Injuries caused by brake pedal loading of the midfoot.

In a frontal car crash, the driver’s foot and ankle may be injured due to loading by the brake pedal. The driver of a vehicle often has time to initiate emergency braking before an impending collision, which places the forefoot or midfoot over the brake pedal. During the crash, the pedal may induce dorsiflexion and axial loading of the ankle due to forward motion of the occupant and rearward intrusion of the pedal relative to the vehicle. In order to investigate the injuries caused by pedal loading, impact tests were conducted on three cadaveric lower limbs. The limbs were braced at the knee, and a pedal positioned beneath the midfoot was driven towards the knee, inducing dorsiflexion and axial loading of the cadaveric limb. Ankle injury was generated in two specimens. Both injured limbs sustained a medial malleolar fracture, and one limb also suffered a talar neck fracture. These results suggest that pedal loading may be an important injury mechanism for fractures of the medial malleolus and talar neck in drivers involved in frontal crashes.