Construction Workers at Increased Risk for Repetitive Motion Injuries

Similar 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.

"Individuals 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. "

Individuals 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."

Over 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.

Source: American College of Foot and Ankle Surgeons, 515 Buse Hwy., Park Ridge, IL 60068.