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Pedorthics: Helping People Get Back to Work
By Miki Fairley  Not every pedorthist faces a
first-time workers-compensation case like this
one!
When 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.
A bush pilot was returning to pick up some fishing clients he
had flown to a nearby lake earlier that week. However, his clients
weren't at the lake, so he walked from his plane inland a bit to
see if he could find them. He inadvertently came between a female
grizzly and her two cubs. He raced for a tree and started climbing,
since he had heard grizzlies couldn't climb trees. Wrong!
As she started up the tree after him, he tried kicking her head
to get her to leave, but then he accidentally stuck his foot right
in her mouth, and she chomped down. The angry grizzly tried to pull
him out of the tree and pulled part of the lateral side of his foot
off. He then began to kick with the other foot, and she bit him on
the lower calf. She then turned loose of the tree, thinking she
would pull him down, but his muscle gave way instead.
The grizzly stayed at the bottom of the tree for a couple of
hours before she finally left, and the hapless pilot could climb
down. By the time he arrived back at his plane, the fishermen were
there, but neither one could fly, so he had to fly the plane
out.
At the hospital, doctors were able to reattach the calf muscle,
but it did not have much function, as a result he had foot drop on
his left side and the lateral side of his right foot was
missing.
The challenge for Decker then became providing the correct
footwear and orthotic support to enable the pilot to continue
working--including being able to hike when necessary as well as fly
his plane. Decker built a high-top boot with enough room to
accommodate an AFO for the left foot, with the boot for the right
foot being constructed with ample filler and lateral support. When
the bear bit down on the lateral side of his foot, she also pulled
a peroneal muscle loose, so his foot really wanted to invert,
Decker recalled. "We had to build a boot that would compensate for
the loss of function of the peroneal muscle," he said.
After describing his "hairy" (ouch!) introduction to workers
comp in a session during last year's Pedorthic Footwear Association
(PFA) Symposium & Exposition, Decker gave some helpful advice
for pedorthists providing care in workers compensation cases.
Decker also discussed the pedorthic approach to workers comp cases
with The O&P EDGE.
Evaluation and Treatment
The first step is to evaluate the case--what has already been
done, i.e., surgery, physical therapy, etc.--and what needs to be
done to get the patient on his feet and back to work. "We see what
the doctor has prescribed, and we determine if we are capable of
doing it, or if we feel that there are other treatment options that
the doctor may be unaware of which might help the patient a lot
more," Decker explained.
The next critical step is looking at what reimbursement will
cover. "We determine what we can do, based on the amount that is
covered; sometimes, we can get the amount increased, based on the
doctor's prescription."
Then, the pedorthist talks with the patient and asks questions
such as, "Do you need to go back to work? How soon? Will you be
going back to the same type of work, or will you be reassigned to a
less physically demanding job?" Other questions revolve around
recreational activities: "What kind of outside activities do you
want to be able to do?" For instance, was the patient someone who
used to go hiking, camping, or was involved in sports?
Putting all these factors together helps determine what
treatment and outcome the pedorthist will try to accomplish. Decker
noted that sometimes physicians, as well as patients, may be
unrealistic as to what is possible as far as restoring function
through pedorthic treatment. However, on the positive side, Decker
points out that with the teamwork of a pedorthist, an orthotist,
and a physical or occupational therapist, there is much that can be
done to restore the patient to optimal possible function.
Decker stressed the importance of a pedorthist having a strong
knowledge of foot and leg anatomy and biomechanics. "For instance,
if certain damaged muscles are not able to function fully, we need
to know what to do mechanically with our orthotic or our shoe.
Being knowledgeable about those muscle groups and functions is
critical to the outcome. We need to know what we have to do to make
the foot function correctly."
Amputations caused by work-related injuries also can involve the
pedorthist. For instance, with a talar amputation, the foot will
still continue to plantarflex due to the unopposed gastroc-soleus
muscle group. "So we need to do something, such as using a brace
and rocker sole, to help lift that toe up so that the foot does not
snag on the ground as the patient walks," Decker said.
Pedorthists also are concerned with a sound contralateral limb,
since the patient tends to put more weight on it, and therefore,
that leg too can become damaged over time. Decker recalls an oil
well driller whose right leg was pulled off by a cable that had
become looped around it. Coworkers grabbed the leg, and at the
hospital, the leg was successfully reattached. However, the
reattached leg was now shorter, and the man began to put more
weight on the uninjured side. "So we had to build an orthosis to
help reduce the stress on that side, and we also put a lift on the
right side to balance that leg out a bit more," Decker
recalled.
Challenging Cases
Crushing injuries are the most frequent cases he has seen,
Decker said. Machinery runs over a worker's foot or it becomes
caught in between a piece of equipment and a hard surface. However,
Decker also has had some unusual and challenging cases besides the
pilot who suffered the bear attack.
The oil well driller also was a professional bull rider on
weekends. After his injury, he no longer could ride bulls, but he
became a judge at bull-riding events. He needed a pair of boots
that would allow an AFO inside and which would enable him to move
quickly out of the way if a bull came at him. Plus, the boots had
to look like cowboy boots. Decker met that challenge.
Another case involved a construction worker who helped build
bridges. To do certain work on a bridge, the man had to work from a
boat. While out on a job he fell out and the boat's propeller hit
him in the calf muscle and severed the Achilles tendon. Although a
surgeon was able to reattach the tendon, the scar tissue severely
damaged his ability to plantarflex, "so that was another one where
we worked with an orthotist, who built an AFO," Decker said. "We
then built a work boot around the AFO and got him back to
work."
As these cases prove, jobs can be hazardous--in any given year,
there are about 120,000 job-related foot injuries, about one-third
of them toe injuries, according to the National Safety Council.
However, pedorthists can play a key role in getting people back to
work--and back to their lives. 
Table Of Contents - December 2005
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A well-known member of the O&P community, Ronnie Graves, CO, BOCPO, LPO, RTP, heroically assisted in the rescue of hundreds of animals in Mississippi.
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Pedorthics: Helping People Get Back to Work
Not every pedorthist faces a first-time workers-compensation case like this one!
Stepping Out
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Natural Disasters: Can Your Practice Survive?
Legal EDGE
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Karl Fillauer: Passionate about O&P
Industry Leader
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Hans Richard Lehneis, PhD, CPO, Passes
Industry Insight
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Got FAQs?
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Luci Busch, RTP
Profile
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Please Don’t Shoot the Messenger
Perspective
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From the Editor: New Managing Editor Joins The EDGE
Viewpoint
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