One Size Doesn’t Fit All

HAZARDS AND CONDITIONS AFFECTING THE FEET

by Mariaan Smit

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According to the US Bureau of Labour Statistics, more than 60,000 foot injuries result in lost workdays annually. The common causes of foot injuries range from things dropping onto a foot, people falling from things, overextension, compression and repetitive motions, as the feet take a lot of abuse from walking, running, climbing and jumping.

Improper footwear, ageing and diabetes are some contributors to foot problems. The employer can therefore not just issue safety footwear in a generic manner, as employees foot conditions as well as workplace hazards need to be considered before an individual is issued with safety footwear.

When considering the type of protective safety footwear, the employer should keep in mind the hazard of foot injuries due to falling or rolling objects, objects that can pierce the sole of the footwear, uneven surfaces where ankle protection is imperative and the hazard of staticdischarge or electric-shock is possible. Other hazards like flying objects; cutting hazards; slips, trips and fall protection; burns, extreme temperatures and even foot fatigue must be taken into consideration when supplying employees with safety footwear.

Protection from hazards

Now let’s look specifically at certain hazards, and how we can protect against them.

Protection from falling, flying and rolling objects

Consider a safety shoe like a steel toe boot to prevent crushing injuries to the feet.

Protection from punctures

Where the hazard of sharp objects that may penetrate the foot sole or even fall from above onto the foot is eminent, one must select a safety shoe with a thick, heavy-duty sole and even extra protection surrounding the safety shoe.

Protection from cutting hazards

Ensure that the safety shoe is made of cut-resistant material.

Protection from electrical hazards

Non-conductive footwear that are made from leather, rubber or other material that do not conduct electricity should be worn in environments where static electricity can lead to electric sparks or where a person could face a potential electrical shock.

Footwear for slip, trip and fall prevention

If a slip, trip or fall hazard exists, select footwear with appropriate traction and proper treads.

Selection of footwear to prevent foot and leg fatigue

Where the man job specification requires a lot of standing, climbing or crouching, footwear should provide adequate cushioning and arch support to keep the feet as comfortable as possible in order to alleviate strain on foot muscles.

Protection from burns

Open flames, molten metal, sparks and chemicals can cause burns and the correct footwear must be issued depending on the type of burn hazard that exists.

Protection from extreme temperatures

Frostbite and hypothermia are hazards associated with cold environments. Cold work employee’s feet should be protected by selecting footwear that will keep their feet warm, and, if rain, water or snow is an added hazard, waterproof or insulated footwear must be considered.

When working in extreme heat environments like steel mills, smelters or foundries, feet can suffer severe injury if not protected. Boots built from special neoprene, heat-resistant soles and leathers treated with heat resistant materials can be selected to protect feet from intense, hazardous hot environments.

Foot conditions

The following are foot conditions that may influence the selection of footwear.

Athlete’s foot

Fungus thrives in warm, damp areas, such as shoes that are warm and damp because of sweating. Fungal exposure can occur in showers or gyms where people walk around barefoot. Tinea pedis, also called athlete’s foot, is a fungal infection that usually begins between the toes causing an itching, burning feeling. It is contagious and can be spread via contaminated floors, sharing towels or clothing. The moccasin variety of athlete’s foot can be mistaken for eczema or even as dry skin and causes scaling and chronic dryness of the soles of the foot, which can extend up the side of the foot. One or both feet can be affected, and it can spread to the nails, hands or even the groin.

The following are good foot care practices to follow in preventing athlete’s foot:

  • Dry your feet and in between your toes after a bath or taking a shower
  • Walk barefoot when at home so that your feet can “air out”
  • Change your socks daily, and if you are prone to sweaty feet, change your socks twice a day
  • If possible, use two pairs of safety shoes to give the shoes time to “air out” by not wearing the same shoes for two consecutive days
  • Protect your feet by wearing waterproof sandals around public showers and locker rooms
  • Use antifungal powder or foot cream daily • Never share shoes with anybody

Bunions

Hallux valgus, better known as bunions, are caused by wearing tight or narrow shoes, as this puts pressure on the metatarsophalangeal joint where the bone on the foot meets the bone of the big toe. Bunions can be identified as a visible bump on the middle side of the foot. Bunions can cause tenderness on the area or around the big toe, pain when walking and difficulty moving the big toe.

A person with bunions should wear properly fitting shoes that are not tight and without high heels. A bunion pad can relieve the area from additional pressure and ice packs may be applied to reduce inflammation. Should the pain not subside, it is best practice to have the bunions removed surgically.

Diabetic neuropathy

Diabetic neuropathy is a group of conditions that cause damage to the feet because of uncontrolled diabetes. Other factors such as family history, smoking and alcoholism can worsen the damage to the nerves in the feet in the diabetic patient. Painful feet with a feeling of numbness and a tingling sensation are symptoms of diabetic neuropathy in diabetics.

As nerve damage is irreversible, diabetic workers should ensure they take responsibility for their own health and do everything possible to control blood sugar levels within acceptable parameters and maintain good health. This includes regular foot exams that incorporate the foot soles and having their toenails professionally trimmed if there is a possibility that self-trimming could break or damage the surrounding skin area.

Ingrown toenails

Toenails that grow into the nail groove can cause significant pain and discomfort. Badly fitting shoes are one of the main causes, as the pressure from shoes that are too narrow from the top or too tight can put extra pressure on the toes. Improper trimming of toenails such as cutting the toenails too short or activities such as running that cause trauma to the feet can contribute to ingrown toenails.

Redness, swelling, pain and drainage from the sides of the toenail are all indications that a person suffers from an ingrown toenail.

The following are good foot care practice to follow in preventing ingrown toenails:

  • Wash the feet with antibacterial soap
  • Ensure that feet are dried properly, also around nailbed areas
  • Cut the toenails in a straight line after a bath or shower when the toenails are still soft
  • Cutting toenails in a round pattern increases the risk of ingrown toenails and should always be avoided
  • Ensure that safety footwear and shoes used when off duty fit well and do not have a pointy toe box

If the above tips do not improve the symptoms of ingrown toenails, one should consult a podiatrist or medical practitioner, as a portion of the toenail may need to be removed. Antibiotics may also be prescribed to treat the infection.

Plantar fasciitis

Plantar fasciitis is pain caused by an inflammation of the ligament that supports the foot’s arch. Plantar fasciitis usually does not have a clear cause. Risk factors include obesity, having a very high foot arch, having tight calf muscles, and participating in activities that repetitively stress the heel such as running or standing for long periods of time.

The first indication of plantar fasciitis is pain on the bottom of the heel that is usually worse in the mornings when getting out of bed, causing a sharp stabbing pain in the heel during the first step. The pain also worsens with activity.

Resting the foot or applying ice can reduce the inflammation. A general practitioner may prescribe non-steroidal anti-inflammatory drugs (NSAIDs) to assist with pain management. Stretching the foot thoroughly before and after physical activity and at regular intervals throughout the working day may assist in pain reduction. In addition, the selection of supportive footwear is crucial. Physical therapy or visiting a podiatrist must be considered if pain levels do not decrease. The Physical Therapist (PT) will teach the person suffering from plantar fasciitis exercises to stretch and strengthen the plantar fasica, achilles tendon and lower leg muscles in an attempt to reduce pain. The PT may also use massage, contrast baths (alternating hot and cold baths) and ultrasonography to assist with long term healing.

Blisters

Blisters often appear after walking or running for extended periods of time due to ill-fitting shoes or when the feet become sweaty. If a blister develops, ensure that a plaster is applied over the blister by using a large blister plaster for heels or a small plaster for toes or other areas on the foot. Be sure that the

plaster is applied to dry skin and press the plaster down firmly to ensure that the plaster stays in place. The aim is to prevent the blister from opening as an open wound can easily become infected.

The aim of the plaster is to:

  • Assist in avoiding additional pressure from shoes on the blister
  • Protect the “blister roof” protective layer of the skin until the blister drains by itself
  • Protect an open blister from infection as it prevents exposure to dirt and bacteria

If the blister wound is deep, bleeding or shows signs of infection consult a general practitioner. If the person suffering from a blister is a diabetic patient, such a person should consult the general practitioner from the onset of the blister, as diabetic patients are prone to Staphylococcus Aureus; an infection such as this can lead to the foot or leg being amputated.

When employees are issued with new safety boots, it is advisable to predict blisters forming during initial use. Employees therefore should be trained in the following:

• Immediately check for blisters if pain or discomfort of the skin is experienced

• Bring an extra pair of socks to work so that socks can be changed in cases where feet are sweating

• If feet did sweat, ensure that feet are dried and that boots are given some time to dry out on the inside before putting them back on

• It is always good practice to bring the previous safety boots to work so that shoes can be rotated until the new boots are “walked in”

Corns Corns can be caused by ill-fitting shoes, hammer toe or bunions, mostly found on the soles of the feet or toes. Corns are normally painless and when they become painful should be treated. Over the counter corn plasters can be used for initial relief, but if these do not help it is recommended that corns are surgically removed.

Heel spur An outgrowth of calcium that develops between the heel bone and the arch of the foot is called a heel spur. Heel spurs are mostly a-symptomatic, but can become painful and cause inflammation. Long-term strain on the muscles and ligaments of the foot are the most common causes of heel spurs, but arthritis and excess body weight are also to blame. Wearing badly fitting or worn out shoes can also cause heel spurs.

Diagnosis of heel spurs is usually confirmed with an x-ray of the foot. Treatments include exercise, antiinflammatory medication, cortisone injections and/or custom-made orthotics. If none of these help, surgery may be necessary.

Claw foot Although high heeled shoes and shoes that squeeze the toes may cause claw foot, claw foot is often rather the result of nerve damage caused by diseases like diabetes or alcoholism, which can weaken the muscles in the foot. Claw toes refer to the toes that appears to dig or claw into the soles of the shoes. It creates painful calluses and usually gets worse without treatment, resulting in permanent deformity over time. Corns can develop under the ball of the foot or even on the top of the toe.

A specialist may need to carry out certain tests to rule out neurological disorders that can weaken the foot muscles, creating imbalances that bend the toes into this abnormal position. Trauma and inflammation may also lead to claw toe deformity.

The following conservative treatment is recommended for early stages of claw foot/toe:

  • Avoid tight fitting shoes and high heeled shoes
  • Ensure that the shoes are soft with enough room for the toes
  • Stretch the toes and toe joints with your hands towards their normal positions on a daily basis
  • Exercise the toes by picking up marbles with your toes or crumple a towel that is laid flat on the floor with your toes

If the claw foot / toe is already in a fixed position, the following can be done:

  • Different orthotic foot products are available like a toe crest, meta pad, raise or bar
  • Wear special “in depth” shoes that allows for extra depth in the toe box
  • Visit a shoe repair shop to stretch a small pocket in the toe box to accommodate the deformity

In instances where safety footwear with a steel cap is a requirement, the toes may only be corrected with surgery.

Metatarsalgia

Metatarsalgia, also called stone bruise may appear after high-impact exercises or because of wearing poor-fitting shoes. It can also be a sign of an underlying medical condition. Metatarsalgia is a common overuse injury that describes pain and inflammation in the ball of the foot that feels like as if there is a stone in one’s shoe. Treatment includes rest, the application of an ice pack and ensuring that all shoes are good fitting shoes. If this does not help, it is best to visit a general practitioner for further assessment and treatment.

Conclusion

Safety footwear, like all other personal protective equipment, cannot be issued generically. Safety footwear should be issued after carefully assessing the hazards and workplace risks. As soon as the hazard and risk assessments are completed, a summary should be drawn up as to what is expected from the safety footwear so that the correct selection can be made to address workplace hazards and risks.

One should keep in mind that employees are not machines: they may have foot problems and underlying medical conditions that may influence the selection of the correct footwear in which specialist advice may be necessary before issuing the footwear and/or custom-made orthotics as part of the safety footwear. Employees may even require training in certain aspects as to prevent foot injury, complications and disease and this should be incorporated in the safety toolbox talks.

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