

36. SOLE Lacerations Puncture Wounds
Treatment = Tetanus, Antibiotics, Debridement,

37. HEEL Traumatic heel pad disruption – inserts.
Plantar fascia tear – Early =rest,NWB,ice Late = inserts
Fractures nondisplaced = cast displaced = ORIF

38. ANKLE #1 most common site of industrial trauma
Mechanism Direct = blunt trauma Indirect = inversion injury

39. ANKLE INJURIES Sprain ligaments Strain or rupture tendons
Fractures =less common

40. ANKLE SPRAIN
Tear LCL
Rx: Protected Mobilization

41. ANKLE FRACTURES Lateral Malleolus Medial Malleolus Bimalleolar
Pilon Fractures
Rx: Non – displaced =SLC – NWB
Rx: Displaced = ORIF

42. INJURIES BY OCCUPATION
Aviators Astragalus
Fracture of the neck of the talus.
Sudden impact of foot against floorboard.
Rx: ORIF

43. FIREFIGHTERS,ROOFERS,& PAINTERS
Mechanism = Fall from height
Injury = Fracture calcaneus
Rx: ORIF

44. WELDERS Mechanism = burns from metal fragments
Rx: Debridement and local wound care.

45. INDUSTRIAL CLEANING Mechanism = scalding water burns
Rx: Debridement and local wound care.

46. PIPELINE WORK
Mechanism = Frostbite
Rx: Local wound care

47. ELECTRICAL WORK Mechanism = high voltage burns
Rx: Debridement plastic surgical reconstruction.

48. INDUSTRIAL SHOEWEAR
Z41 Committee of ANSI (American National Safety Institute)
Mandates Safety Shoe standards.

49. INDUSTRIAL SHOEWEAR
Must protect from exposure to specific hazards on the job.
Constuction = safety toe shoes & puncture resistant soles.
Electrical = nonconductive soles.

50. THANK YOU !