Foot-ankle injuries have increased in relative importance in the recent years. As a basis for future countermeasures, an epidemiology study has been undertaken in which Swedish accident data from Folksam Insurance was used. The database consists of 805 foot-ankle injuries out of 57,949 car occupant injuries reported from 1985 to 1991.

The influence of crash location, seating position and occupant age is determined for the frequency and relative risk of foot-ankle injury in car crashes. Frontal car crashes produce 76% of the AIS 2-3 foot-ankle injuries with 13% in side impacts and 8% in roll-overs. The relative risk of AIS 2-3 foot-ankle injury is 13.9 per 1000 injuries in all crash locations and is similar irrespective of seating positions. Ankle fractures and sprain both occur at a rate of 3.7 per 1000 injuries, followed by malleolus fractures at 2.7 and metatarsal fractures at 2.4.

The relative foot-ankle injury risk is significantly greater (p<0.01) in near oblique-frontal crashes than for 12 o'clock frontals. For drivers in 11 o'clock and front passengers in 1 o'clock, the relative risk is 27.8 per 1000 injuries as compared to 17.5 for drivers and front-passengers in 12 o'clock crashes.

Occupant age is not as significant as seating position and crash location;​ however, there are higher relative risks for rear occupants > 60 years old in oblique frontal crashes.

Using the new AAAM Impairment Injury Scale (IIS), 48% of the foot-ankle injuries are rated with residual impairment IIS 1-2. The relative risk in near-seated occupants is 1.5 times greater in oblique frontal crashes than in frontals. The relative risk for IIS 1-2 impairment in near oblique-frontal crashes is 12.8 per 1000 occupant injuries as compared to 8.3 in frontal crashes.