My four-year son got in a lawnmower accident in February and lost his big toe on his left foot.
He has now recovered and wears normal shoes. i was wondering if you think that he may need a toe filler for his shoe or if you think he would do fine without one. He does not complain at this point but then again he is four. If he does need one how would i go about getting that if needed?
Dr. Nirenberg replies:
I am sorry to hear about your son’s accident, but ecstatic to hear how well he seems to be coping with this traumatic injury!
Lawnmower injuries of the feet and toes are more common than most people realize–and often to children. Each year in the U.S. approximately 9400 children suffer lawnmower injuries.
According to David Vollman and Gary Smith (PEDIATRICS Vol. 118 No. 2 August 2006, pp. e273-e278 (doi:10.1542/peds.2006-0056)
“The lawnmower voluntary safety standard American National Standards Institute/Outdoor Power Equipment Institute B71.1-2003 should be revised to include more rigorous performance provisions regarding prevention of penetration of feet and toes under the mower and into the path of the blades.”
Vollman and Smith also recommend setting the lawn mower so it cannot go in reverse.
When persons have a toe amputated, whether as a result of a lawnmower injury or other reason, these people will often have a toe filler made that takes the place of the missing toe or toes. Toe fillers are spacers that fill the space where an amputated toe or toes would’ve rested. The toe spacer helps the person walk normally and prevents drifting of the other toes into the area of the absent toe or toes.
In the case of your young child, whether to use a toe spacer or not is less clear. Some people in the business of making these spacers (such as orthotists, prosthetists or podiatrists), would say the spacer is necessary. If you choose to have a spacer made, a podiatrist or these other specialists can make one for your son. Keep in mind that you will need a new spacer made rather often—to accommodate your son’s growing foot!
An argument could be made though, given the young age of your son and the ability of a child’s foot to ADAPT, that the spacer MAY not be necessary.
The lesser toes may “take over” for the loss of the big toe and your son may never need the spacer. One thing is almost certain: if you give him a spacer now, he will need one for life.
You may hold off on the spacer for now and very carefully watch the foot as it develops. If your son continues to ambulate well, he may be fine and never need the spacer. I would recommend having a podiatrist observe your son’s foot with you, perhaps seeing the podiatrist every three to six months for the next few years.
As an aside, if you decide against a spacer, this would be an interesting case study to present and I would love you to take photos of his foot over the next few years—this might turn out to be a case even worthy of publication.
Final Thoughts on Cutting Down Lawnmower Injuries to Children
Parents need to do their best to supervise their children around lawn mowers.
Young children are not just at risk for injury or amputation from a lawnmower injury, but could possibly die from a severe lawnmower accident.
Don’t encourage your children to play with a lawnmower or use the lawnmower for rides–lawnmowers are not for transportation!
Remember that a lawnmower may look like an exciting toy to a young child, and as a result, never leave a lawnmower that is running unattended—especially, when children are in the vicinity. In fact, tell your children they need to be inside the house whenever you are cutting the lawn. If your child steps outside, turn off the lawnmower immediately.
And lastly, of course, always wear closed-toe shoes (not flipflops!) when operating a lawn mower.
Vollman D, Smith GA, “Epidemiology of Lawn Mower–Related Injuries to Children in the United States, 1990–2004” PEDIATRICS Vol. 118 No. 2 August 2006, pp. e273-e278 (doi:10.1542/peds.2006-0056