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

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. .

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.

ETIOLOGY Foot 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 Injury Work – related injuries to the foot and ankle due to repetitive trauma are VERY UNCOMMON.

IMPACT Median number of days missed from work = 5.

IMPACT National 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 INJURY American National Standards Institute Sole=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 FRACTURES TREATMENT External Fixation Internal Fixation

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

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

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

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

METATARSAL REGION TREATMENT 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 !