R. Schubert, M. Junge, H. Zwipp

• The accident research of Hanover and (from 1999 on) Dresden registered 736 leg injuries (AIS ≥ 2) from 1983 to March 2007. 174 of these injuries (23.6 %) were fractures or dislocations of foot and ankle. 149 feet of 141 front seat car occupants in 140 cars were affected. Of these 117 were drivers, 24 were front seat passengers. The mean age of occupants was 38.5 -± 16.8 years. Ankle fractures were the most frequent injury (n = 82; 80 malleolar fractures, 2 pilon fractures). 34 fractures and dislocations affected the hindfoot (5 talus and 26 calcaneal fractures, 2 subtalar dislocations and 1 subtotal amputation) , 16 to midfoot (4 navicular fractures, 5 cuboid fractures, 3 fractures of cuneiformia, 2 dislocations of chopart joint, 1 subtotal amputation, and one severe decollement) and 39 the forefoot (metatarsal fractures). Open fractures were seldom seen (2 malleolar fractures, 1 metatarsal fracture). Both feet were injured in 10 cases. 33 occupants (23.4 %) were polytaumatic had a polytrauma, 17 of them died. 81 percent of the occupants were belted. The cars were divided in pre EuroNCAP (year of manufacture 1997 and older) and post EuroNCAP cars (year of manufacture 1998 and newer). Most of the foot injuries were seen in pre EuroNCAP cars. Most of the occupants sat in compact cars (40 drivers and 9 front seat passengers) and large family cars (27 drivers and 7 co-drivers). 49 of 140 accidents occurred on country roads, 26 on main roads and 13 on motorways. The crash direction was mostly frontal. Generally were found no differences of delta v- and EES-level between the injured foot regions, but divided into pre- and post-EuroNCAP cars there was a tendency to higher delta v- and EES-levels in newer cars. The frequency of foot injuries increased linearly with increasing delta v-level; but above delta v-level of 55 km/h the linear increase only was seen in pre-EuroNCAP cars, post-EuroNCAP cars showed no further increase of injuries. The footwell intrusion showed no difference between the injured foot regions but pre-EuroNCAP cars had a tendency to higher footwell intrusion. There were no differences in footwell intrusion between the car types. Only 29 of 174 fractures or dislocations of foot were seen in post-EuroNCAP cars, the predominate number of these injuries (n = 145) were noticed in pre-EuroNCAP cars. A lower probability of long-term impairment was found in post-EuroNCAP cars for equal delta v levels, using the AIS2008 associated Functional Capacity Index (FCI) for the foot region.