Dr. William Scholl, designer of the Dr. Scholl's foot product line, often commented, "When your feet hurt, you hurt all over." An employee's efficiency level, concentration, willingness to work and attitude greatly decrease when he is experiencing foot pain. This can lead to inattention on the part of employees, and, possibly, more injuries.
Detecting foot problems and resolving them quickly can also prevent injury to the knees, hips or back caused by "favoring" a painful foot, which is potentially more expensive, more severe and more difficult to relieve. In 1983, the American Podiatric Medical Association reported that 83 percent of the U.S. industrial work force had foot or lower leg problems resulting in discomfort, pain or orthopedic deformities.
Most businesses have replaced the wood floors from 50 years ago with concrete, which is damaging to the lower extremities because it provides minimal resistance and no shock absorbency. It is becoming obvious that the percentage of employees that have foot and lower leg pain is increasing because of the longer standing requirements on the cement flooring.
Causes of Foot Pain
The most influential activity or foot position that affects foot pain is the stance. When a person is standing, the feet are dealing with two strong forces, one coming from the heel-to-ground contact and one from the vertical weight of the person. The three movements that are termed the "gait cycle" are also important in causing foot problems. The longest phase of the gait cycle is the contact. This accounts for 27 percent of the entire cycle and is where most of the damage takes place.1 A common problem is pronation, which is when a person turns the foot towards the inside so the sole bears most of the body weight, and is constantly making unbalanced contact with the ground. This causes the person to re-adjust his knees, hips, pelvic region and back to align himself enough to walk. When there is an onset of foot pain, notes the American Podiatric Medical Association (APMA), an employee should be examined by a podiatrist in order to prevent complications with the knee, hips, back, etc.
Standing all day at a workstation can be especially detrimental to a person's body, according to the Canadian Centre for Occupational Health and Safety (CCOHS). Standing for long periods of time causes a decrease in the blood supply to the lower extremities and therefore increases fatigue and soreness in the muscles. Also, prolonged standing creates an accumulation of blood in certain areas of the feet and legs, which leads to irritated and inflamed veins, otherwise known as varicose veins. In addition, the continuous pressure on a person's feet causes bone misalignment and joint degeneration.
Working in a mobile, rotating station is still bad for the lower extremities, but is better than stationary positions. When a person is in a rotating position, he or she is able to stretch and exercise different muscle groups and can avoid excessive stress from prolonged standing. However, at a stationary workstation, the feet and legs are under unrelenting gravity pressure, causing localized pressure points in the heels and the balls of the feet.
Eventually, this pressure can lead to stretching and straining of the plantar fascia, known as plantar fasciitis. It is estimated that 2 million people require treatment for plantar fasciitis in the United States every year. Plantar fasciitis is often associated with heel pain, but it involves more than the heel, notes APMA. There are many different causes of this diagnosis including: prolonged standing, structural biomechanical imbalance, irregular movement and too much stress on the heel bone and attached tissues. Employees that stand on their feet all day are susceptible to this problem because of the amount of stress that is placed on the heel bone and the constant wear and tear of the connective tissues that comprise the plantar fascia.
The age of workers is gradually increasing as baby boomers (over 50 years old) keep their positions in factories and industries where standing all day is a job requirement. The age increase leads to more lower extremity injuries because when a person ages, all the tissues in the body, including ligaments, tendons and fascia, lose their elasticity. The fascia and tendons decrease their shock absorbency and become more susceptible to tearing. The aging person also loses the fat pads on the bottom of the feet that helped absorb shock. Lastly, there is a decrease in the range of motion in elder employees due to the arthritic changes that occur. The decrease in range of motion leads to more shock transmitted up the leg, knee and back because the foot joint no longer moves properly to absorb the shock.2
Preventing Plantar Fasciitis
There are three basic ways that employers can attempt to prevent inflammation of the plantar fascia and minimize the occupational injury costs. Employers can add anti-fatigue matting to standing workstations, employees can wear anti-fatigue insoles in their shoes, and employees can perform preventative stretching, icing and elevation before and after work.
Anti-fatigue mats are designed to decrease the stress on the feet and legs by providing a cushioning surface for people to stand on over prolonged periods of time, according to CCOHS. These mats can be made of rubber, carpet, vinyl or even wood.
A customized "Lower Extremity Symptoms Survey" was developed for evaluating lower extremity limb discomfort at manufacturing facilities where workers stand all day to perform their tasks. In recent pilot studies at an aluminum manufacturing plant and a large engine plant, employees in standing positions were either interviewed or asked to complete the survey themselves. The results indicated that the use of wooden bricks in the assembly line floor greatly decreased their foot, ankle, knee and back pain.
Both companies originally used wooden brick flooring. However, the aluminum plant is slowly replacing all the wooden bricks with cement as the bricks break. After speaking to employees, it was discovered that there was a significant degree of difference between their lower extremity discomfort when the old wooden bricks were in place and when the new cement was poured.
In order to compensate for the reported discomfort, the aluminum company provided rubber anti-fatigue matting at almost all standing workstations. This decreased some of the discomfort that began with the new cement floors. The anti-fatigue mats are most useful in stationary positions, because a mat may cause a tripping hazard to a mobile employee who is constantly moving on and off the mat.
Shoe insoles are ideal for mobile workstations. At the engine plant, there were numerous stations that required moving supplies repeatedly from one area to another area 20 feet away, which may be hazardous if mats are covering the floor. Insoles also provide relief by absorbing shock and preventing the degeneration of bone joints and bone structure.
The type of insole that will be most beneficial differs for each person. If an employee has pronated, or flat feet, then an arch support insole that has an arch build-up on the inside portion of the insole would be ideal. However, an employee who has high arches does not need an insole with arch support. Too much arch support for people who already have high arches could be more detrimental than beneficial. Instead, these workers should use flat, cushiony insoles.2
Prepare for Work
A third part of the solution is to stress the importance of proper foot care and proper daily stretching of the plantar fascia. A person that is going to be standing, stationary or mobile, for an entire shift needs to properly prepare his or her feet daily.
There are certain stretching exercises that can be done in the morning, at lunch and after work that will keep the muscles and ligaments warmed up and prepared to handle the physical stress of the day.
- Rolling an ordinary 12-ounce can under the arch of each foot for five minutes a foot is very useful in stretching the plantar fascia that runs along the arch of the foot.
- Picking up a towel off the ground using only the toes 30 times a foot stretches the forefoot muscles and the plantar muscles and tendons in the feet. These are the supporting muscles in the foot and are therefore the most important to warm up each day in order to prevent excessive strain and inflammation that result in serious pain and damage.
- Stretching the calf muscles by leaning against a wall with one knee bent and the other leg straight out behind you with both feet flat on the floor can be extremely beneficial. The plantar fascia attaches at the calcaneal and cuboidal bones and is stretched during these calf exercises.
Stretching, resting, elevating and icing both feet for an hour after work will decrease swelling and help rejuvenate the feet for the following day.
Foot problems, especially plantar fasciitis, are a large problem in the standing work force. This diagnosis can lead to weeks of strapping and therapy (at up to $150 every visit) followed by functional orthotics (at approximately $400 per pair), and possibly surgery (approximately $5,000). Every person that works in a standing position is susceptible to these problems. Essentially, the cost may range between $2,000 and $5,000 (at minimum) per standing employee if this problem is not addressed and the proper precautions are not taken.
Anti-fatigue mats are recommended for all employees whose work requires them to stand the entire workday. Mobile employees should invest in an inexpensive shoe insole that will absorb the shock and allow them to move from position to position without the hazard of tripping, slipping, and falling. In either case, the results will greatly improve if the proper footwear is being used and maintained, and the daily exercises are being practiced in the morning, at lunch and after work. If all of these recommendations are followed, it is very likely that employers will decrease their pay-out in the medical care of the employee's feet, ankles, legs, knees, lower extremities and backs.
Carolyn Neuhoff conducted her research on cumulative trauma disorders of the lower extremities under the direction of Dr. James D. McGlothlin, associate professor of Ergonomics in the School of Health Sciences at Purdue University. Neuhoff is a doctoral student in podiatric medicine at Scholl College of Podiatric Medicine at Finch University of Health Sciences/Chicago Medical School, North Chicago, Ill. She can be reached via e-mail at: Carolyn.Neuhoff@finchcms.edu.
Sidebar: Tips for the Well-Heeled Worker
Employees should maintain well-fitting, well-padded shoes. If the arch support of the shoes has decreased and the soles are disintegrating, then the foot is no longer being supported. This leads to a decrease in the shock absorption from the soles and to improper foot alignment, and may cause bone and joint problems.
Regularly replacing shoes is key to decreasing foot pain, especially in standing employees. Some tips from the American Podiatric Medical Association for choosing proper foot wear are: the shoe must grip the heel tightly, the forefoot area must be wide and allow movement, the inner aspect of the shoe should be straight from heel to toe, and there should be fastening across the arch to decrease pronation. The fastening keeps the shoe tight against the foot and helps to prohibit the foot from turning inside and transmitting excessive body weight to the sole.
The ideal time to purchase shoes is at the end of a workday due to the swelling that can accumulate throughout the day. Shoes need to be tried on before purchase and must be walked in, because when a person is standing or walking, their toes and arch structure spread out. This changes the fitting of the shoes because of the widening of the forefoot. .