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Construction Workers at Increased Risk for Repetitive Motion Injuries(From the September 1995 issue of Demolition, published by the NADC)
to "Carpal tunnel" of the hand and wrist, "tarsal
tunnel" affects the feet. Construction workers who are typically on
their feet more than six hours a day and work on concrete and tile are
highly susceptible to heel pain and tarsal tunnel syndrome, according to
a podiatric surgeon's research released at the annual meeting of the
American College of Foot and Ankle Surgeons (ALFAS) in San Francisco.
who are prone to walking repetitively on hard surfaces may crush or
pinch the nerves around the heel," said Philadelphia podiatric
surgeon Harold Schoenhaus, DPM, president of ACFAS. "Low-heeled
boots and shoes, while generally the best for maintaining foot and ankle
health, can be harmful without arch support or a thick supportive sole.
Ironically, women who wear high heels on hard surfaces do not suffer
tarsal tunnel syndrome as frequently, but their feet are damaged in
other ways by walking on the balls of their feet. This may result in a
tight Achilles tendon and other painful foot conditions. "
with heel pain are frequently diagnosed with spurs, a bone growth
resulting from the pulling of the plantar muscles on the bottom of the
heel bone. The plantar fascia, which may become inflamed, is a fibrous
tissue that travels along the bottom of the foot and provides strength
and shock absorption. But when a group of patients with heel pain were
not responding to conventional treatment for spurs, a podiatric surgeon
dug for answers. "People are quick to identify carpal tunnel
syndrome in wrists and hands. When it comes to the feet, tarsal tunnel
syndrome, which can result from pinched nerves, is often a last
diagnosis," said podiatric surgeon Robert W. Sullivan, DPM, a
fellow of ALFAS, who performed the research. "Tarsal tunnel
syndrome is hard to detect because nerves are not visible on X-rays so
we can't see when something is amiss. Rather, in heel pain sufferers, we
frequently see a bone mass that is thought to be a spur."
13 months (July 1993-August 1994), Dr. Sullivan, associate professor of
surgery at Eastern Virginia Medical School in Norfolk, examined and
followed 392 new patients through treatment for heel pain. Traditional
treatment methods were first advised including arch supports, cortisone,
anti-inflammatory drugs and pads. Of the patient population, 33 percent
(129) did not respond to conventional treatment. Dr. Sullivan advised
they go through nerve conduction studies with a neurologist to track
whether the nerves running through the heel were properly functioning.
Of these 129 patients, 90 bad nerve changes consistent with tarsal
tunnel syndrome, and 57 elected for tarsal tunnel release surgery with a
93 percent success rate.
American College of Foot and Ankle Surgeons, 515 Buse Hwy., Park Ridge,