industrial injuries to the foot and ankle
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
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INDUSTRIAL INJURIES TO THE FOOT AND ANKLE
Michael J. Shereff, M.D.
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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.
.
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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.
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ANKLE Service jobs = 25% Manufacturing =
17% Retail = 17% Construction = 13%
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FOOT Manufacturing =
25% Service & Retail =
18% Construction = 15%
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TOES Decreasing Order of
Frequency: Manufacturing Construction Retail Service
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Construction Industry 83% Foot and Ankle
injuries occur in men.
Mean age = 34years.
More frequent in summer.
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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.
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ETIOLOGYFoot and Ankle Injuries
Sprains/Strains = 42%
Contusions = 9% Lacerations = 8% Fractures = 6% Other causes = 35%
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ANKLE Sprains & Strains =
70% Fractures = 15% Contusions = 5% Cuts, punctures,
burns & amputations = less common.
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FOOT Contusions = 30% Fractures = 20% Sprains & Strains =
15% Cuts & Punctures =
less common.
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TOES Fractures = 47% Bruises = 23 % Remaining causes =
less common.
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ETIOLOGY Ontario Construction
Industry Puncture wounds=6.3% Fractures=19.6% Sprains=34.3%
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Most Common Mechanism of Injury Contact with an
object Falls Exposure to a
harmful force – vehicles & machinery.
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Mechanism of InjuryWork – related injuries to the foot and
ankle due to repetitive trauma are VERY UNCOMMON.
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IMPACTMedian number of days missed from
work = 5.
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IMPACTNational Safety Council (U.S.) 600 million dollars paid in
compensation for work related injuries to the foot and ankle.
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NATIONAL ACADEMY OF SOCIAL INSURANCE Total costs to employers for Workers
Compensation have increased.Costs per covered employee has
declined.
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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.
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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
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SITE OF INJURYAmerican National Standards InstituteSole=30%Midfoot=23%Toes=22%
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SITE OF INJURY Canadian Injury
Survey Ankle=32% Metatarsal
Area=31% Toes=25% Heel=6% Sole=6%
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SITE OF INJURY Ontario Construction
Industry Ankle=50.1% Metatarsal
Area=32% Toes=7.3% Heel=5.4% Sole=3.9%
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PREDISPOSING FACTORS Increased in young
inexperienced workers
55% < 30 years 65% < 5 years
experience
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PREDISPOSING FACTORS Most common on
Mondays Decreases rest of week Increases before lunch Increases late in
afternoon Least common = Friday
AM
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OCCUPATIONAL INJURIES Phalangeal Area Metatarsal Region Sole Heel Ankle
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PHALANGEAL AREA Mechanism=direct
blow Phalangeal
Fractures Contusion-severe
crush
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FOREFOOT FRACTURES 50% = hallux and 1st
metatarsal Most common sites
= distal metatarsal and phalanx Great Toe
25% = 5th ray 25% = digits 2,3,&4.
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FOREFOOT FRACTURESTREATMENT External Fixation Internal Fixation
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METATARSAL REGIONMECHANISM Direct = foot trapped
or impacted beneath heavy object.
Indirect = plantar flexion & inversion injury
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METATARSAL REGIONTYPES OF INJURIES Contusion Traumatic synovitis
extensor tendons Fracture metatarsal
bones Lis Franc fracture-
dislocation Compartment
Syndrome
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METATARSAL REGIONTREATMENT Soft Tissue Injury:
Contusion Traumatic Synovitis Rx: Protected
mobilization = Boot/Post-op Shoe &
Crutches –NWB –PWB-FWB
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METATARSAL REGIONTREATMENT METATARSAL
FRACTURES Nondisplaced =
SLC-NWB Displaced = closed
or open reduction (+/-) internal fixation
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METATARSAL REGIONTREATMENT FRACTURE –
DISLOCATION Closed or open
reduction (+/-) internal fixation.
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COMPARTMENT SYNDROMES Treatment =
Fasciotomy
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SOLE Lacerations Puncture Wounds Treatment =
Tetanus, Antibiotics, Debridement,
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HEEL Traumatic heel pad
disruption – inserts. Plantar fascia tear –
Early =rest,NWB,ice Late = inserts
Fractures - nondisplaced = cast displaced = ORIF
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ANKLE #1 most common
site of industrial trauma
Mechanism Direct = blunt trauma Indirect = inversion injury
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ANKLE INJURIES Sprain ligaments Strain or rupture
tendons Fractures =less
common
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ANKLE SPRAIN Tear LCL Rx: Protected
Mobilization
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ANKLE FRACTURES Lateral Malleolus Medial Malleolus Bimalleolar Pilon Fractures Rx: Non – displaced
=SLC – NWB Rx: Displaced =
ORIF
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INJURIES BY OCCUPATION Aviators Astragalus Fracture of the neck
of the talus. Sudden impact of
foot against floorboard.
Rx: ORIF
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FIREFIGHTERS,ROOFERS,& PAINTERS Mechanism = Fall
from height Injury = Fracture
calcaneus Rx: ORIF
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WELDERS Mechanism = burns
from metal fragments
Rx: Debridement and local wound care.
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INDUSTRIAL CLEANING Mechanism =
scalding water burns Rx: Debridement
and local wound care.
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PIPELINE WORK Mechanism =
Frostbite Rx: Local wound
care
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ELECTRICAL WORK Mechanism = high
voltage burns Rx: Debridement
plastic surgical reconstruction.
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INDUSTRIAL SHOEWEAR Z41 Committee of
ANSI (American National Safety Institute)
Mandates Safety Shoe standards.
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INDUSTRIAL SHOEWEAR Must protect from
exposure to specific hazards on the job.
Constuction = safety toe shoes & puncture resistant soles.
Electrical = nonconductive soles.
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THANK YOU !