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Injuries to the leg and foot account for about 13% of traumatic wounds evaluated in the ED, distributed roughly into a third each for the foot, calf, and knee and thigh regions.1 Traumatic wounds to the foot can be sustained in a variety of ways, from simple plantar puncture wounds to catastrophic lawn mower injuries. The leg or foot is commonly injured in sports and recreational activities.2 Urban children can sustain foot lacerations while playing in water from fire hydrants, mostly due to stepping on broken glass.3 Bicycle spoke injuries result in complex lacerations with marked surrounding abrasions and even tissue loss, usually occurring over the Achilles tendon area.4 Metal lawn and garden edging is associated with plantar and knee lacerations.5 Home exercise equipment, particularly exercise bikes and treadmills, are a cause of lower extremity lacerations, fractures, and dislocations in children.6 Hockey skates are associated with boot-top injuries; typically these consist of a small cutaneous laceration with injury to the underlying tibialis anterior tendon, extensor hallucis tendon, and dorsalis pedis artery and nerve.7 High-pressure water spray cleaning systems cause complex laceration-injection injuries.


Lawnmowers are also a common cause of lower extremity injury. For children in the U.S, lawn mower injuries cause an estimated 3400 injuries to the lower extremity, feet, or toes each year.8 Lacerations are the most common injury sustained by children in lawn mower injuries, followed by burns, amputations, fractures, and nonlaceration soft tissue injures. Injuries to lawn mower operators are usually sustained from the blades of push mowers, often when being pulled backward.9 Children bystanders can be injured by riding mowers.10 Lawn mower–induced foot lacerations can also be sustained from debris flying out from the undercarriage. Unfortunately, footwear often does not provide protection from these injuries. Importantly, all lawn mower-induced lacerations are typically heavily contaminated with multiple organisms.


During standing and walking, the soles of the feet are in contact with the ground. The relatively small surface area of the sole tells the body about its position and the terrain being traversed. The plantar epidermis and dermis are thick, except in the arch area. This thick skin is able to withstand the force produced by a moving body, but is also quite sensitive to two-point discrimination and pressure. The primary “shock absorber” in the sole of the foot is a modified layer of fat. The heel has an 18-mm-thick modified pad of fat separated into chambers by fibrous septae. There is an additional broad internal fibrous arch, called the inner cup ligament, that helps maintain the shape of the heel. The skin of the sole readily hypertrophies and can become quite thickened, especially in people who walk barefoot. The dense fibrous fatty tissue of the ball of the foot and heel makes wound exploration and visualization difficult in the ED. Lacerations to the arch, although less common, are more readily explored.


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