Shoes and driving. Foot injuries
An unsuitable shoe can cause health problems as well as risks while driving.
As well as fitting the length and width of the foot, good shoes should provide anteroposterior flexibility, and transverse flexibility should also be present in the metatarsalphalangeal joint region, allowing the foot to bend to release or press down on the car’s pedals.
On the other hand, driving shoes should support the foot correctly; both at the heel where it should hold the calcareous bone in a relaxed and physiological position, and at the instep.
The ideal support for the instep is provided by lace ups, which should do up along the centre of the foot, allowing plenty of space for the toes which should be free of lateral and distal pressure.
The soles of driving shoes should preferably be made of rubber, which provides optimum adherence to the pedals and the floor of the vehicle.
Heels are always unsafe for driving, and because of this, the smaller they are, the better supported the driver’s feet will be.
Rugs in poor condition can twist around or develop holes, which are the worst enemy of women’s heels, as they increase the risk of losing control in an unforeseen situation on the road.
From the above, it can be seen that the majority of shoes suitable for city wear are sufficient for safe driving.
Correctly laced trainers are very efficient, while sandals and open backed clogs are dangerous.
Driving or travelling as a passenger on a motorcycle or moped means wearing high-legged boots at all times, as the limbs are vulnerable while using this type of vehicle.
Falling off a motorcycle grazes the skin when it comes into contact with the surface of the road and the foot is too vulnerable not to suffer serious injury in these situations.
On the other hand, the high leg of the boot will protect the ankle somewhat better, and the limitation it places on movements does not seriously interfere driving.
Some drivers are in the habit of using certain shoes for driving and changing out of them into more suitable attire when they leave the vehicle.
This is a sensible option, so long as no shoes are stored by the driver’s feet, as when using the brakes or doing other manoeuvres they could move around, perhaps getting stuck under the pedals and causing an accident.
In summer holiday areas, people often drive barefoot or wearing flip flops, which is a very dangerous habit, as if the driver needs to react quickly and use feet he won’t have the ability to safely apply pressure to the pedals.
This situation increases the level of damage suffered, as the driver can’t brake correctly. The same mistake made by the drivers and passengers of motorcycles and mopeds greatly increases injuries.
There are many reasons for temporary loss of foot function, and it is a good idea to remember them and warn our patients not to drive until their problems have completely cleared up.
We shouldn’t make light of any skeletal injuries, which can cause definitive sequelae that can disable the foot, which is an essential part of the body for walking and vital for driving.
These are very common and require special attention if the patient is to recover without sequelae, as untreated seriously twisted ankles can lead to relapses, chronic instability of the ankle and arthrosis.The usual treatment for sprained ankles is six weeks of rigid bandaging, non-steroidal antiinflammatories or a plaster cast to immobilize.
Total rupture of the Achilles tendon:
This is produced when the tendon is suddenly overstretched or a triceps contraction.Partial ruptures are treated by immobilization by means of a plaster cast.Surgical treatment is only carried out on total ruptures, and although weight can be put on the foot after six weeks, driving and sports are not permitted until at least six months later.
Fractures and luxations:
- Fractures of the astragalus are not common
- Fractures of the calcaneus are usually caused by falls. If surgery is required, recovery can take up to a year, and if pain persists subastragal fusion may be necessary
- Navicular fractures are not common. If partial, and associated with pulled muscle insertions, life can go back to normal after a month in plaster; if they are involve the navicular body, they require osteosynthesis and a long period off work
- Fractures of the metatarsals are common in the diaphysis of the intermediary metatarsals, requiring bandaging and an orthopedic sole, which limit movement for driving.
- The first and fifth metatarsals usually require osteosynthesis, which makes driving impossible for at least two months.Toe fractures are treated by fixing the fractured digit to its neighbour, and although this does not generally interfere with driving, it should be avoided as a precaution.
Fractures can leave many types of sequelae including retractile scars, paralysis, deformities, bony callous, pseudoarthrosis, trophic conditions, arthropathy and modification of plantar supports, among others.
- Driving is not possible when the foot is immobilized with a bandage or with plaster.
- Many foot fractures require a long time off work until they are cured, during which time driving is not allowed.
- The treatment of toe fractures doesn’t generally interfere with driving, but patients should be advised against doing so as a precaution.
- The specialist will make a recommendation in each case, depending on the treatment required for each illness and the patient’s ability to drive and will give the patient and update on this at each check up.
- Foot surgery requires varying periods of time to recover function and safety, and driving should not start again until a specialist issues a report in favour.
- After surgery, it is up to the doctor how long the patient must wait until he can drive without limitation again.
- All sequelae, including partial sequelae, can affect foot function.
- If sequelae remain, they should be evaluated within the context of their possible effects on driving and this should be reported to the patient, along with the possibility of recovery in time.
- The evaluation of patients in bipedestation or with movement on walking, running or carrying loads, in addition to using stairs, driving, and complications with shoes and residual pain can allow us to pinpoint functional limitations of the foot.
- All sequelae that limit movement, strength or sensitivity should be the subject of a detailed specialist report, giving details of the disability and the new situation and evaluating the patients driving possibilities, to ensure safety.
- Permanent disability can be evaluated by a specialist medical report so that a vehicle can be adapted to the driver and driving can be allowed within the limitation of the Law in each case.