<img style="float: right;" src="https:\/\/opedge.com\/Content\/OldArticles\/images\/2005-12_07\/so.jpg" hspace="4" vspace="4" \/>\r\n\r\n<b><i>Not every pedorthist faces a first-time workers-compensation case like this one!<\/i><\/b>\r\n\r\nWhen he first received his dramatic introduction to workers-comp injuries, Wayne Decker, CPed, and his wife Nancy were operating a custom bootmaking and pedorthic facility in Durango, Colorado. The Deckers now own and operate American Footcare and the Pedorthic Shoe Institute, a continuing education provider, in Henryetta, Oklahoma.\r\n\r\nA bush pilot was returning to pick up some fishing clients he\r\nhad flown to a nearby lake earlier that week. However, his clients\r\nweren't at the lake, so he walked from his plane inland a bit to\r\nsee if he could find them. He inadvertently came between a female\r\ngrizzly and her two cubs. He raced for a tree and started climbing,\r\nsince he had heard grizzlies couldn't climb trees. Wrong!\r\n\r\nAs she started up the tree after him, he tried kicking her head\r\nto get her to leave, but then he accidentally stuck his foot right\r\nin her mouth, and she chomped down. The angry grizzly tried to pull\r\nhim out of the tree and pulled part of the lateral side of his foot\r\noff. He then began to kick with the other foot, and she bit him on\r\nthe lower calf. She then turned loose of the tree, thinking she\r\nwould pull him down, but his muscle gave way instead.\r\n\r\nThe grizzly stayed at the bottom of the tree for a couple of\r\nhours before she finally left, and the hapless pilot could climb\r\ndown. By the time he arrived back at his plane, the fishermen were\r\nthere, but neither one could fly, so he had to fly the plane\r\nout.\r\n\r\nAt the hospital, doctors were able to reattach the calf muscle,\r\nbut it did not have much function, as a result he had foot drop on\r\nhis left side and the lateral side of his right foot was\r\nmissing.\r\n\r\nThe challenge for Decker then became providing the correct\r\nfootwear and orthotic support to enable the pilot to continue\r\nworking--including being able to hike when necessary as well as fly\r\nhis plane. Decker built a high-top boot with enough room to\r\naccommodate an AFO for the left foot, with the boot for the right\r\nfoot being constructed with ample filler and lateral support. When\r\nthe bear bit down on the lateral side of his foot, she also pulled\r\na peroneal muscle loose, so his foot really wanted to invert,\r\nDecker recalled. "We had to build a boot that would compensate for\r\nthe loss of function of the peroneal muscle," he said.\r\n\r\nAfter describing his "hairy" (ouch!) introduction to workers\r\ncomp in a session during last year's Pedorthic Footwear Association\r\n(PFA) Symposium & Exposition, Decker gave some helpful advice\r\nfor pedorthists providing care in workers compensation cases.\r\nDecker also discussed the pedorthic approach to workers comp cases\r\nwith <i>The O&P EDGE<\/i>.\r\n<h4>Evaluation and Treatment<\/h4>\r\nThe first step is to evaluate the case--what has already been\r\ndone, i.e., surgery, physical therapy, etc.--and what needs to be\r\ndone to get the patient on his feet and back to work. "We see what\r\nthe doctor has prescribed, and we determine if we are capable of\r\ndoing it, or if we feel that there are other treatment options that\r\nthe doctor may be unaware of which might help the patient a lot\r\nmore," Decker explained.\r\n\r\nThe next critical step is looking at what reimbursement will\r\ncover. "We determine what we can do, based on the amount that is\r\ncovered; sometimes, we can get the amount increased, based on the\r\ndoctor's prescription."\r\n\r\nThen, the pedorthist talks with the patient and asks questions\r\nsuch as, "Do you need to go back to work? How soon? Will you be\r\ngoing back to the same type of work, or will you be reassigned to a\r\nless physically demanding job?" Other questions revolve around\r\nrecreational activities: "What kind of outside activities do you\r\nwant to be able to do?" For instance, was the patient someone who\r\nused to go hiking, camping, or was involved in sports?\r\n\r\nPutting all these factors together helps determine what\r\ntreatment and outcome the pedorthist will try to accomplish. Decker\r\nnoted that sometimes physicians, as well as patients, may be\r\nunrealistic as to what is possible as far as restoring function\r\nthrough pedorthic treatment. However, on the positive side, Decker\r\npoints out that with the teamwork of a pedorthist, an orthotist,\r\nand a physical or occupational therapist, there is much that can be\r\ndone to restore the patient to optimal possible function.\r\n\r\nDecker stressed the importance of a pedorthist having a strong\r\nknowledge of foot and leg anatomy and biomechanics. "For instance,\r\nif certain damaged muscles are not able to function fully, we need\r\nto know what to do mechanically with our orthotic or our shoe.\r\nBeing knowledgeable about those muscle groups and functions is\r\ncritical to the outcome. We need to know what we have to do to make\r\nthe foot function correctly."\r\n\r\nAmputations caused by work-related injuries also can involve the\r\npedorthist. For instance, with a talar amputation, the foot will\r\nstill continue to plantarflex due to the unopposed gastroc-soleus\r\nmuscle group. "So we need to do something, such as using a brace\r\nand rocker sole, to help lift that toe up so that the foot does not\r\nsnag on the ground as the patient walks," Decker said.\r\n\r\nPedorthists also are concerned with a sound contralateral limb,\r\nsince the patient tends to put more weight on it, and therefore,\r\nthat leg too can become damaged over time. Decker recalls an oil\r\nwell driller whose right leg was pulled off by a cable that had\r\nbecome looped around it. Coworkers grabbed the leg, and at the\r\nhospital, the leg was successfully reattached. However, the\r\nreattached leg was now shorter, and the man began to put more\r\nweight on the uninjured side. "So we had to build an orthosis to\r\nhelp reduce the stress on that side, and we also put a lift on the\r\nright side to balance that leg out a bit more," Decker\r\nrecalled.\r\n<h4>Challenging Cases<\/h4>\r\nCrushing injuries are the most frequent cases he has seen,\r\nDecker said. Machinery runs over a worker's foot or it becomes\r\ncaught in between a piece of equipment and a hard surface. However,\r\nDecker also has had some unusual and challenging cases besides the\r\npilot who suffered the bear attack.\r\n\r\nThe oil well driller also was a professional bull rider on\r\nweekends. After his injury, he no longer could ride bulls, but he\r\nbecame a judge at bull-riding events. He needed a pair of boots\r\nthat would allow an AFO inside and which would enable him to move\r\nquickly out of the way if a bull came at him. Plus, the boots had\r\nto look like cowboy boots. Decker met that challenge.\r\n\r\nAnother case involved a construction worker who helped build\r\nbridges. To do certain work on a bridge, the man had to work from a\r\nboat. While out on a job he fell out and the boat's propeller hit\r\nhim in the calf muscle and severed the Achilles tendon. Although a\r\nsurgeon was able to reattach the tendon, the scar tissue severely\r\ndamaged his ability to plantarflex, "so that was another one where\r\nwe worked with an orthotist, who built an AFO," Decker said. "We\r\nthen built a work boot around the AFO and got him back to\r\nwork."\r\n\r\nAs these cases prove, jobs can be hazardous--in any given year,\r\nthere are about 120,000 job-related foot injuries, about one-third\r\nof them toe injuries, according to the National Safety Council.\r\nHowever, pedorthists can play a key role in getting people back to\r\nwork--and back to their lives.