The research question investigated in this study is what are the key attributes of foot and ankle injury in the between-rail frontal crash? For the foot and ankle, what was the type of interior surface contacted and the type of resulting trauma? The method was to study with in-depth case reviews of NASS-CDS cases where a driver suffered an AIS=2 foot or ankle injury in between-rail crashes. Cases were limited to belted occupants in vehicles equipped with air bags. The reviews concentrated on coded and non-coded data, identifying especially those factors contributing to the injuries of the driver's foot/ankle. This study examines real-world crash data between the years 1997-2009 with a focus on frontal crashes involving 1997 and later model year vehicles. The raw data count for between-rail crashes was 732, corresponding to 227,305 weighted, tow-away crashes. A previous study suggested that the frequency of between-rail crashes (where the direct damage is between the 2 longitudinal rails) is about 6.1% of all frontal crashes. Further, it was suggested that the between-rail crash has a higher risk of AIS ≥ 2+ fatality than any other crash type studied. For between-rail crashes, approximately 15% of the AIS ≥ 2+ fatality injuries were to the foot or ankle. The distribution of AIS = 2 injuries is presented by anatomical structure for the foot and ankle. The significance of the results is that the between-rail frontal crash inflicts high levels of disability on the driver.