Both motorcyclists and cyclists can sustain spoke injuries if not wearing the proper footwear. Bicyclists get more spoke injuries than motorcyclists because two riders will often ride on a vehicle meant for one person. The rider on a motorcyclist is also at risk for spoke injuries if he or she is riding behind the driver.
The heel is the part of the body most injured in spoke injuries. In one study, 42 patients who had sustained a spoke injury received a heel flap to repair their spoke injury. These were selected from among 216 patients, all who sustained some type of lower extremity injury. The researchers graded the injuries from Class l-lll, depending on the extent of the injury and on its severity. The classification of the injury determined the treatment.
Posterior heel injuries were covered with different types of flaps, depending on how big the defect was, where the defect was and how complex the defect was. A total of eighty percent of the heel injuries were on the right side of the body because the chain guard covers the spokes on the left hand side of the vehicle. Having poor footwear made a big difference in getting a heel spoke injury. A total of 57 percent of spoke injuries were felt to be due to the design of the motorcycle.
Heels injured in spoke injuries heal much more slowly than other injuries, even when there is no secondary calcaneus fracture. It is the momentum of the motorcycle and the rigidity of the spokes that causes these types of injuries.
Prevention of these injuries has not improved at all since half a century ago. Protective foot gear should be a must, especially for motorcycle riders and changes in the rear wheel design are necessary.
With regard to a bicycle spoke injury, what you see is often just the tip of the iceberg. It generally affects the passenger on a bicycle but the driver could be affected as well. Children will often put their feet into the front or rear wheel, trapping the limb between the spokes of the wheel and the fork of the bicycle frame.
The injury may look minor but in fact, there has been a great deal of tissue necrosis going on. The treatment of such an injury cannot be passive or conservative. Active treatment is necessary. The wound must be completely debrided with rest and elevation of the limb for several days. If the doctor simply sutures the wound, it is often dehisced later, causing more problems. This can result in a long period of healing by secondary intent. What is recommended is careful debridement of the wound followed by skin grafting procedures. The subcutaneous fat around the heel needs to be removed in order to maximize the success of the graft. In order to prevent these types of injuries from happening, there needs to be legislation or public pressure to put guards on bicycle wheels and to discourage two riders riding on a bicycle intended for one rider.