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.

Plantar Fasciitis


Related Terms

  • Inflammation of Plantar Fascia

Differential Diagnosis

Specialists

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

Factors Influencing Duration

Compliance with recommended treatment and activity restrictions, active participation in physical therapy and especially home therapy, job requirements such as standing and walking, and response to treatment affect the duration of disability.

Medical Codes

ICD-9-CM:
728.71 - Plantar Fascial Fibromatosis; Contracture of Plantar Fascia; Plantar Fasciitis (Traumatic)

Overview

Plantar fasciitis is a painful condition that results when the thick, fibrous band on the sole of the foot, which extends from the bottom of the heel bone (calcaneus) to the base of the toes (plantar fascia), becomes irritated and swollen (inflamed). Plantar fasciitis is the most common cause of heel pain. Sometimes, this condition is referred to as “heel spurs,” but that is really a misnomer, since there is no connection between the presence of a heel spur and plantar fasciitis.

The plantar fascia holds the many foot bones in place, supports the arch of the foot, and acts as a shock absorber. Inflammation and / or degeneration of the plantar fascia can result from mechanical strain (traumatic fasciitis), abnormalities of foot structure (biomechanical plantar fasciitis), systemic inflammatory diseases, or unknown (idiopathic) causes.

Foot pain caused by plantar fasciitis may occur in several locations: (1) along the entire course of the plantar fascia due to microtears in the band, (2) at the plantar fascia's point of attachment to the calcaneus, (3) along the inside edge of the arch (medial band plantar fasciitis), (4) in the middle of the arch (central band plantar fasciitis), or (5) along the outer edge of the arch (lateral band plantar fasciitis). Both feet are involved in about one-third of cases.

Incidence and Prevalence: Plantar fasciitis occurs in about 10% of the general population and represents 10–15% of foot problems requiring professional care (Singh). Women are twice as likely as men to get plantar fasciitis (Foye).

Source: Medical Disability Advisor



Causation and Known Risk Factors

The condition is most common in runners and other athletes and those with jobs that require prolonged walking or standing on hard surfaces. Obesity, pronation of the feet, flat feet (pes planus), heel spurs, leg length discrepancy, and reduced range of motion in the ankle are other risk factors. Suddenly switching from high-heeled to lower-heeled shoes, as well as wearing ill-fitting shoes, may precipitate the condition. Although the exact cause is unknown, repetitive microtrauma may play a role.

Source: Medical Disability Advisor



Diagnosis

History: The individual usually complains of intense, sharp pain in the bottom of the heel or in the arch. Characteristically, the pain is worst with the first few steps in the morning or after periods of rest. Pain decreases with ambulation throughout the day. At the end of the day, the pain may change to a dull ache that improves with rest. Pain is worsened by walking barefoot, especially on hard surfaces, and improves when shoes are worn. Careful questioning may reveal that the onset of pain was associated with a new activity or a change in activity level, change in the type of exercise surface, or new footwear.

Physical exam: Typical physical exam findings include tenderness when touching (palpating) the bottom of the heel and mild swelling (edema). Bending the foot toward the shin (ankle dorsiflexion) may increase the pain, especially if the toes are simultaneously hyperextended. Standing on tiptoe or walking on one’s toes reproduces the pain in many individuals.

Tests: The diagnosis of plantar fasciitis is based on history and physical examination. If plantar fasciitis presents in both feet (bilateral), blood tests may be obtained to detect any underlying conditions, such as systemic inflammatory diseases.

Laboratory tests may include a complete blood count (CBC), general tests for inflammation (erythrocyte sedimentation rate, C-reactive protein), and specific tests for different types of arthritis (rheumatoid factor, human leukocyte antigen typing). Although imaging studies are rarely indicated for making the diagnosis, x-rays can help to rule out stress fractures.

Source: Medical Disability Advisor



Treatment

About 95% of individuals with plantar fasciitis improve with conservative treatment (Erstad). Treatment may consist of icing the foot; using heel pads, heel cups, over-the-counter arch supports, prescription arch supports (orthotics), or heel lifts in cases in which one leg is longer than the other; performing exercises to stretch the Achilles tendon; going to physical therapy; taking nonsteroidal anti-inflammatory drugs (NSAIDs); taping or casting the foot; or walking with crutches. Rolling the foot over a bottle of warm water can improve circulation, reduce pain and accelerate healing. Sometimes a splint is worn at night to stretch out the plantar fascia and is highly effective with long-term use. Weight loss is essential if the individual is obese.

Although conservative treatment is effective, it can often take several weeks or even months for the pain to resolve. Some type of shoe insert (heel pad or cup, arch support, or orthotic) is usually necessary after treatment to prevent recurrence.

Extracorporeal shock wave therapy may be the next step for individuals who do not respond to initial conservative treatment (Frontera; Gerdesmeyer; Wang). High-energy shock waves break up damaged tissue and increase blood flow. One to two treatments may be necessary over an 8-week period.

Corticosteroid injections may improve pain temporarily and function for up to 1 month; however, there may be some risks such as plantar fascia rupture and atrophy of the fat pad of the heel (Crawford).

Local autologous blood injections may stimulate an inflammatory reaction that paradoxically initiates the healing process (Pasquina). Cold laser is shown to be effective in reducing the pain.

Surgery is seldom required, but when it is, several procedures are used. Some surgeons advocate cutting the tight fascia to relieve the tension (Schön procedure, Baxter procedure), whereas others resect the heel spur and detach the plantar fascia (DuVries procedure). Surgeons have performed a plantar fascia release (plantar fasciotomy) using an endoscope (endoscopic plantar fasciotomy, Barrett procedure) and experienced mixed, but some highly favorable results (Saxena; Murphy).

Source: Medical Disability Advisor



ACOEM

ACOEM's Practice Guidelines, the gold standard in effective medical treatment of occupational injuries and illnesses, are provided in this section to complement the disability duration guidelines.*
 
Ankle and Foot Disorders
 
* The relationship between the MDGuidelines (MDA) content and ACOEM's guidelines is approximate and does not always link identical diagnoses. The user should consult the diagnostic codes in both guidelines, as well as the clinical descriptions, before assuming an equivalence.

Source: ACOEM Practice Guidelines



Prognosis

Most cases of plantar fasciitis respond well to conservative treatment with complete resolution of pain over time. Some individuals will need to wear orthotics permanently to prevent symptom recurrence. Surgery decreases pain in 75% of individuals, but the remaining 25% have persistent pain (Erstad).

Source: Medical Disability Advisor



Rehabilitation

Because plantar fasciitis is a self-limiting disease, it usually resolves within a nine-month period, with residual symptoms in about 10% of all cases (Pasquina). The condition becomes chronic if pain persists for longer than 6 months. A variety of treatments are commonly implemented to treat plantar fasciitis with many of these treatments unsubstantiated by sound scientific evidence. Common treatments include exercise, ultrasound, night splints, taping, and custom and standard orthotics. Injections are also used as treatment (Landorf; Pasquina). Night splints with custom orthotics may have some benefit for functional improvement but not necessarily pain (Hawke).

During the acute phase of treatment, ice massage may be helpful, especially after activity (Pasquina). Therapeutic ultrasound, while not proven beneficial to recovery, may help reduce pain and facilitate participation in rehabilitation. Exercises emphasizing stretching of the Achilles tendon are commonly prescribed. For greater benefit, a plantar fascia tissue stretching program should be utilized and combined with overall stretching and strengthening of the lower leg, thigh, and hip (Frontera). Individuals should be told to stretch for 30 seconds at least 10 times per day (Pasquina). After the acute phase of recovery, strengthening exercises for the foot intrinsic muscles are added, and conditioning exercises that allow low impact activity (e.g., cycling, swimming, or deep water running) may be initiated (Pasquina).

Orthotics are commonly used to provide external support to the foot in an anatomically proper alignment. No clear evidence indicates the benefit of custom devices (Hawke). A combination of stretching and shoe inserts is likely to yield favorable results, and padded floor mats may help in some work settings (Pasquina). Cushioned insoles with active bipolar magnets have not been shown to have any therapeutic value (Winemiller).

If surgery is required, the treating physician will dictate the rehabilitation protocol.

FREQUENCY OF REHABILITATION VISITS
Nonsurgical
SpecialistPlantar Fasciitis
Physical TherapistUp to 12 visits within 6 weeks
The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice.

Source: Medical Disability Advisor



Complications

Discomfort may be sufficient to disrupt work, leisure, and recreational activities. The individual’s manner of walking (gait) may change in an effort to relieve pain, causing other leg, hip, back, or foot problems (Erstad). Decreased mobility and inability to participate in activities of daily living (ADL) may also result (Foye).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Restrictions or accommodations depend on the severity of the condition. Standing and walking (ambulation) may need to be restricted. If casting or crutches are used postoperatively, the individual will need to limit ambulation and must be allowed to elevate the foot. If orthotics are prescribed, the individual must be allowed to wear enclosed shoes (e.g., nursing shoes or work boots) that will accommodate the orthotics. Shoes with proper padding, a stiff sole, and arch support can help prevent recurrence.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Has diagnosis of plantar fasciitis been confirmed?
  • Has x-ray or a bone scan ruled out a stress fracture of the calcaneus?
  • Does individual have an underlying condition such as obesity or arthritis that could affect recovery?

Regarding treatment:

  • Do symptoms persist despite treatment? Has enough time elapsed for pain to resolve?
  • If unable to lose weight on his or her own, would individual benefit from enrollment in a community weight loss program?
  • Is individual a candidate for surgical intervention?

Regarding prognosis:

  • Has enough time elapsed to evaluate the effectiveness of treatment?
  • Would individual benefit from consultation with a podiatrist?
  • Is individual compliant with preventive measures, such as wearing shoe inserts, heel pads or cups, arch supports, or orthotics?
  • Is individual realistic about prognosis?

Source: Medical Disability Advisor



References

Cited

Crawford, F., et al. "Interventions for Treating Plantar Heel Pain." Cochrane Database of Systematic Reviews (2000): CD000416. National Center for Biotechnology Information. National Library of Medicine. 5 Jan. 2009 <PMID: 10908473>.

Erstad, Shannon. "Should I have Surgery for Plantar Fasciitis?" WebMD.com. Eds. Kathleen Ariss, et al. 23 Jul. 2007. WebMD, LLC. 5 Jan. 2009 <http://www.webmd.com/a-to-z-guides/should-i-have-surgery-for-plantar-fasciitis?>.

Foye, Patrick M., and Todd Stitik. "Plantar Faciitis." eMedicine. Eds. Everett C. Hills, et al. 3 2008. Medscape. 5 Jan. 2009 <http://emedicine.com/pmr/topic107.htm>.

Gerdesmeyer, L., et al. "Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar faciitis: Results of a confirmatory randomized placebo-controlled multicenter study." American Orthopaedic Society for Sports Medicine 36 11 (2008): 2100-2109.

Hawke, F., et al. "Custom-made foot orthoses for the treatment of foot pain." Cochrane Database of Systematic Reviews. Eds. W. Laupattarakasem, et al. John. Wiley & Sons, 2008.

Landorf, K. "Plantar heel pain and fisciitis." BMJ Clinical Evidence Handbook: Musculoskeletal disorders. Eds. N. Collins, et al. BMJ Publishing Group, 2007. ClinicalEvidence. 5 Feb. 2008

Murphy, G. Andrew. "Disorders of Tendons and Fascia." Campbell's Operative Orthopaedics. Eds. S. Terry Canale and James H. Beaty. 11th ed. Philadelphia: Mosby Elsevier, 2008.

Pasquina, Paul F., and Leslie F. Foster. "Chapter 86 - Plantar Fasciitis." Essentials of Physical Medicine and Rehabilitation. Eds. Walter R. Frontera, Julie K. Silver, and Thomas Rizzo. 2nd ed. Philadelphia: Saunders, Elsevier, 2008.

Saxena, A. "Uniportal Endoscopic Plantar Fasciotomy: A Prospective Study on Athletic Patients." Foot & Ankle International 25 12 (2004): 882-889. National Center for Biotechnology Information. National Library of Medicine. 5 Jan. 2009 <PMID: 15680101>.

Singh, Deepika, Mark Silverberg, and L. Milne. "Plantar Fasciitis." eMedicine. Eds. Miguel C. Fernandez, et al. 2 Oct. 2008. Medscape. 5 Jan. 2009 <http://emedicine.medscape.com/article/827468-overview>.

Wang, C., et al. "Extracorporeal shockwave for chronic patellar tendinopathy." American Journal of Sports Medicine 35 6 972-978.

Winemiller, M. H., et al. "Effect of Magnetic vs Sham-Magnetic Insoles on Plantar Heel Pain: A Randomized Controlled Trial." JAMA 290 11 (2003): 1474-1478. National Center for Biotechnology Information. National Library of Medicine. 5 Jan. 2009 <PMID: 13129987>.

Source: Medical Disability Advisor






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