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PubMed2002

Nerve injuries to the foot and ankle in the industrial setting.

Nerve injuries of the foot and ankle are among the most difficult to diagnose and treat. With the added influences of potential secondary gain and poor motivation of the work injured patient, these injuries can be taxing and frustrating to manage in the acute or chronic setting. This article reviews the neuroanatomy, mechanisms of injury, diagnosis and management of these injuries with specific reference to the patient injured in the industrial setting.

Accidents, Occupational↗
PubMed1997

Primary care of foot and ankle injuries in the athlete.

A thorough knowledge of foot and ankle anatomy is required to allow an accurate and focused examination of the injured athlete. This short review has attempted to educate the treating physician on our approach to foot and ankle injuries commonly seen in athlete. We have tried to elucidate less common injuries that present in similar manner to the more common foot and ankle sprains and strains.

Ankle Injuries↗
PubMed2002

Return to work after foot and ankle injury.

A surgeon faces important issues when returning a patient to the workplace, including workers' compensation issues and the need for physician guidance. These patients deserve appropriate diagnosis and treatment protocols, and the other members of the workers compensation treatment team can help maximize the effects of careful guidance by a physician. The speediest possible return to the workplace is usually best for all concerned, the injured worker, the employer and the physician. The treatment team within the workers' compensation system assists in the facilitation and coordination of the medical care and assists in bringing the patient back to work. The team includes the nurse case manager, the insurer, and physical and occupational therapists. Appropriate use of work hardening programs or functional capacity evaluations can be valuable in the return-to-work effort. Physicians who make use of these resources may find it easier to guide this process efficiently to achieve the desired outcome of return to work of the injured worker.

Accidents, Occupational↗
PubMed1996

[Torture-related injuries--a medical challenge. Diagnosis and treatment of Falanga victims].

Torture victims are generally reluctant to present complaints linked to the torture. Many patients from refugee populations have experienced traumatic events such as war, violence and torture. Health professionals need to know more about the nature of these traumas, and how to diagnose the sequelae of torture. If they are to give torture victims adequate treatment they need to be familiar with the relevant diagnostic procedures, and how to treat health problems caused by systematic violence. A clinical case history is used to present the method of torture called Falanga, the beating of the soles of the feet. The case shows how the diagnosis and treatment of the physical injuries have a marked effect on the rehabilitation process. After receiving treatment for his foot injuries, patient's physical and mental health both improved dramatically, as did his psychosocial rehabilitation.

Foot Injuries↗
PubMedDate not supplied

Injuries of the foot and ankle in occupational medicine: a 1-year study.

With occupational injuries, both the employee and employer are impaired by monetary or physical damages. Administrative and clinical data can assist in identifying risks for these injuries. While musculoskeletal injuries are well known, foot and ankle injuries are not as frequently described as back and hand injuries. Changes in the workplace may then be implemented dependent on the risk factors identified. A retrospective study was completed on all foot and ankle injuries that were reported to the Oakwood Hospital Downriver Center Occupational Medicine Clinics over 1 year. Of 3851 new injuries, 245 (6.4%) were due to foot and ankle injuries. The mean age was 36.7+/-9.2 (mean +/- S.D.) years and 64% men. No seasonal variation was seen. Most commonly the ankle (46.9%) was injured. A diagnosis of sprain was most frequent (40.8%), followed by contusions (26.5%). A twisting mechanism of injury was seen 27.3% of the time. Medical charges ranged from $100 to $6414, although over two thirds of the patients had expenses between $250 and $749. Eleven patients required surgery, costing $9125+/-2321. Most often injured were operators, fabricators, and laborers. Workers were restricted for 20.5+/-21.4 days, although they were allowed light duty most of the time (16.8+/-16.5 days).

Adult↗
PubMed2002

Traumatic foot and ankle injuries in the athlete.

Unrecognized and inappropriately managed foot and ankle injuries can lead to significant long-term functional disability. As many of the above injuries are frequently diagnosed late or not even considered because of the benign appearance of the foot or radiograph, it behooves the sports medicine physician to carefully assess the foot and obtain appropriate radiographs, including stress views as needed. Although quick return to athletic play is among the goals of treatment for the elite athlete, this must be tempered by the fact that certain injuries require significantly greater time for complete recovery. A functional rehabilitation program is the best means to rapidly return the player to competition and while prolonging the athletic career.

Ankle Injuries↗
PubMedDate not supplied

Ankle flexibility and injury patterns in dancers.

Lower-extremity injuries are common among dancers and cause significant absences from rehearsals and performances. For this study of lower-extremity injuries in 101 ballet and 47 modern dance students, injuries requiring medical attention sustained over 1 academic year were associated with the following data obtained at the beginning of the school year: ankle flexibility, sex, dance discipline, previous injury, body mass index, and years of training. Eighty-three of the 148 students (age range, 12 to 28 years) reported prior lower-limb injuries, the most common being ankle sprains (28% of all dancers). Previous leg injuries correlated significantly with lower dorsiflexion measurements and with more new injuries. Female students had greater ankle and first metatarsophalangeal flexibility. Modern dancers had greater ankle inversion. Ninety-four students sustained 177 injuries during the study, including 75 sprains or strains and 71 cases of tendinitis. Thirty-nine percent (N = 69) were ankle injuries; 18% (N = 33) were knee injuries; 23% (N = 40) were foot injuries; and 20% (N = 35) were either hip or thigh injuries. Sixty-seven percent (N = 78) of the injured students were ballet dancers. Age, years of training, body mass index, sex, and ankle range of motion measurement had no predictive value for injury; previous injury and dance discipline both correlated with increased risk of injury.

Adolescent↗
PubMed1997

Gait abnormalities in diabetic neuropathy.

OBJECTIVE: To investigate the effect of peripheral neuropathy on gait in diabetic patients. RESEARCH DESIGN AND METHODS: Gait analysis was performed in the following groups matched for age, sex, and BMI: 20 normal healthy control subjects (NC), 20 non-neuropathic diabetic control subjects (DC), 20 neuropathic diabetic subjects (DN), and 20 neuropathic diabetic subjects with a history of foot ulceration (DNU). All subjects with orthopedic foot problems were excluded from the study. The following gait parameters were investigated: 1) walking speed; 2) stance phase duration; 3) joint angles and moment arms for the ankle, knee, and hip joints in both sagittal and frontal planes; 4) the components of the ground reaction force (GRF) vector; and 5) the ankle, knee, and hip joint moments originating from the GRF vector in both planes. RESULTS: There were no statistical differences in any of the parameters studied between the NC and DC groups. Walking speed was significantly slower in the DNU group compared with the two control groups (P < 0.02). The maximum knee joint angle was smaller in the sagittal plane for the DNU group compared with the DC group values (P < 0.05). The maximum value of the vertical component of GRF was found to be higher (P < 0.03) in the two control groups compared with the DNU group. The maximum value of the anteroposterior forces was also found to be higher (P < 0.001) in the DC group compared with the DNU group. The maximum frontal plane ankle joint moment was significantly higher (P < 0.05) in the DN compared with the NC group. CONCLUSIONS: Diabetic subjects with peripheral neuropathy demonstrate alterations in some gait parameters during walking. These alterations could facilitate foot injuries, thus contributing to frequent foot ulceration.

Adult↗
PubMed2005

SPTLC1 and RAB7 mutation analysis in dominantly inherited and idiopathic sensory neuropathies.

BACKGROUND: The variable clinical features of hereditary sensory and autonomic neuropathy (HSAN I) suggest heterogeneity. Some cases of idiopathic sensory neuropathy could be caused by missense mutations of SPTLC1 and RAB7 and not be recognised as familial. OBJECTIVE: To screen persons with dominantly inherited HSAN I and others with idiopathic sensory neuropathies for known mutations of SPTLC1 and RAB7. PATIENTS: DNA was examined from well characterised individuals of 25 kindreds with adult onset HSAN I for mutations of SPTLC1 and RAB7; 92 patients with idiopathic sensory neuropathy were also screened for known mutations of these genes. RESULTS: Of the 25 kindreds, only one had a mutation (SPTLC1 399T-->G). This kindred, and 10 without identified mutations, had prominent mutilating foot injuries with peroneal weakness. Of the remainder, 12 had foot insensitivity with injuries but no weakness, one had restless legs and burning feet, and one had dementia with hearing loss. No mutation of RAB7 was found in any of these. No known mutations of SPTLC1 or RAB7 were found in cases of idiopathic sensory neuropathy. CONCLUSIONS: Adult onset HSAN I is clinically and genetically heterogeneous and further work is required to identify additional genetic causes. Known SPTLC1or RAB7 mutations were not found in idiopathic sensory neuropathy.

Acyltransferases↗
PubMed1994

Puncture wounds of the foot: can infective complications be avoided?

The bacteriological flora of the foot and shoe was studied concurrently in 200 volunteers without foot injuries, and 80 patients with puncture wounds of the foot. Seven of 28 child patients developed clinical infections, three with Pseudomonas aeruginosa. Eleven of 52 adult patients also developed infections. No patients developed infection if oral antibiotics were given within the first 24 h after injury (P < 0.05). Oral antibiotic prophylaxis is recommended for puncture wounds of the foot.

Adolescent↗
PubMed1987

Reconstruction of soft tissue injuries of the foot and ankle with microsurgical techniques.

Microsurgical reconstruction for injuries of the foot and ankle includes, in addition to repair of small nerves, vessels, and tendons, coverage of soft tissue defects. Local transpositional and island pedicle flaps are ideal when available and adequate. The choice of free vascularized flaps is based on its potential durability, contour, bulk, and appearance. Thin cutaneous flaps, fascial flaps, and muscle flaps covered with split thickness skin grafts are appropriate in specific areas. Neurosensory flaps and methods of reinnervation may have a place in extensively denervated feet. Good postoperative pedorthic care aids in the final outcome.

Ankle↗
PubMed1989

The epidemiology of foot and ankle injuries in sports.

A 6 1/2-year review of 16,754 injuries seen in a multispecialty sports medicine clinic found that 25 per cent of the 12,681 injuries in the top 19 sports occurred at the ankle and foot. The percentages of foot and ankle injuries varied substantially from sport to sport, as did the proportion of sprains versus overuse injuries at each location. An appreciation of the patterns and numbers of injuries presenting can be helpful in patient management and can aid the planning of both clinical investigations and educational programs.

Ankle Injuries↗
PubMed2002

Epidemiology of foot and ankle injuries in the workplace.

Injuries to the ankle, foot, and toes of injured workers are common. Although the workers' compensation system attempts to collect information about these injuries and report them in a meaningful way, the process is somewhat inconsistent, inaccurate, and provides information relevant to government agencies but not to physician organizations seeking to improve the prevention and treatment of work-related injuries. Several improvements in data collection could greatly increase the system's efficiency and usefulness. The first is to establish a national system of uniform data collection from each State. The second improvement involves standardization of the forms and means that the data are collected from the worker including a system to retrieve information that has been omitted during the initial encounter. The third, and most important, refinement is to change the reporting of the illness to match currently accepted medical diagnosis codes (ICD-9). Using the current system and making these improvements, the United States would be able to collect more meaningful data on work injuries in this country. From that point forward medical interventions could then be created and their effects more meaningfully analyzed. All those involved in the care and treatment of the injured worker must recognize not only the limitations of the collected data but also how this information can be manipulated. For example, whereas the total cost of benefits paid by employers increased during one decade the average cost per covered employee decreased. Employers and insurers can argue that their total costs have consistently risen but only by knowing that the cost per covered employee had decreased during that same time period can that argument be countered. Similarly, implementation of certain safety practices during a given time period may be accompanied by a reduction in the number of injuries. Changes in the laws that altered injury reporting and reduced the coverage for certain injuries, however, may have created a situation where the reported injury rates were reduced by accounting practice, not medical practice. It is also well established that insurance company profits may be linked as much to the general economy and stock market as they are to premiums and claims. It is hoped that this article begins an understanding of the extent of the problem of foot and ankle injuries in the working population. Additional statistical information on specific topics is presented elsewhere in this issue.

Accidents, Occupational↗
PubMed1985

Foot and ankle injuries in theatrical dancers.

The theatrical dancer is a unique combination of athlete and artist. The physical demands of dance class, rehearsal, and performance can lead to injury, particularly to the foot and ankle. Ankle sprains are the most common acute injury. Chronic injuries predominate and relate primarily to the repeated impact loading of the foot and ankle on the dance floor. Contributing factors include anatomic variation, improper technique, and fatigue. Early and aggressive conservative management is usually successful and surgery is rarely indicated. Orthotics play a limited but potentially useful role in treatment. Following treatment, a structured rehabilitation program is fundamental to the successful return to dance.

Achilles Tendon↗
PubMed1990

[Microsurgical autotransplantation in the correction of post-traumatic foot defects].

In the article is analyzed the experience of treatment of 211 patients with traumata, which are the results of thermal and irradiation foot injuries. 30 patients were subjected to microsurgical reconstruction with application of complex of tissular transplants. There were differentiated 3 types of foot tissue injuries, determining transplants and operative technique selection. It has been determined that the closure of ulcerous defects in case of post-thrombotic disease is possible with utilization of radial graft of forearm on long venous pedicle. Prevention of venous anastomosis thrombosis is contributed to by formation of peripheral arteriovenous anastomosis in the transplant. Impartment of the points of fixation of the muscular part with the locomotive nerve suture contributes to the increase of adequate reliability of musculocutaneous graft. Utilization of osseous transplant of iliac crest allows to perform an orthopaedic correction of the lost anterior part of foot and prevents limb amputation.

Adolescent↗
PubMed1998

Lisfranc injury of the foot: a commonly missed diagnosis.

Lisfranc joint injuries are rare, complex and often misdiagnosed. Typical signs and symptoms include pain, swelling and the inability to bear weight. Clinically, these injuries vary from mild sprains to fracture-dislocations. On physical examination, swelling is found primarily over the midfoot region. Pain is elicited with palpation along the tarsometatarsal articulations, and force applied to this area may elicit medial or lateral pain. Radiographs showing diastasis of the normal architecture confirm the presence of a severe sprain and possible dislocation. Negative standard and weight-bearing radiographs do not rule out a mild (grade I) or moderate (grade II) sprain. Reevaluation may be necessary if pain and swelling continue for 10 days after the injury. Proper treatment of a mild to moderate Lisfranc injury improves the chance of successful healing and reduces the likelihood of complications. Patients with fractures and fracture-dislocations should be referred for surgical management.

Adult↗
PubMed2003

Patterns in childhood sports injury.

OBJECTIVE: The purpose of this epidemiologic study is twofold: first, to determine the relative frequency of sports-related injuries compared with all musculoskeletal injuries in patients 5 to 21 years of age presenting to the emergency department (ED), and second, to evaluate the sports-specific and anatomic site-specific nature of these injuries. METHODS: Patterns of injury in patients 5 to 21 years of age presenting to four pediatric EDs with musculoskeletal injuries in October 1999 and April 2000 were prospectively studied. Information collected included age, sex, injury type, anatomical injury site, and cause of injury (sports-related or otherwise). Information about patient outcome and disposition was also obtained. RESULTS: There were a total of 1421 injuries in 1275 patients. Musculoskeletal injuries were more common in male patients (790/62%) than in female patients. The mean age of the patients was 12.2 years (95% CI, 12.0-12.4). Sprains, contusions, and fractures were the most common injury types (34, 30, and 25%, respectively). Female patients experienced a greater percentage of sprains (44% vs 36%) and contusions (37% vs 33%) and fewer fractures (22% vs 31%) than male patients. Sports injuries accounted for 41% (521) of all musculoskeletal injuries and were responsible for 8% (495/6173) of all ED visits. Head, forearm, and wrist injuries were most commonly seen in biking, hand injuries in football and basketball, knee injuries in soccer, and ankle and foot injuries in basketball. CONCLUSIONS: Sports injuries in children and adolescents were by far the most common cause of musculoskeletal injuries treated in the ED, accounting for 41% of all musculoskeletal injuries. This represents the highest percentage of sports-related musculoskeletal injuries per ED visit reported in children to date. As children and adolescents participate in sports in record numbers nationwide, sports injury research and prevention will become increasingly more important.

Adolescent↗