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.

Bunionectomy

bunionectomy in Deutsch (Deutschland)

Related Terms

  • Keller Operation
  • Mayo Operation
  • McBride Bunionectomy

Specialists

  • Orthopedic (Orthopaedic) Surgeon

Factors Influencing Duration

If both feet require surgical correction (bilateral bunionectomy), the individual's period of disability will be lengthened. Complications such as infection may also affect length of disability.

Individuals who perform tasks while seated may be able to return to work within several days. Individuals who must stand, walk, or drive in the course of their work may require several weeks or longer for recovery.

Medical Codes

ICD-9-CM:
77.51 - Bunionectomy with Soft Tissue Correction and Osteotomy of the First Metatarsal
77.52 - Bunionectomy with Soft Tissue Correction and Arthrodesis
77.53 - Other Bunionectomy with Soft Tissue Correction
77.54 - Excision or Correction of Bunionette; That with Osteotomy
77.59 - Other Bunionectomy; Resection of Hallux Valgus Joint with Insertion of Prosthesis

Overview

A bunionectomy is a procedure used to remove a painful bump (bunion) on the big toe (great toe).

Bunions typically form because of instability and misalignment of the bones and related structures in the feet. With these abnormalities, normal stresses applied to the foot are accompanied by improper distribution of weight. Misaligned and/or enlarged bones that cause the great toe to push against the neighboring second toe create a painful bunion. The condition worsens as friction from shoe pressure creates swelling and inflammation of soft tissue overlying the affected great toe joint (metatarsophalangeal joint). Improperly fitted shoes that are too narrow or have high heels commonly aggravate the condition, which is why women tend to require bunionectomy much more often than men. Heredity is also an important factor in the formation of bunions.

There are dozens of different procedures and approaches for surgical correction of bunions. Bunions may be classified as mild, moderate, severe, or arthritic.

Source: Medical Disability Advisor



Reason for Procedure

Nonoperative (conservative) treatments such as wearing comfortable, well-fitting shoes with sufficient toe room or a special toe pad or corrective sock, likely will be attempted first. If these approaches fail, or if a bunion grows too large and/or painful, then surgical correction often is required. Without surgical intervention, large bunions often worsen, and the condition becomes increasingly painful. Surgical correction also may be needed to keep the condition from recurring.

Source: Medical Disability Advisor



How Procedure is Performed

Methods of performing a bunionectomy vary. Surgery is usually done on an outpatient basis. Over 100 different surgical procedures have been described for bunions, and over a dozen remain in common use today. Common features of bunion surgery are described below.

Usually, a regional anesthetic is used, with sedation given as needed. In some cases, general anesthesia may be required. A tourniquet may be applied to the thigh or ankle to prevent bleeding during surgery. The leg and thigh are washed to prevent infection. An incision is made at the top of the great toe (the great toe metatarsophalangeal joint) or, in other methods, through the side of the foot. Part of the exposed bone may be removed (the bony prominence or bunion deformity). The great toe is then realigned. A portion of the pad-like sac (bursa), which reduces friction between tendon and joint, may also need to be removed. Tendons and other soft tissue may be manipulated or lengthened to assist with realignment. For more severe and hereditary bunions, the metatarsal bone is surgically divided (osteotomy of the first metatarsal) and realigned (reduced). Screws or wires may be required to help maintain the new alignment (open reduction internal fixation [ORIF]). Recovery from osteotomy requires postoperative time in a cast until the surgically created fracture heals. Pain medication (analgesics) may be prescribed. Individuals usually are advised to keep the foot elevated for all but brief periods during the first 48 hours after surgery.

Source: Medical Disability Advisor



Prognosis

Most individuals undergoing a bunionectomy experience a full recovery and correction of the underlying condition. Success rates depend on the severity of the original condition, how much arthritis has developed in the great toe metatarsal-phalangeal joint, and how much range of motion remains. The possibility of future complications can be reduced if individuals wear shoes that do not constrict the forefoot and aggravate the condition.

Recovery time depends on the severity of the condition and the surgical method used for correction. During the healing process, individuals typically will be fitted with bandages and specially adapted, sandal-like footwear for at least several weeks before regular shoes can be worn.

Source: Medical Disability Advisor



Complications

Individuals who do not follow proper procedures for protecting the foot after surgery may experience re-injury or infection of the surgical wound. The original condition may return despite surgery. The individual also may experience joint stiffness or bone death caused by an impaired blood supply (osteonecrosis). Other conditions that may accompany bunions, such as nerve tumors (neuromas), bone deterioration (osteoarthritis), calluses, or misaligned toes (hammertoes), may require additional treatment. In some cases, the individual may experience numbness over the great toe following surgery.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals may be unable to walk for long distances, stand for extended periods, or safely and effectively operate vehicles or machinery for several weeks following surgery. Temporarily modified duty assignments that permit sitting with the affected leg elevated may be a necessary accommodation. Recent studies reveal that individuals who undergo an osteotomy of the first metatarsal on their right foot as part of their bunionectomy require 6 weeks of postoperative healing before being able to brake a vehicle as they normally would in emergency circumstances (Holt). Complete recovery for routine bunionectomy may take 3 to 5 weeks ("Bunion Removal"). Company policy on medication usage should be reviewed to determine if pain medication use is compatible with job safety and function.

Source: Medical Disability Advisor



References

Cited

"Bunion Removal." MedlinePlus. 5 May. 2008. National Library of Medicine. 19 Dec. 2004 <http://www.nlm.nih.gov/medlineplus/ency/article/002962.htm>.

Holt, G., et al. "Emergency Brake Response Time after First Metatarsal Osteotomy." Journal of Bone and Joint Surgery 90 (2008): 1660-1664.

Source: Medical Disability Advisor






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