Footwear and falls: a case involving new cowboy boots

We present a case in which footwear contributed to a fall that resulted in a severe closed head injury. The woman in this case was wearing new cowboy-style boots with 1.5-inch heels that placed her ankles at a position of 25 degrees plantar flexion. Each boot heel tapered at a 50 degrees angle at its posterior edge. A steel shank protruded 2.5 in posterior to the metatarsal head, serving as the anterior contact surface in lieu of normal metatarsal contact. The design of the boot plus the fact that she was carrying groceries, reduced her ability to regain her balance after she slipped, and she fell backward, hitting the floor with full force on the occiput. Initial computed tomography scan showed large subdural and epidural hematomas and hemorrhagic contracoup contusions. The patient developed clinical signs and symptoms of secondary brainstem injury, which was later substantiated by magnetic resonance imaging scan.