Foot and ankle pain are common occupational problems that many people experience, yet these issues are often overlooked. Foot and ankle disorders are considered one of the main musculoskeletal problems in the workforce. As a result, it is important to increase awareness and understanding of how foot and ankle conditions develop and how to prevent them. In doing so, the number of people affected by these disorders can be alleviated, as well as the number of severe cases reduced. This can also help to decrease the amount of sick leave taken, improve worker productivity, and help to lower the cost for worker’s compensation. These beneficial results can be achieved by maintaining a focus on preventing foot and ankle disorders.
Common Occupational Factors
Footwear plays an enormous role in foot health for everyone, but it is of even greater importance for those that are often standing for prolonged periods of time at work. The type of shoe and fit can greatly affect the amount of pressure and stress that is applied to the foot. Studies have shown that the amount of pressure on the bottom of the foot while standing is doubled when wearing a shoe with a hard sole as compared to being barefoot. The same study also concluded that there is considerably less pressure on the foot and heel when walking in athletic shoes as compared to work shoes. This is very significant as greater pressure translates to greater stress on the soft tissue and bones of the foot. High heels are also a common choice of footwear. Although they are not the direct cause of any specific foot ailment, they have been shown to cause an increase in forefoot pressure, often leading to painful conditions.
Many people are required to stand for long periods of time while carrying out their duties in the workplace. Professions such as teaching, retail, waiting tables, and working in a factory require workers to be on their feet for most of the day. This can take a toll on the lower extremities, causing foot and ankle pain. One common problem that causes foot pain from prolonged standing is plantar fasciitis. Plantar fasciitis is an inflammation of the band of tissue (plantar fascia) that extends from the heel to the toes. The plantar fascia supports the arch of the foot and acts as a shock absorber. When standing for long periods of time, the fascia becomes overstressed and results in micro tearing and then inflammation. Another common problem is tired and aching feet. This can be due to simple fatigue of the soft tissue of the foot because it is not used to standing for so long. It can also cause the feet to swell, leading to discomfort and various foot problems.
Standing for Prolonged Periods
Leg pain and fatigue caused by prolonged standing have been shown to be significantly increased when compared to sitting. This, in turn, has negative effects on task performance. One randomized control trial investigated the effects of leg pain on simulated work assembly tasks in a laboratory setting. It was found that those with induced leg pain took longer to complete the tasks and were more likely to cease work due to the pain. Even after the pain was no longer present, individuals who had experienced leg pain performed worse than those who had not. This suggests that prolonged standing and the leg pain it causes can hinder job performance and productivity. This also has negative economic implications. For example, in a worker’s compensation case relating to varicose vein stripping surgery, it was argued that the work had resulted in the development of varicose veins and had hindered the claimant’s ability to perform his job effectively.
Prolonged standing, such as that experienced by salespeople, teachers, and factory workers, has been demonstrated to negatively influence lower extremity pain. This is particularly true for muscle fatigue and pain. In a study investigating the relationship between occupational standing and chronic venous insufficiency, it was found that occupational standing significantly increased the likelihood of the respondents having bilateral and severe symptoms. This was compared to those who did not have an occupation that required prolonged standing. Teachers, in particular, are susceptible to leg pain due to varicose veins, with a prevalence of 70% compared to an average of 25% in the general population. There is also evidence to suggest a link between prolonged standing and joint disease. Although it is not entirely clear whether occupational standing is a causative factor for osteoarthritis, one study demonstrated a significant association between occupational knee bending and standing/squatting activities. Workers who stood for greater than 6 hours per day had a two-fold increased risk of tibiofemoral osteoarthritis compared to those who did not have an occupation with prolonged standing. A similar exposure response was observed for frequent squatting. This evidence substantiates the possibility of a causal relationship between prolonged standing and joint disease, which has considerable implications for foot and ankle pain. Such evidence has led to the establishment of recommended exposure limits for occupational activities that involve knee bending and heavy lifting in an effort to prevent disability due to joint disease.
Wearing Inappropriate Footwear
Forefoot width is usually not a consideration when people are buying shoes. Ill-fitting shoes can lead to a variety of disorders in the foot, with skin lesions arguably being the most common problem. In a study, it was found that in the United States of America and Germany, 36-39% of the population had one or more corns. Corns were significantly related to surgery, impairment, and a wide variance of pain disorders. The major factor reported by all groups was that the subjects’ footwear was too narrow. Other skin lesions such as blisters, calluses, and ingrown toenails are also linked to ill-fitting shoes. Blisters in the athletic population can also lead to ulcers and have been regarded as a major issue for people requiring rehabilitation for foot injury.
Inappropriate footwear is a considerable contributing factor to pain and injury in the lower extremity. The foot functions as a dynamic structure, and the interaction between the foot and shoe can influence the stress on the musculature and the joint structures of the foot and lower extremity. Factors such as heel height can excessively load the forefoot. A study found that heel height was directly related to the increase in forefoot pressures. They found that wearing a 3.8 cm and 6.4 cm heel significantly increased the pressures under the first MTP joint and second MTP joint.
Repetitive Motions
Repetitive movements can cause an increase in activity for certain muscles, resulting in pain due to overuse or to a build-up in muscle tension. For example, electromyography data has shown increased activity and fatigue in the tibialis posterior with prolonged periods of standing. This has implications for those required to stand and walk a lot at work, as the tibialis posterior is an important dynamic stabilizer of the medial longitudinal arch and provides support for the foot, and overuse can lead to symptoms of its overloading or to insertional tendonitis at the medial rearfoot.
Workers who are required to carry out the same task or movement continually are at risk for foot and/or lower limb pain. Movements can range from high intensity such as constant lifting on shoulders, moderate intensity such as frequent stair climbing, and low intensity involving long periods of standing.
Ergonomic Solutions
An ergonomic approach recommends that individuals should seek to wear supportive footwear, which is a different concept from footwear mobility strategies. This is of particular importance for the older individual or person with a lower extremity injury who is seeking to reduce the additional risk factors associated with footwear choice on task performance. In prosperous individuals or those seeking to avoid added stress on their foot and ankle, an orthotic device can be used within the footwear to add further support and/or to help initiate movement to a lesser pain-riddled body state. An example of this is a later onset of custom-made orthoses to reduce pain associated with rheumatoid arthritis.
To enhance the health of your foot and ankle, appropriate musculoskeletal function should be the goal of any ergonomically based program. There is evidence to suggest that the use of an ergonomic approach, which identifies and then reduces the physical stress on the body that can hinder musculoskeletal function, is effective in reducing the incidence of foot and ankle pathology. As the majority of people spend approximately 40 hours at work within a 5-day week, it seems more than reasonable to suggest that emphasis should be given to occupational ergonomics in order to maintain worker foot and ankle health. This method is supportive in nature, by identifying the risk factors and intervening to reduce their presence in an effort to avoid the development of further osteoarthritis.
Proper Workstation Setup
When setting up a workstation for a single task, bending and moving the knee or hip away from neutral position increases the risk of pain or injury. To decrease the risk for chronic injury or pain in the foot, ankle, knee or hip, it is important to minimize sustained postures. Prolonged sitting can result in static loading of the back and lower extremity. This occurs because the person is sitting, but the muscles of the lower extremity and trunk are engaged to maintain a seated position. This is a very inefficient way to perform a sedentary task. Over time it can lead to increased risk of injury and pain. To decrease static loading, it is important to change positions frequently and shift the weight off of one side of the body. This can be accomplished by using a sit/stand stool or a stool with a footrest to enable the person to offload one lower extremity. Also, changing from a seated to a standing position can unload the back and lower extremity. This can be accomplished with an adjustable height work surface. Recently, there has been a rise in the use of treadmill desks. This type of workstation has shown to be effective at reducing lower back pain and its associated functional limitations. This type of mobile workstation results in an average weight loss of 3.6-4.6 kg/year. While this may not be suitable for every task, data suggests that there are many benefits to decreasing sitting time during the workday.
Regular Stretching and Exercise
There are a number of stretch exercises that can be done to help prevent and alleviate foot and ankle pain. For stretches surrounding the ankle joint, consider circling the shin and foot clockwise and then counterclockwise for 2-3 minutes each. This can help to maintain mobility in the ankle joint. An alternative exercise is to sit the affected side out straight and work the foot up and down to point and flex the toes. Hold each flex position for 10 seconds and repeat this exercise 10 times. This provides a simple but effective stretch and strength to the muscle on the back of the shin.
– Move into the stretch position slowly and avoid bouncing, which may actually tear muscles. – Stretch on both sides, even if the pain is only on one side. – Do not avoid stretching before exercise, but it is also very important to stretch after exercise. – Where possible, hold a stretch for at least 20 seconds.
As professionals look for ways to prevent and alleviate foot and ankle pain, it is important for them to participate in regular stretching exercises. Stretch exercises can help maintain foot mobility while providing a stretch and strength to the muscles of the foot. When doing any stretch exercises, it is important to remember the following:
Using Supportive Footwear
Although footwear may be of little importance in the working environment of an office or administration worker who is frequently seated, it is a significant factor for those who are subject to prolonged periods of standing and/or walking tasks. So, the usage of supportive footwear has an important role in the prevention of foot and ankle pain, especially for those whose footwear is currently inappropriate for their work situation.
It should be realized that certain foot disorders are also due to hereditary factors. But despite this, the use of appropriate footwear can still determine the compromise to foot health from these congenital conditions. This, in turn, can also affect the outcome or recovery from an acute musculoskeletal or traumatic incident. So, in brief, all these factors are the occupational etiology of foot and ankle disorders in the workforce.
Foot and ankle injuries account for 12-20% of all industrial injuries. Pain and discomfort in the lower extremities is the main reason given by workers as to why they shift from standing work to seek more rest. Foot and ankle pain can also lead to pain further up in the kinetic chain, thus inducing pain in the knees, hips, and back. The key factor in the progression of a foot and ankle disorder is compromised foot mechanics. So, inadvertent tipping, bouncing, shifting, and increased pressures under the foot from unfavorable or poor footwear affect the balance and coordination of movement of lower limbs, which in turn predisposes the lower limbs to stresses and strains that cause injury and/or pain.
Ergonomics is defined as the study of the relationship between workers and their environment. The goal of workplace ergonomics is to create a work environment that is conducive to worker productivity and health. This is important because the effects of work-related musculoskeletal disorders (MSDs) have both social and economic impacts. These effects can range from mild discomfort to severe chronic pain and disability. In the United States alone, direct and indirect costs of MSDs are about $15-20 billion annually.
Taking Breaks and Alternating Tasks
An effective method to prevent pain and disability is to implement an exercise intervention at the workstation to improve conditioning, reduce body weight and lower extremity loading, and increase flexibility. This approach can significantly improve or prevent foot and ankle pain that is associated with excessive weight or obesity, lower extremity osteoarthritis, and weight bearing occupational tasks.
In a focused repetitive task, breaking up the duration of that task with rest periods that include changing body positions and/or stretching is well established. Ideally, the length of time required to complete an activity or work task that is primarily done in one position should be limited to 30-60 minutes. At the end of this time, the work should be changed to a different task or the individual should take a 5-10 minute break. During these breaks, stretching activities should be implemented to offset musculoskeletal disorders, including foot and ankle pain.
In a survey investigating the prevalence and causes of foot and ankle pain in an urban black community, health care seeking behavior was low (45%), and the most cited reason for not seeking care was that pain was not serious enough to seek care (47%).
We recommend hourly five-minute breaks to interrupt the work and provide a new focus and mental rest. Promote the regular use of available vacation time, particularly for individuals who work in a sitting or standing position. Integrate the use of task rotations to alternately and interchangeably assign employees to various tasks to reduce the duration of a specific, potentially harmful duty. Provide in-between shift breaks and establish a limit on overtime work. Remember it takes less time to prevent a musculoskeletal disorder than it does to treat one.