Foot disorders result in pain and disability (Neale, 2006). One of these conditions is plantar fasciitis (PF) - chronic heel pain, or heel spur syndrome. It is most common in those aged 40 to 60 years old and accounts for 10-15% of all adult foot complaints (Irving et al, 2007).
Riddle et al (2003) indicate contributory factors in the development of PF include prolonged weight-bearing, limited ankle dorsiflexion, or bending, and obesity (Irving et al, 2007). Other influences include poor biomechanics, anatomical variations, and inadequate footwear (Roxas, 2005).
Aetiology (the causes of PF) is poorly understood (Singh et al, 1997), but is generally considered to be an inflammatory response to repetitive trauma: micro-tears in the plantar fascia (the thick connective tissue that supports the ankle) resulting in foot pain and swelling changed patterns of weight bearing and associated knee and hip pathology.
More than 30 million working days are lost annually due to illness (Health and Safety Commission, 2007), the most common cause being musculoskeletal disorders. This case study examines the impact of PF on work performance, together with the variables used to assess fitness for work.
The client, a postal delivery-man (pseudonym: Paul), was referred to OH by his manager in relation to sickness absence.
An exact aetiology of PF is debatable (Roxas, 2005). Contributory factors include excessive weight, anatomical variations, poor biomechanics, occupationally-related activities and inadequate footwear (Roxas, 2005), however there is a lack of supporting empirical evidence relating to many of these (Irving et al, 2007). PF may also be due to lack of cushioning, increased stretching in flat feet, and heel spurs - growths of bone on the underside of the foot in the area of the heel bone) (DeMaio et al, 1993).
It is thought that PF originates from repetitive micro-trauma to the plantar fascia at its origin on the calcaneus (Singh, 2006), and associated inflammatory processes. However, Lemont et al (2003) suggest that some presentations are more degenerative than inflammatory.