title: Escalators, rubber clogs, and severe foot injuries in children.
abstract: BACKGROUND
  Reports in the media suggest that escalator-related foot injuries are on the rise. Trendy, bright-colored rubber clogs have been implicated in a significant number of these incidents involving children. We review the children who sustained severe foot injuries on escalators, were wearing rubber clogs at the time of injury, and who were admitted to hospital for emergency surgery.
  
  
  METHODS
  A list of children who sustained foot injuries on escalators was generated from the hospital database and included for study. From clinical chart review, demographic data, footwear type, and injuries sustained were recorded. Inpatient or outpatient treatment rendered was also recorded for each patient.
  
  
  RESULTS
  Between September 2006 and September 2008, we treated 17 children for escalator-related foot injuries. There were 10 boys and 7 girls who were between 2 and 9 years of age (mean: 5.5). Thirteen children (76.5%) from this group were wearing rubber clogs at the time of injury. Nine of these 13 (69.2%) children sustained severe foot injuries that required admission to hospital for emergency surgery and are the focus of this study. One child had an unsalvageable traumatic amputation of the great toe at the level of the interphalangeal joint. Two children sustained crush injuries to the great toe: 1 with severe degloving and the other with an open fracture of the proximal phalanx. One child had an open fracture-dislocation of the second metatarsophalangeal joint with a comminuted fracture of the second metatarsal. Five children sustained multiple deep lacerations in the foot and 2 of them had associated cut tendons that required repair. In the group not wearing rubber clogs, 3 of 4 children had severe foot injuries. In this series, 4 children with rubber clogs and another child with a different footwear sustained minor injuries; they were treated as outpatients.
  
  
  CONCLUSIONS
  Escalator-related foot injuries involving rubber clogs can result in severe crushing of the foot and even traumatic amputation. The broad toe-box design may give a false perception of the distance between the foot and the side of the escalator, whereas the 'softness' of these rubber clogs makes them vulnerable to crush by moving escalator steps. This is the first report in the literature describing escalator-related severe foot injuries in children who were wearing rubber clogs. Injuries sustained can be significant and permanent. The potential dangers of escalators and rubber clogs must not be underestimated.
  
  
  METHODS
  Level IV, Case Series.
authors.affiliation: Department of Orthopaedic Surgery, KK Women's & Children's Hospital, Singapore. Kevin.Lim.BL@kkh.com.sg
authors.forename: Kevin Boon Leong
authors.initials: KB
authors.lastname: Lim
authors.forename: Inn Kuang
authors.initials: IK
authors.lastname: Tey
authors.forename: Elvin Salioc
authors.initials: ES
authors.lastname: Lokino
authors.forename: Robert Tze-Jin
authors.initials: RT
authors.lastname: Yap
authors.forename: Dingrin Khawn
authors.initials: DK
authors.lastname: Tawng
mesh_terms: D017677:Age Distribution; D000673:Amputation, Traumatic / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D004607:Elevators and Escalators; D005260:Female; D018409:Foot Injuries / Q000453:epidemiology* / Q000209:etiology*; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D018570:Risk Assessment; D012408:Rubber; D017678:Sex Distribution; D012775:Shoes / Q000009:adverse effects*; D012846:Singapore / Q000453:epidemiology; D017695:Soft Tissue Injuries / Q000453:epidemiology / Q000209:etiology; D014034:Toes / Q000293:injuries
chemical_list: D012408:Rubber