The Foot and Industrial Consequences of Injury - Part 3

Saturday, January 29, 2005 | 0

This is the third article in a series of four by foot and ankle specialist, Dr. Jodi Schoenhaus. The first article contained facts about the human foot and possible ailments due to work-related injuries. The second article reviewed facts about the human ankle. This article discusses common work-related foot and ankle injuries and how to treat them. Earlier articles can be accessed by clicking on the title in the right side bar.

Part Three: Common Work-Related Foot and Ankle Injuries

It should be noted that most of the lower extremity injuries discussed in this series of articles require an initial week of rest and elevation, ice, anti inflammatory or pain management, and cast immobilization. After the acute phase of healing from an injury is complete, the patient will usually require additional immobilization and rest. For some people, this may require complete bed rest, however, for the majority of injuries and conditions, the patient can be given a temporary position at work where they perform sedentary duties and the limb can be elevated.

Positions that require a lot of movement or utilization of crutches may lead to continued pain due to having the foot and ankle in a dependent position instead of elevated. Work in the field is limited and a desk position is usually acceptable until healing and rehabilitation has occurred. Some injuries that require four to six weeks of cast immobilization, whether in a walking boot or a below knee cast will lead to cast disease. This is a condition where there is stiffness of the joints and muscle atrophy. A work hardening program is utilized in this scenario.

Numbness and tingling, burning and sharp, shooting pains that persist in the office are usually associated with a nerve injury. A minor injury to a nerve, causing a bruise or contusion to the sheath surrounding the actual nerve fibers, will cause sensations of burning and tingling and sharp, shooting pains. Forefoot fractures or injuries of the tarsometatarsal joint commonly seen with crush injuries and in workers wearing steel toed shoes can result in the neuritic type of pain.

Steel-toed shoes are highly recommended in the working field, however injuries can occur in this area. Most of the injuries that are noted with steel toed work boots are due to a crush or breaking of bones where the end of the steel portion of the shoe meets the foot. This can lead to chronic neuritis and pain. Most nerve related injuries will heal uneventfully, however, it does take a reasonable amount of time. Nerve tissue heals approximately 1mm a day and is a slow and painful process. Unilateral foot pain with signs of nerve injury is usually associated with a lower back injury and these patients are usually sent to a neurologist or spine specialist. A slipped disc or compression on a nerve can cause pain in the foot.

Although chronic nerve pain is debilitating, one must be able to recognize the true presence or absence of the pain. Chronic regional pain syndrome (CRPS) is a condition that includes Type I or Reflex sympathetic dystrophy (RSD) and Type II Causalgia. Direct trauma to a nerve does not need to occur in RSD, however, if there is direct trauma to a nerve, the condition is causalgia. There are various stages of RSD and when it is diagnosed and treated early the results can be promising.

Diagnosis of RSD is made by a corroboration of clinical examination, bone scan, nuclear imaging studies, and sympathetic nerve blocks. For causalgia where there is direct trauma to a nerve, the diagnosis can be made through an EMG/ nerve conduction velocity studies. Aside from the patient complaining of debilitating pain, with RSD there are various signs that a physician can note. In early stages, one will experience sweating, reddening, shiny appearance of the skin, warmth to the touch, and pain that is out of proportion. Later changes include disuse atrophy, osteopenia and stiffness as well as coolness and a bluish tone of the skin.

Patients who do have RSD or causalgia will require intense physical therapy as well as sympathetic blocks or other therapeutic modalities. Again, the prognosis is good if the diagnosis is made with early onset of symptoms and treatment is initiated. If not treated early, chronic pain can last many years to a lifetime.

The fourth and final article in this series will discuss diabetes and the foot.

Contributed by foot and ankle specialist, Dr. Jodi Schoenhaus of Total Orthopaedic Care, Ft. Lauderdale, FL. Dr. Schoenhaus can be reached at 954-735-3535.

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