Foot–ankle injuries: Influence of crash location, seating position and age

Foot–ankle injuries have increased in relative importance in recent years. As a basis for future countermeasures, an epidemiology study has been undertaken using Swedish accident data from Folksam Insurance. The database consists of 805 foot–ankle injuries out of 57,949 car occupant injuries reported from 1985 to 1991. The influence of crash location, seating position and occupant age is determined for the frequency, incidence and rate of foot–ankle injury in car crashes. Frontal car crashes produce 76% of the AIS 2–3 foot–ankle injuries with 13% in side impacts and 8% in roll-overs. The rate of AIS 2–3 foot–ankle injury is 24.7 per 1000 occupants injured in all crash locations and is similar irrespective of seating positions. Ankle fractures and sprains both occur at an incidence of 3.7 per 1000 injuries, followed by malleolus fractures at 2.7 and midtarsal fractures at 2.4. The foot–ankle injury incidence and rate are significantly greater (p < 0.01) in near oblique–frontal crashes than for 12 o'clock frontals. For drivers in 11 o'clock and front passengers in 1 o'clock, the incidence is 27.8 per 1000 injuries as compared with 17.5 for drivers and front passengers in 12 o'clock crashes. Occupant age is not as significant as seating position and crash location; however, there are higher incidences for rear occupants ⩾60 years old in oblique frontal crashes. Using the new AAAM Impairment Injury Scale (IIS), 48% of the foot–ankle injuries are rated with residual impairment IIS 1–2. The incidence in near-seated occupants is 1.5 times greater in oblique frontal crashes than in frontals. The incidence for IIS 1–2 impairment in near oblique–frontal crashes is 12.8 per 1000 occupant injuries as compared with 8.3 in frontal crashes.