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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:
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
14. Most Common Mechanism of Injury Contact with an object
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
22. SITE OF INJURY Canadian Injury Survey
23. SITE OF INJURY Ontario Construction Industry
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
27. PHALANGEAL AREA Mechanism=direct blow
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
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
32. METATARSAL REGION TREATMENT Soft Tissue Injury:
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
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
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.
43. FIREFIGHTERS,ROOFERS,& PAINTERS Mechanism = Fall from height
Injury = Fracture calcaneus
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 !