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.

Tarsal Tunnel Release


Related Terms

  • Posterior Tibial Nerve Decompression

Specialists

  • Orthopedic (Orthopaedic) Surgeon

Comorbid Conditions

Factors Influencing Duration

Since weight bearing is restricted during recovery, disability depends on job requirements. Even after recovery, activities that require impact to the lower extremity, especially to the foot, may be restricted. Individuals whose jobs require them to use their foot in repetitive pedaling movements or to be on their feet for long periods of time and who cannot be retrained for other positions may be permanently disabled.

Medical Codes

ICD-9-CM:
04.44 - Lysis of Adhesions and Decompression of Cranial and Peripheral Nerves; Tarsal Tunnel Release

Overview

Tarsal tunnel release involves relieving pressure on the posterior tibial nerve as it passes along the inside of the ankle, behind the ankle bone (medial malleolus of the tibia). In this procedure the laciniate ligament is cut, which allows the nerve to expand.

The posterior tibial nerve may be trapped by abnormal anatomy or may have pressure applied by inflammation, cysts (ganglions), fatty tumors (lipoma), or other lesions that take up space in the tunnel. Pressure on or irritation of the nerve causes heel pain. This condition is known as tarsal tunnel syndrome.

Source: Medical Disability Advisor



Reason for Procedure

If conservative treatment of tarsal tunnel syndrome has failed, tarsal tunnel release is often recommended to relieve symptoms of pain and changes in sensation (paresthesia) in the foot or lower leg. Relief is obtained by relieving pressure on the involved nerve and its branches. It may also be necessary to restore circulation around the nerve that may have been compromised prior to treatment.

Source: Medical Disability Advisor



How Procedure is Performed

Surgery is done under regional or general anesthesia and in an outpatient setting.

The procedure is carried out through an incision along the inner back side of the ankle, along the nerve course. The tunnel is examined and, perhaps, opened. Any abnormalities that may be causing pressure on the nerve are corrected by removing synovitis, ganglia, or lipomas. Any bony obstructions will also be removed. The blood supply to the nerve is checked all along the nerve, and any constrictions are repaired.

After the wound is closed with sutures, a soft dressing is used to control edema, and weight bearing is restricted for 3 weeks.

Source: Medical Disability Advisor



Prognosis

Complete relief of symptoms is reported to be about 90% in individuals with localized symptoms, and of those individuals with more generalized symptoms about the foot, 70% report good results (Mann). Pain and paresthesia are often lessened but not cured, especially if the nerve is hit (percussed).

Source: Medical Disability Advisor



Rehabilitation

Individuals who undergo tarsal tunnel release may require therapy at a frequency of 2 to 3 times a week for 6 to 8 weeks. Physical therapists first address control of pain and swelling. Individuals also learn to perform scar massage at the surgical site to decrease the risk of forming painful adhesions.

The second goal of physical therapy is to increase the flexibility of the toes, foot, and ankle. Because there is a decrease in the nerve impulse to the foot associated with tarsal tunnel syndrome, the arch may increase, and the toes may become clawed. If an increased arch is present, therapists may perform cross-friction massage to the arch of the foot. Therapists may also passively stretch the toes and forefoot into extension and may perform joint mobilizations on the toe joints. Individuals learn to manually stretch the toes and forefoot and the ankle (into inversion, eversion, plantarflexion, and dorsiflexion). Individuals also actively move the ankle to further increase range of motion.

The third goal of physical therapy is to strengthen the foot and ankle. Therapists may use manual resistance against the toes as they flex and extend and against the foot as the individual moves the ankle. The final goal of physical therapy is to regain functional abilities. Since weight bearing will be limited for a period of time after surgery, therapists focus on normalizing an individual's gait pattern once full weight bearing through the foot is established. Individuals progress from using crutches to using a cane to walking without assistance during the course of therapy.

Individuals with an increased arch may need an orthosis to give some cushioning at the arch and to decrease weight bearing along the lateral border of the foot.

Source: Medical Disability Advisor



Complications

Complications include infection, nerve and blood vessel damage, and failure to relieve symptoms.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Walking, standing, climbing, or squatting may have to be temporarily limited. Immediately after surgery, individuals will not be allowed to put any weight on the foot and will need assistive devices such as crutches, canes, walkers, or wheelchairs. Use of these devices may restrict upper body dexterity as well.

Source: Medical Disability Advisor



References

Cited

Mann, Roger A. "Entrapment Neuropathies of the Foot." DeLee and Drez's Orthopaedic Sports Medicine. Eds. Jesse DeLee and David Drez. 2nd ed. 2 vols. Philadelphia: W.B. Saunders, 2003. 2475-2476. MD Consult. Elsevier, Inc. 29 Dec. 2004 <http://home.mdconsult.com/das/book/body/0/1103/1148.html?printing=true>.

Source: Medical Disability Advisor






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