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.

Warts, Plantar


Related Terms

  • Human Papillomavirus
  • Infection of the Feet
  • Verruca Plantaris

Differential Diagnosis

Specialists

  • Dermatologist
  • Orthopedic (Orthopaedic) Surgeon

Comorbid Conditions

  • Compromised immune system

Factors Influencing Duration

For most cases, disability will not occur. However, when it does occur, severity of symptoms, localization of warts (weight-bearing versus non-weight-bearing), and rate of healing after treatment will influence length of disability. Following cryotherapy, laser excision, or surgical excision, duration depends on rate of healing and weight-bearing versus non-weight-bearing location.

Medical Codes

ICD-9-CM:
078.12 - Diseases Due to Viruses and Chlamydiae, Other; Plantar wart; Verruca plataris

Overview

Plantar warts occur on the sole of the foot or between the toes and are one type of wart caused by the human papillomavirus (HPV). There are over 70 different types of HPV that produce many different types of warts. Plantar warts are mainly caused by HPV types 1, 2, 4, 60, or 63 (Weber).

Plantar warts differ from other types of warts in that they are generally associated with some degree of pain. This is because the warts tend to occur on the soles of the feet. The pressure of walking forces them to flatten and grow inward instead of making the raised type of growth many people associate with warts. Transmission of plantar warts is often indirect. For example, if an individual with plantar warts walks barefoot across a damp floor (such as in a locker room or public shower), another person can become infected by walking barefoot on the same floor.

Incidence and Prevalence: Plantar warts are a widespread condition that occurs in a fraction of the estimated 7% to 10% of adults with warts of any type (Cole).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Women are affected slightly more often than men. Plantar warts can occur at any age, but are more common in children 12-16 years of age and young adults.

Conditions leading to increased risk of infection include skin conditions such as atopic dermatitis, any disease that weakens the immune system (such as HIV/AIDS or lymphomas), treatment with drugs that suppress the immune system, and use of locker rooms and shared showers (such as in dormitories and gyms).

Source: Medical Disability Advisor



Diagnosis

History: Individuals with plantar warts often complain of tenderness or pain on the balls of the feet or the heel that is likely to worsen when the individual stands, walks, or runs and is relieved when weight is taken off the foot. Leg or back pain may be reported, indicating that the individual's posture is distorted in an effort to avoid pressure on the foot.

Physical exam: The exam may reveal single or grouped fleshy, grainy lesions on the sole of the foot with disruption of the normal skin markings. The surface is gray-yellow or brown, rough, and may have black pinpoint dots (thrombosed capillaries). Callus may be present over the wart.

Tests: Visual inspection of the lesions is often sufficient to make the diagnosis of plantar warts. A magnifying glass may be helpful to visualize the orderly, mosaic pattern of the lesion due to fusion of several warts (as opposed to a callus). A shave biopsy may be obtained for histopathological examination.

Source: Medical Disability Advisor



Treatment

Often treatment is not necessary as plantar warts are generally harmless and usually resolve on their own. Those that are painful or rapidly multiplying can be treated in several ways, and treatment varies depending on the severity of the infection and location.

Chemical treatments such as cantharidin and salicylic acid may be applied to the surface of the wart. These treatments require regular application for up to 12 weeks for favorable results. Some warts may be frozen off (cryotherapy); cryotherapy is uncomfortable but not terribly painful, and requires frequent treatments (every 1 to 3 weeks) for 3 to 4 months. Laser treatment can also be used to remove warts. This treatment effectively kills the virus, but is expensive, often to the point at which the expense outweighs the benefits Very stubborn warts may be injected with interferon, an agent that boosts the immune system, or bleomycin. Imiquimod cream, another type of immunotherapy, may also be used.

Cutting away the wart is not generally recommended, as this method will leave a permanent scar and is no more effective than other, nonscarring methods.

Source: Medical Disability Advisor



Prognosis

The outcome is good regardless of treatment. In up to 60% of cases, complete recovery will occur, even without treatment (Cole).

Topical treatments are effective in up to 80% of cases if the individual is compliant with the application regimen (Weber). Pulsed dye laser treatment is also effective in more than 70% of cases (Weber).

Despite treatment, plantar warts frequently recur.

Source: Medical Disability Advisor



Complications

Pain, bleeding, and scarring may occur with overaggressive treatment.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

In general, work accommodations and/or restrictions are not required. If the wart is located in a place that causes painful walking or standing, reassignment to a more sedentary position may be advised until the wart has resolved.

Risk: Individuals with plantar warts who work in damp environments with bare feet (e.g., pool lifeguards) should wear sandals to prevent indirect transmission of the virus.

Capacity: Capacity is dependent on the weight-bearing surfaces of the foot. Individuals may be able to offset loading on the affected portion of the foot during recovery by using shoe inserts with cutouts to decompress the wart cluster.

Tolerance: Tolerance varies between individuals and depends on whether a weight-bearing part of the foot (e.g., heel, ball of foot) is affected by the warts. Once the warts have resolved, tolerance is no longer an issue.

Source: Medical Disability Advisor



Maximum Medical Improvement

180 days.

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:

  • Does individual complain of pain on the balls of the feet or the heel?
  • Does exam reveal singular or grouped lesions on the sole of the foot with disruption of the normal skin markings?
  • Is individual's skin rough with black pinpoint dots (thrombosed capillaries)? Is callus present over the wart?
  • Were other conditions with similar symptoms eliminated, such as corns (clavi), calluses, other skin diseases with hyperkeratosis, and skin cancer?
  • Was diagnosis of plantar warts confirmed with visual inspection by a physician?

Regarding treatment:

  • Does individual have severe pain or rapidly multiplying warts that require treatment? Has individual kept up with treatment frequency? If so, were chemical treatments effective in eliminating warts?
  • If warts persisted, was cryotherapy or laser treatment considered? Were repeated treatments necessary?
  • Have more aggressive therapies, such as injections of bleomycin or interferon, or imiquimod cream, been considered?

Regarding prognosis:

  • Was individual compliant with prescribed treatment regimen?
  • Does individual have an underlying condition (immune suppression) that may affect recovery?
  • Have the warts recurred despite treatment? If so, were other, more aggressive treatments considered?

Source: Medical Disability Advisor



References

Cited

Cole, Gary. "Plantar Warts." eMedicine Health. 17 Jul. 2015. WebMD, LLC. 3 Aug. 2015 <http://www.emedicinehealth.com/plantar_warts/article_em.htm#plantar_warts_overview>.

Weber, Christina, and Kristine Hoffman. "How To Treat Recalcitrant Plantar Warts." Podiatry Today 26 7 (2013): NA. Podiatry Today. 3 Aug. 2015 <http://www.podiatrytoday.com/how-treat-recalcitrant-plantar-warts>.

Source: Medical Disability Advisor






Feedback
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you!
Send this comment to:
Sales Customer Support Content Development
 
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.