Case Study: Foot

Mr. Spring is a 39-year old man, who injured his left foot when he slipped and tripped at a wholesale warehouse store.

Mr. Spring underwent foot surgery that involved arthroscopy with extensive debridement and excision left talar dome lesion. Follow-up medical reports indicate that Mr. Spring developed a traumatic type neuroma in his left foot, secondary to changes in gait pattern following surgery; degenerative arthritis of the left ankle, chronic pain syndrome of the left ankle/foot, Reflexive Sympathetic Dystrophy (RSD); and has a permanent left ankle injury.

Activities of Daily Living

Mr. Spring is independent in his activities of daily living (ADL), experiencing left foot strain and pain when performing all tasks that require standing or weight bearing. This affects his ease of transfers, especially to/from the shower, his car and truck. Mr. Spring avoids the stairs whenever possible; he does limited carrying and cannot carry grocery bags up the steps.

Occupational Performance Issues

At time of injury, Mr. Spring was the owner of a property maintenance company that did mainly lawn care and landscaping and some hardscaping. Since his injury, Mr. Spring now mainly sits in a rider truck to cut grass. He can no longer perform related lawn care tasks (e.g. hedging, trimming, weed wacking, planting, etc.) that require walking on level and uneven terrain, and are more physically demanding. He has had to hire an assistant to accompany him to all jobs.

According to the U.S. Department of Labor’s Dictionary of Occupational Titles and Selected Characteristics of Occupations Defined in the Dictionary of Occupational Titles (1981), the job of Landscaper is described as having heavy work demands (lift 100 pounds maximum and lift/carry objects up to 50 pounds, frequently). Heavy work also requires significant amounts of standing and walking.

Evaluation Findings

•Ambulation without use of assistive devices, but with a limp
• Maintenance of left foot in an inverted and supinated posture
• Reduced left foot mobility in all planes
• Weight bearing when standing and ambulating primarily on the un-involved leg
• Weight bearing on the left foot limited to primarily along the lateral foot border and very briefly (< 5 seconds)
• Inability to push off the left foot when getting up from kneel or squat positions
• Stand tolerance of <10 minutes without symptom exacerbation
• Right hip/leg strain while standing secondary to nearly all weight bearing on this extremity
• Poor body mechanics during low level lifts with 10 & 20 pound loads secondary to reduced weight bearing on the left leg
• Inability to stand steadily during waist - overhead level lifts with 10 and 20 pound loads secondary to reduced weight bearing on the left leg
• During stairs, avoidance of contact of the left forefoot with the step; use of external support and no reciprocal foot placement
• Sharp left forefoot pain when contact is made with this area when standing
• Increased pain levels with standing and weight bearing activities (from a 6/10 at onset of evaluation to an 8-9/10 after 1.5 hours)

Mr. Spring avoids contact with the left forefoot during all weight transfers
and cannot ascend/descend steps with reciprocal foot placement.

Summary


Following a fall where Mr. Spring injured his left foot, he had surgery that involved arthroscopy with debridement and excision left talar dome lesion. He then developed a neuroma in the left forefoot and now has post traumatic arthritis of the left ankle, chronic pain and RSD in this foot.

Mr. Spring is significantly limited in his abilities to weight bear on the left foot. He has limited stand and walk tolerances, reduced transfer skills related to his inability to stand briefly on this foot alone, cannot push off on the forefoot during stair activities or other weight transfers, and has limited lifting/carrying capacities secondary to a poor standing base of support. Mr. Spring utilizes external support whenever possible to minimize strain on the left foot when standing.

Mr. Spring’s weight bearing restrictions significantly limit his abilities to assist his wife at home and resume the recreational activities that he used to enjoy. Mr. Spring cannot perform his full occupational duties as a landscaper because of his very reduced standing and walking tolerances, inability to easily navigate on uneven terrain, or safely handle light loads or heavier. Because of these factors, he is now limited to mainly riding a mower and supervising employees, and has begun exploration of other work that he can perform with his physical limitations, given his limited education and work skills.

Contact us at 973. 334.7499 or at ellen@ellenradersmith.com