Foot conditions, such as plantar fasciitis, can arise without proper support
On March 19, 1999, a night cook in Manitoba applied for workers’ compensation for his plantar fasciitis. In his application describing his last shift, he said the soles of his feet “gave out” and they were swollen and inflamed with extreme soreness and tenderness. The pain extended from the heel to the ball of both feet. The worker said his condition arose out of his employment as he was required to walk and stand on a particularly hard surface for extended periods of time. He had been working as a chef for more than 15 years and not once did he ever have similar problems with his feet. In the nine months that he worked for this employer, he went through three pairs of expensive footwear.
A workers’ compensation board adjudicator originally denied the claim and that decision was upheld by the review office. However, a worker advisor appealed the decision and the appeal commission determined the claimant’s plantar fasciitis arose out of and in the course of his employment, and the claim was accepted.
Plantar fasciitis is a fairly common injury that health and safety managers need to be aware of. One way they can help prevent this painful diagnosis is by ensuring that safety footwear not only checks all the safety requirements, but is comfortable and supportive, too.
“We see a ton of plantar fasciitis,” says Brad Sonnema, president of the Canadian Podiatric Medical Association in Edmonton. “Safety boots are very protective; they have a lot of qualities for protection, but they are not always supportive. If you look at the inside, they tend of be quite flat… So you’re on your feet all day and you need that little extra support for whatever reason but you don’t have it, then the plantar facia will start to take up a lot of stress.”
According to the Canadian Podiatric Medical Association, there are many other common foot ailments that can occur or be made worse from unsupportive or ill-fitting footwear:
•Bunions — an enlargement at the base of the big toe caused by a misalignment of the joint. It may be swollen, tender and painful.
•Blisters — painful, fluid-filled lesions often caused by friction and pressure from ill-fitting shoes, stiff shoes, wrinkled socks against the skin, excessive moisture or foot deformities.
•Corns and calluses — a build up of the skin that forms at the points of pressure or over bony prominences. Calluses form on the bottom and sides of the foot while corns form on the top of the foot and between the toes.
•Hammertoes — a contraction deformity, resulting in bony prominences on the toes.
•Ingrown nails — a painful condition caused by the nail growing into the surrounding skin, leading to inflammation and possible infection of the toe.
•Neuromas — often referred to as a pinched nerve, swollen nerve or nerve tumour, this painful condition is a benign growth of nerve tissue frequently found between the third and fourth toes (also known as Morton’s Neuroma), however, it can also occur between the second and third toes. It may result in pain, burning, tingling or numbness between the toes and in the ball of the foot.
Aside from being painful or uncomfortable, these foot issues can cause a distraction, which is a safety concern, says Brian Cassidy, director of environment, workplace safety and health at Purolator in Mississauga, Ont.
“If our mind is distracted toward a blister or pinching or ill fitting footwear, if we are thinking about our footwear, then we are not thinking about mind on task,” he says. “When we have the proper footwear on our feet that fit right and are doing their job, we don’t think about them at all.”
It’s important to note that the effects of poor footwear extend beyond the feet.
“Workers who walk or stand for long periods of time during the workday, without the proper footwear, foot support, shock absorption, they are susceptible to pain and musculoskeletal disorders that can really have lasting effects on the body,” says Kevan Orvitz, owner and founder of MegaComfort, an ergonomic anti-fatigue insole company in Toronto.
Workers may face an increased risk of inflammation and muscle fatigue as well as ankle, knee, back, hip and neck pain. These injuries can not only result in workers’ compensation claims, they can also cause an increase in absenteeism and a decrease in productivity.
“The feet really are the foundation of the whole body. It’s like a building: If the foundation is weak, the entire structure of the entire building is weak as well,” says Orvitz.
SIZE AND FIT
As children, our feet were measured regularly with a metal Brannock Device that we stepped on at the shoe store, but not many of us do this as adults — something we ought to reconsider.
“It’s amazing how many people don’t wear the right size shoes,” says Michael Hampton, marketing manager at Mister Safety Shoes in Toronto. “They think they do and they think they know what their size is but they don’t actually.”
Improper fit is a “recipe for pain and disaster,” says Sonnema, so it’s of the utmost importance that workers get the right safety boot for them. First, workers need to be properly evaluated so they know exactly what size they need. A lot of people have feet that are slightly different sizes, so it’s important to size for the larger of the two feet.
At Red Wing Shoes, associates use a 3D imaging machine for sizing because it provides an even more accurate picture of the customer’s foot length and width, says David Greulich, Canada region director for Red Wing in Waterloo, Ont.
“Even myself, I started selling shoes in 1990 and for the longest time, I went to a shoe store and the guy fitted me to an 11 triple E. But when I started at Red Wing five years ago, I went on the (3D imaging) machine and it showed I was 13D,” he says. “The shoes fit snuggly around my foot and offer support both laterally and all over. It kind of encapsulates the foot like a glove.”
When trying on footwear, there should be at least a thumb’s width from the big toe to the end of the shoe. The worker should be able to put his index finger down the back of the boot when standing comfortably to ensure the boot is not too tight. Workers should look for padded lining and a firm sole that will provide stability.
“Try it on. Wear the boot around a little bit. If you’re feeling pinching or rubbing, especially on the steel toe cap, then this boot is not fitting you properly,” says Sonnema. “Regardless of the price, don’t buy it.”
He also encourages workers to lace the boot up properly when trying them on at the store — an important piece that is often neglected. It’s also important to go shopping at the end of the day because the foot will swell throughout the day. Workers might find a boot fits great in the morning but it could be quite tight by the end of the shift.
According to the Government of Canada’s Protect Your Feet! document, an individual must not feel any uncomfortable pressure once the shoes are tied or fastened. Models that are too narrow or have toe caps that are too low should be avoided.
“If you can feel the toe caps with your toes, wearing your shoes will become unbearable after a certain amount of time,” the document says.
It also recommends buying work shoes and boots that have little or no decorative strips or seams as they may bother the wearer over time.
Wearing the right socks at the time of a fitting is also important. Workers should wear the same kind that they wear on the job, says Hampton.
Unlike street shoes that can sometimes stretch a bit, with safety boots, what you see is what you get.
“Safety boots are not very forgivable. If you’ve got a rigid toe cap, you’re just not going to get that forgivingness out of them,” says Sonnema. “If it doesn’t fit in the store, it’s not going to fit on the job site.”
Work boots that fit properly are not only going to be more comfortable for the worker, they will last longer, says Greulich.
“If your foot is loose inside the shoe, if it’s too long, your heel is going to slip, you’ll get blisters in the back of your shoe. You’re going to wear through that heel counter and your shoes will wear out prematurely and you’ll be uncomfortable in the process,” he says. “Getting that proper fit is the critical piece to comfort, longevity, durability and safety, for that matter.”
It’s important that employees consider the temperatures they will be working in when selecting a work boot. They may need boots with insulation, such as Thermolite or Thinsulate, if working in the extreme cold.
Depending on the nature of the job, workers may require heavier boots in the winter and lighter shoes in the spring and summer.
Breathability is another consideration. A moisture-wicking lining will take moisture away from the foot.
“That is important especially if you’re doing something very physical and you’re moving around a lot or you work in an environment that’s a lot warmer,” says Hampton. “There’s nothing worse than having feet that are sweaty and you can feel it while you’re working; it’s just a horrible feeling and it’s a distraction.”
According to Protect Your Feet!, work shoes without breathability cause the foot temperature to increase and soften or swell the skin. This creates an environment that promotes the development of micro-organisms and the forming of cracks and blisters. The government recommends a boot made of lightly finished full-grain leather (the classic yellow leather) as it is very permeable to perspiration. It also cautions against synthetic leather (known as poromer) because it does not allow air to flow.
A lot of athletic safety shoes have lining made of breathable mesh and some leather boots have Gore-tex linings, which breathe well, says Hampton.
Socks play an important role in breathability and workers should wear those with moisture-wicking properties, such as merino wool blended with nylon and acrylic, says Greulich.
As a side note, if improper socks are worn, athlete’s foot can develop — a common fungal infection of the skin and nails which usually results in itching, scaling, redness and the formation of small blisters.
The weight of the safety boot is also something to consider, although they are much lighter now than years ago. According to Protect Your Feet!, a good pair of shoes should not weigh more than 1,300 grams.
“They’re not like 20 years ago with cement on your feet. Not at all. Some are designed for maximum protection so they are going to have more weight behind them,” says Hampton. “In general, there are good options that have different weights to them so someone will find one they are comfortable with.”
It’s important to take job tasks into consideration because a worker may need a safety shoe that allows him to be more agile, says Hampton. For example, jobs that regularly involve kneeling down, such as welders
and roofers, need a shoe that has good flexibility.
“Are you just standing all day or are you moving a lot like in a warehouse? Do you have to be very nimble and get around? All those things affect how we define what would be comfortable for what you’re doing,” Hampton says. “Work boots that are meant to really protect your feel are not going to be great if you have to dodge and weave around a warehouse; you need something much more flexible.”
The surface the worker is working on can also impact what boot she chooses, from a comfort standpoint. For example, if she is standing on concrete for long periods of time, she wants a shoe that has cushioning support, such as one with polyurethane in the midsole, says Greulich.
Workers with some medical conditions, such as diabetes or chronic ankle instability, may need to pay special attention to certain comfort considerations and seek out boots that are best suited to their condition.
Arch support is one of the most critical components in ensuring safety footwear is comfortable — and this is where insoles come in. The insole might be a custom orthotic made after a consultation with a foot doctor for workers with more severe issues, or simply an after-market insole. Most of the linings that come with safety footwear are removable and can be replaced with a more supportive insole.
“If you’re slightly flat footed, your foot tends to go to the inside, pronate, then you can put in an insole that offers arch support and holds the foot in its natural position and doesn’t allow it to pronate,” says Greulich. “Therefore, you will be comfortable for a much longer period of time and reduce the risk of injury at the same time.”
Insoles can do much more than provide arch support. For example, some keep feet dry and cool with an aerated design, provide extra shock absorption or specialize in anti-fatigue.
Insoles can also help alleviate pressure points. The 3D imaging machine at Red Wing Shoes maps the worker’s foot, identifying pressure points, and associates recommend suitable insoles. Many vendors have some type of pad or kiosk that workers can step on to help them identify the proper insole.
A caution when it comes to cushioning: More is not always better. A lot of people think they need something softer if they are having heel or foot pain, but that is a misconception, says Sonnema, adding jamming a bunch of soft cushioning in the shoe creates instability.
“I see a lot of guys come in and they will have three layers of insoles in their boots. But when you rip out all those insoles and put in a solid orthotic that controls the foot and gets it functioning better, all of a sudden everything falls into place and the pain goes away,” Sonnema says. “It’s kind of counterintuitive but cushioning is not always the answer to everything.”
Many employee health benefits plans, including Purolator’s, offer coverage for orthotics. Cassidy strongly recommends that his workers visit a podiatrist and have their feet evaluated.
“It’s part of prevention and looking after our health,” he says. “Our feet are probably one of the most important pieces of equipment we have and why not get them checked out and get a specific recommendation, just like our teeth?”
To make sure workers are selecting the right safety boots, you may want to bring the boots to them. At some of Purolator’s locations, a footwear truck comes to the site with knowledgeable associates who can help workers make the right selection.
Mister Safety Shoes goes directly to workplaces with its mobile stores and it also has retail outlets. When it is working with a company on a managed safety footwear program, it meets with health and safety managers to determine what boots would suit their needs.
“We usually do a walk-through with these managers at their companies to get a sense of what their employees are doing all
day, what they are wearing currently and then we come back with a recommendation,” says Hampton.
With a managed program, all employees’ names and numbers for a particular company are registered electronically in the vendor’s system, so when a worker goes to the store, all of his footwear requirements pop up on the screen, says Greulich. This eliminates the need for vouchers or cards.
How the boots are paid for is something health and safety professionals need to consider. Workers at Purolator are required to purchase the footwear and then they are reimbursed up to $125 annually. This type of annual subsidy is a common approach. However, it comes with some risk because employees have to pay out of pocket and it might take some time to be reimbursed, says Hampton.
“They can make the decision to buy a poorer quality boot that fits within their own budget and then they are at risk,” he says.
The other option is to be part of a managed program with a retailer where the company is billed directly once or twice per year and there are no out-of-pocket costs for workers. The employer would still pre-determine a maximum amount per worker and if a worker wants to choose boots that exceed that, then he would chip in for the remainder. To further encourage choosing a comfortable shoe or boot, this remainder can be paid through a payroll deduction program, which the employer can set up with the vendor.
With an aging workforce, comfortable and supportive footwear is of the utmost importance.
“What generally happens to our feet with age and gravity is that people who have arches that aren’t particularly good, (the arches) tend to fall or have problems,” says Hampton.
When a worker has been in the workforce for 30 years, it starts to take its toll, says Orvitz. Proper foot support is needed to prevent strain and stress on the body as well as long-term problems, such as reduced circulation, arthritis and degenerative joint disease.
Health and safety managers first need to make sure the boots and shoes their workers wear meet all necessary safety requirements, but comfort should be a close second. Ultimately, Cassidy from Purolator says it best: “The more people feel comfortable and feel good in their safety footwear, the more likely they are to wear it.”
This article originally appeared in the February/March 2018 issue of COS.