Decision #10/04 - Type: Workers Compensation

Preamble

An Appeal Panel hearing was held on December 11, 2003, at the request of the union representative, acting on behalf of the claimant. The Panel discussed this appeal on the same day.

Issue

Whether or not the claim is acceptable.

Decision

The claim is not acceptable.

Decision: Unanimous

Background

In January 2003, the claimant submitted an application for compensation benefits in which she related her left foot/heel difficulties to the nature of her employment activities on August 30, 2002.

In a letter dated January 30, 2003, the claimant stated that her left foot/heel injury was caused by the motions of continual pushing and pulling of a manual pallet jack on cement floors. She stated that this was further aggravated as the result of an earlier accident when her right foot was crushed between two forklifts. "Having to put my full weight on my left foot to compensate for the tenderness in my right foot, has resulted in a condition called bilateral plantar fasciitis which continued to get worse and more painful in the following months."

On October 8, 2002, the attending physician reported that the claimant had bilateral plantar fasciitis, much worse on the left side. He stated that this condition would cause chronic pain but had responded to job changes as well as a recent cortisone injection. The physician noted that the condition was exacerbated by prolonged standing, walking or lifting/pulling heavy objects. It was also exacerbated by improper shoewear (i.e. work boots) and cement floors.

On February 11, 2003, a WCB adjudicator contacted the claimant by phone and the following information was obtained:
  • the claimant started working for the employer in March 2000 in packaging.

  • her duties included ordering boxes, bringing the boxes downstairs and distributing boxes. These duties were performed up until the end of August 2002.

  • the difficulties with her left foot/heel started in January 2002 while working in packaging and there was no specific accident.

  • the claimant said she wore a brace on her right foot from November 2001 to May 2002 as a result of a previous WCB claim. She stated that her right foot was not strong enough and she was using her left foot too much for pulling and pushing at work. The claimant believed that her left foot difficulties were related to having worn a brace on her right foot.

  • the claimant wore leather steel-toed boots that her employer supplied. She normally worked on flat surfaces and would use stairs if the elevator wasn't working. The claimant said she carried 70 lb. boxes approximately 30 feet, 10 times a day.

  • no one was aware of her left foot/heel difficulties in January 2002. The claimant did speak with the company nurse in August 2002 but no cause was provided for her difficulties. The claimant indicated that there were coworkers who were aware of her difficulties before August 2002 but she could not recall their names.
In a decision letter to the claimant dated February 21, 2003, a WCB adjudicator noted that plantar fasciitis was not known to be peculiar to, or characteristic of, any particular trait or occupations, or particular to the claimant's particular type of employment. He indicated that complaints of foot pain are frequent and not normally related to a specific cause, and the etiology of plantar fasciitis was multi-factorial. Based on the available, information, the adjudicator was unable to substantiate that the claimant's left foot/heel difficulties arose "out of and in the course of" her employment. Therefore the claim for medical aid treatment was denied. On March 26, 2003, the decision was appealed by a union representative and the case was forwarded to the Review Office for consideration.

On June 5, 2003, Review Office considered the union representative's appeal along with a submission from the employer's advocate dated May 5, 2003. Review Office also sought the medical advice of a WCB orthopaedic consultant and his response is on file dated May 22, 2003.

Review Office confirmed that the claim was not acceptable. Review Office noted that there was no specific incident or accident involved nor was the claimant making such a contention. It was the claimant's contention, however, that her symptoms came on gradually over a period of time due to both her general duties and her perception that extra stressors were being placed on the left foot to compensate for a weaker right foot which was injured on September 18, 2001 during the course of her employment. Review Office referred to the opinion expressed by the WCB orthopaedic consultant dated May 22, 2003 in which he stated that the causes of plantar fasciitis are multi-factorial and an injury to the opposite right foot would not necessarily lead to the condition in the claimant's opposite foot. He also indicated that patients with plantar fasciitis were just as likely to be symptomatic in and outside of work with any standing or ambulation.

Review Office agreed with the rationale used by the adjudicator to deny the claim in his decision letter of February 21, 2003. Review Office was also of the opinion that it had been unable to establish anything more than a speculative relationship between the claimant's left foot plantar fasciitis condition and her employment. On September 10, 2003, the union representative appealed Review Office's decision and an oral hearing was arranged.

Reasons

This case involves a worker who has been diagnosed with bilateral plantar fasciitis. She attributed the cause of this condition to her employment duties. She further believed that the reason this condition was worse on her left foot was due to her overcompensating because of an earlier compensable injury to her right ankle.

Her application for compensation was denied, as it was determined that there was no causal relationship between her condition and her employment. This decision was upheld upon reconsideration by Review Office. She then appealed to the Appeal Commission.

For her appeal to be successful, the Appeal Panel would have to determine that her plantar fasciitis arose out of and in the course of her employment, as required by statute. We were not able to make that determination.

In coming to our decision, we conducted a thorough review of the claim file, as well as holding a hearing, at which we heard testimony from the claimant, her union representative, an employer representative and the employer's advocate.

It was incumbent upon us to consider this matter from two angles. Was her condition caused by the general conditions of her employment, i.e. working on her feet all day, placing stresses on her feet when she pulled or pushed dollies? Or, was it a sequela of her earlier crush injury to her right ankle, caused or exacerbated by her favouring that foot and, thus, overusing her left?

We could find no medical support for either premise.

While her treating physician noted that this condition is "exacerbated by prolonged standing, walking or lifting/pulling heavy objects", she did not express any opinion as to its cause. In rejecting her claim, the WCB adjudicator noted that "plantar fasciitis is not known to be peculiar to, or characteristic of, any particular traits or occupations."

As noted in the Background section, a board orthopaedic specialist, after reviewing the file, offered the opinion that her work duties were not the cause of her condition. He wrote:
"… patients with plantar fasciitis are just as likely to be symptomatic in and outside of work - with any standing or ambulation."
He also wrote that her right ankle injury would not have played a role in the development of left heel plantar fasciitis:
"The causes of plantar fasciitis are multifactorial and an injury to the opposite right foot would not necessarily lead to the condition in the opposite foot."
In considering a diagnosis of plantar fasciitis, we referred to a discussion paper prepared for our Ontario counterpart, the Workplace Safety and Insurance Appeals Tribunal1. In respect of the causes of this condition, the paper notes:

"There is no consensus regarding etiology. … it is reasonably certain that a condition which has so many different theories of etiology and treatment does not have valid proof of any one cause. Factors associated with or aggravating this condition are better defined: age, sex, obesity, seronegative inflammatory disorders and activity levels. The average age is 45 years. Prevalence is twice in females vs. males. There may be a history of elevated stress to the foot as a result of increased activities, prolonged standing or weight gain. Physical activity certainly aggravates and can sometimes precipitate the heel pain.
….  

"Factors such as acute injury, the presence of a heel spur, the type of footwear, the walking surface and employment or chronic repetitive activity (other than athletics) have been proposed, but they have not been established as causative. A correlation between prolonged standing or walking has been suggested, but direct causation is unsubstantiated since heel pain can occur in all types of patients with varying levels of recreational activities and job requirements. The consistency of the surface on which one walks has not been established as a causative or aggravating factor. This is likely because tension, rather than compression, is the primary force which precipitates injury and inflammation of the plantar fascia. The magnitude of the tensile forces placed through the plantar fascia is related more to the activity level, types of activities, body weight and stability of the medial arch rather than the consistency of the walking surface."

The paper concludes:
"The plantar fascia is an inelastic structure that plays an important role in maintaining the stability of the medial arch and midtarsal joints. The primary force placed through the plantar fascia is tension, not compression. It functions as a tie-rod in the foot truss and, during the gait cycle, is under maximal tension in the mid-portion and terminal portions of the stance phase. It is generally accepted that the primary etiology of heel pain is the result of repetitive tensile forces placed through aging tissue that is no longer capable of tolerating the stresses. While associated factors for this condition have been identified, no one activity is known to be the cause of heel pain."
This substantiates, for us, the opinion of the board orthopaedic specialist, noted above. This leads us to conclude that we are unable to determine that the claimant's plantar fasciitis arose out of her employment.

Accordingly, the appeal is dismissed.

Footnotes

1Timothy Daniels, MD, Plantar Fasciitis (Heel Pain), March 2003.

Panel Members

T. Sargeant, Presiding Officer
B. Popowich, Commissioner
M. Day, Commissioner

Recording Secretary, B. Miller

T. Sargeant - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 15th day of January, 2004

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