Complex forefoot injuries in motorcycle couriers

We reviewed all the severe forefoot injuries admitted to two urban hospitals over a 12-month period. These included 13 tarsometatarsal injuries, of which nine occurred in motorcycle couriers. Analysis of these nine patients suggests a combination of direct trauma leading to open multifragmented metatarsal fractures, and indirect force with dorsiflexion and rotation leading to midfoot disruption. In two cases there was significant other trauma which led to delayed treatment. In six of the nine cases, inadequate footwear was noted. All the patients underwent operative reduction and stabilization, and two necessitated later plastic surgical intervention. Our review suggests that motorcycle couriers are at significant risk of severe forefoot and midfoot trauma. A high index of suspicion is necessary when such patients are admitted with multisystem injuries. Education regarding correct footwear is also warranted.