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.

Excision of Bone Spur, Foot


Related Terms

  • Bone Spur Resection
  • Exostectomy
  • Osteophyte Removal

Specialists

  • Orthopedic (Orthopaedic) Surgeon
  • Physical Therapist

Factors Influencing Duration

Factors that may influence the length of disability include the number and severity of postoperative complications (i.e., wound infection, bleeding, chronic pain, edema, or an adverse reaction to anesthetic), location of the bone spur (top or bottom of the foot), individual's ability to bear weight after surgery, success of the surgery, individual's nutritional status, mental and emotional stability, individual's access to rehabilitation facilities, and job requirements.

Medical Codes

ICD-9-CM:
77.68 - Local Excision of Lesion or Tissue of Bone, Tarsals and Metatarsals
77.69 - Local Excision of Lesion or Tissue of Bone, Other: Pelvic Bones, Phalanges (of Foot) (Hand); Vertebra

Overview

Excision of a bone spur is the surgical removal of a benign bony growth that projects from a bone (exostosis or osteophyte).

Bone spurs are caused by abnormal bone growth or imperfect bone remodeling in response to pressure or trauma. Bone spurs in the foot most frequently occur in the heel bone (calcaneus), in the ankle joint after a fracture, or on the top of the foot. In the toes, bone spurs may occur on the sides of any toe but are most common on the fifth toe (Koepsel). A bone spur located under a toenail is called a subungual exostosis. Bone spurs are common, although most do not cause symptoms. Individuals with diabetes are more likely to develop bone spurs in the feet (Charcot foot) because of impaired sensation (peripheral nerve damage or peripheral neuropathy) (Mrugeshkumar).

Source: Medical Disability Advisor



Reason for Procedure

Foot pain is the primary indication for surgery. Pain may occur when the bone spur puts pressure on a nerve, especially while wearing shoes. If the bone spur is on top of the foot, excision may be indicated if wearing modified shoes or using orthopedic padding does not relieve pain. A bone spur also may limit the range of motion of the ankle or bind ("catch") the joint during a certain movement. A bone spur that is causing a wound (ulceration) on the skin (as in a Charcot foot) usually is excised. Bone spur excision also may be used to treat heel spur syndrome (plantar fasciitis), but typically only if the bone spur is large and impinging on nearby nerves (Panchbhavi).

Source: Medical Disability Advisor



How Procedure is Performed

Bone spur excision usually is performed on an outpatient basis. Since the foot is moist and carries a high number of bacteria, special care is taken to prepare for surgery. The foot and lower leg are scrubbed for 8 to 10 minutes using an antibacterial soap with particular attention given to the toe web spaces. The foot and lower leg are then wrapped in sterile gauze until the individual is on the operating table. Immediately before surgery, the foot is washed with an antiseptic solution.

Anesthesia may be regional or general. General anesthesia is used for those individuals in which regional anesthesia is undesirable (e.g., for diabetics) or has failed. Regional anesthesia can be applied to the forefoot (forefoot or metatarsal block) for excisions in the front of the foot, or to the ankle (ankle block) for excisions in the back of the foot (hindfoot). Removal of a minor bone spur from a toe may be performed under local anesthesia. A sedative often is used to relax the individual, both before application of regional anesthesia and during surgery. A tourniquet may be applied to the ankle and foot to reduce blood flow to the foot and allow for a clear work field. During surgery, the foot is held firmly to prevent motion. At the ankle joint, a bone spur can be excised arthroscopically by use of a drill (burr). Bone spurs on the foot are removed via an open procedure by cutting (incising) into the foot, taking care to avoid damage to nerves and tendons. After the affected bone is exposed, a chisel-like knife (osteotome) is used to remove the spur, and the site is smoothed using a coarse file (rasp). The incision is closed using stitches (sutures).

Removal of a subungual exostosis involves excising a strip of toenail and lifting the remainder of the nail or removing the entire nail to expose the bone spur beneath. The bone spur is then removed in one piece by cutting it (osteotomy) from the distal bone of the toe (distal phalanx). The remaining surface is smoothed with a burr, the wound is irrigated, and the elevated nail, if preserved, is repositioned. The nail fold is sutured to cover the bony end. Sutures normally are removed in 3 weeks, during which time the individual may bear weight as tolerated (Canale).

The individual usually wears postoperative shoes designed to accommodate swelling and bulky dressings. Antibiotics and analgesics are used as needed. The individual will need to rest and elevate the affected limb for 3 to 7 days following surgery.

Source: Medical Disability Advisor



Prognosis

In most cases, bone spur excision succeeds, and the individual experiences a complete recovery and a return to normal function. In only 5% to 6% of cases of subungal exostosis removed by scraping does the bony growth recur (DeLee 2533). Bone spur excision to relieve the pain associated with plantar fasciitis has only limited success.

Source: Medical Disability Advisor



Complications

Bone spur excision can weaken the bone, which may lead to a fracture. Bone spurs can form again.

Other complications include wound infection, the formation of scar tissue, damage to plantar nerves, accumulation of blood (hematoma), swelling (edema), splitting open of the incision site (dehiscence), complex regional pain syndrome, deep venous blood clot (thrombus), and superficial vein inflammation caused by a thrombus (thrombophlebitis). Pressure on the local blood vessels from swelling or bleeding can result in compartment syndrome, which can cause permanent muscle and nerve damage. Toenail damage and toenail loss can occur.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Prolonged standing or walking temporarily may be limited; individuals whose work requires standing or walking may need temporary reassignment to a more sedentary position. Operation of a car or other motor vehicle may temporarily be affected. The individual may need to elevate the affected leg, possibly use a cane to walk, and may need to wear special postoperative footwear. He or she may need a parking space closer to the work site. 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

Canale, S. Terry, and James H. Beaty, eds. "Disorders of Nails and Skin." Campbell's Operative Orthopaedics. 11th ed. Philadelphia: Mosby Elsevier, 2008. MD Consult. Elsevier, Inc. 4 Aug. 2009 <http://www.mdconsult.com/das/book/body/144383952-5/854345399/1584/640.html#4-u1.0-B978-0-323-03329-9.50087-8--cesec20_4386>.

DeLee, Jesse, and David Drez, eds. "Subungual Exostosis." DeLee and Drez's Orthopaedic Sports Medicine. 2nd ed. 2 vols. Philadelphia: W.B. Saunders, 2003. 2532-2533. MD Consult. Elsevier, Inc. 5 Oct. 2004 <http://home.mdconsult.com/das/book/body/0/1103/1176.html>.

Koepsel, K. A. "Bone Spur Surgery of the Toes." Podiatry Network. 19 Jun. 2009 <http://www.podiatrynetwork.com/document_disorders.cfm?id=142>.

Mrugeshkumar, S., and W. Panis. "Charcot Arthropathy." eMedicine. 29 Aug. 2007. Medscape. 24 Jul. 2009 <http://emedicine.medscape.com/article/1234293-overview>.

Panchbhavi, V. K. "Plantar Heel Pain." eMedicine. Ed. Heidi M. Stephens. 17 Jun. 2008. Medscape. 19 Jun. 2009 <http://emedicine.medscape.com/article/1233178-overview>.

Source: Medical Disability Advisor






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