Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Amputation, Toe


Related Terms

  • Terminal Syme Amputation
  • Toe Removal or Excision

Specialists

  • General Surgeon
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist
  • Vascular Surgeon

Comorbid Conditions

  • Bleeding disorders
  • Cardiovascular disease
  • Diabetes mellitus
  • Obesity
  • Pre-existing vascular insufficiency
  • Pulmonary disease

Factors Influencing Duration

The underlying disease condition, complications, number of toes removed, individual's psychological status, and individual's job requirements may influence length of disability.

Medical Codes

ICD-9-CM:
84.11 - Amputation of Toe; Amputation through Metatarsophalangeal Joint; Disarticulation of Toe; Metatarsal Head Amputation; Ray Amputation of Foot (Disarticulation of the Metatarsal Head of the Toe Extending Across the Forefoot just Proximal to the Metatarsophalangeal Crease)

How Procedure is Performed

A general or regional anesthesia may be used. The skin is cleaned and an incision made, in a flap fashion if possible, to enable easier postoperative skin closure. The type of skin incision may vary according to which toe is involved. Tendons are divided and allowed to retract to the level of the intended bony stump. Nerves and blood vessels are identified and then clamped and tied off (ligated), or sealed through heat (cauterized). A cut is made through the bone (osteotomy) or through the joint (disarticulation), and the amputated segment is then detached and sent to the pathology department for examination. The remaining end of the bone is rasped smooth. In the case of great toe amputation at the junction of the toe with the foot (metatarsophalangeal joint), small bones within the tendon (sesamoid bones) may also be removed. ("Ray amputation" refers to removal of a toe and part of the corresponding metatarsal bone.) Following amputation, a flap of skin and soft tissue is then positioned to cover the cut bone or joint surface, and stitched to the adjacent skin with nonabsorbable sutures.

A terminal Syme amputation of part of the last bone of the toe (distal phalanx) is done via an elliptical incision and involves resection of the toenail, nail bed, and approximately half of the distal phalanx, usually of the great toe. After the initial skin incision, the flexor and extensor tendons on the part of the distal phalanx closest to the body (proximal distal phalanx) are left intact if possible. Nerves and vessels are clamped off or tied, and the bone is shortened and contoured smoothly part-way along the distal phalanx. The nail bed including the toenail is removed. The wound is closed by placing the skin flap over the stump and suturing the skin.

If there is an active infection, a drain is inserted into the wound and then removed in 24 to 72 hours. Sometimes, in severely infected wounds, the wound is left open to fill in (granulate) by the healing process known as secondary intention. If the wound is left open, it is packed with moist dressings that are changed daily until healed.

Source: Medical Disability Advisor






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