«DECISION NO. 1044/97 Disablement (repetitive work); Fasciitis (plantar). The worker appealed a decision of the Appeals Officer denying entitlement ...»
DECISION NO. 1044/97
Disablement (repetitive work); Fasciitis (plantar).
The worker appealed a decision of the Appeals Officer denying entitlement for right plantar fasciitis.
The worker's condition was a disablement from the nature of the worker's work for a muffler
manufacturer, which required repetitive work pressing a pedal when spot welding, operating a press, and
raising, lowering and moving a panel lifter. The appeal was allowed. [10 pages] DECIDED BY: Robeson; Anderson; Chapman DATE: 30/09/99 ACT: WCA TRIBUNAL DECISIONS CONSIDERED: Decision No. 280 (1987), 6 W.C.A.T.R. 27 consd;
Decision No. 915 (1987), 7 W.C.A.T.R. 1 consd
WORKPLACE SAFETY AND INSURANCE
APPEALS TRIBUNALDECISION NO. 1044/97
This appeal was heard in Burlington on September 16, 1997, by a Tribunal Panel consisting of:
 V.R. Robeson : Vice-Chair, S.L. Chapman : Member representative of employers, J. Anderson : Member representative of workers.
Post-hearing activity was completed in December 1998.
THE APPEAL PROCEEDINGS
The worker attended the hearing with her representative, W. Willis, United Steelworkers of  America, Local 2894. G. Kennedy from the same union local attended the hearing with the worker’s representative as an adviser. G. Newton, health and safety co-ordinator, attended the hearing from the accident employer who was represented by J. Gagné, human resources representative.
THE EVIDENCEThe following exhibits were marked as evidence in this appeal: Case Record (Exhibit #1),  Addendum #1 (Exhibit #2), Addendum #2 (Exhibit #3), a letter from W. Wills dated September 10, 1997 (Exhibit #4), a photograph identified as a pallet lifter (Exhibit #5), a pamphlet entitled “Heel Spur Syndrome: The New Treatment” from R. Chelin, D.P.M.
(Exhibit #6), Post- hearing Addendum #1 (Exhibit #7), Post-Hearing Addendum #2 (Exhibit #8), and submissions from the worker’s representative, W. Wills, dated April 22, 1998, and from the employer’s representative, G. Newton, dated April 16, 1998 (Exhibit #9).
The worker testified under oath. The representatives made oral submissions and written  submissions.
THE ISSUEThe issue to be decided in this appeal is whether the worker was disabled from  August 26, 1994, by a right foot condition, diagnosed as plantar fasciitis, resulting from the nature of her employment for the accident employer.
“pre-1997 Act”) and substitute provisions from the WSI Act. The amended provisions apply, with necessary modifications, to pre-1998 injuries and to decisions of the Board rendered before January 1, 1998.
Subsection 112(4) provides that, if a Tribunal Panel began to hear or consider an appeal or  an application but did not make a final decision before section 112 came into force on January 1, 1998, the Panel may continue to deal with the matter as though this section had not come into force.
The effect of subsection 112(4) is to preserve the Panel’s authority to render a decision  based on the Act as it read at the time of the hearing. All references to the “Act” in this decision mean the Workers’ Compensation Act as it read on December 31, 1997.
The worker experienced an onset of right foot pain in early 1994. These jobs are discussed  below. She experienced a sudden onset of intense right foot pain on August 26, 1994, as she was using her right foot to turn a pallet lifter. The worker attributed the right foot pain to walking on cement floors and, particularly, to using her right foot to press a pedal when spot welding, operating a press, and raising, lowering and moving a panel lifter.
In her accident report to the Board, the worker described experiencing a very bad pain in  her right heel on August 28, 1994, when she was putting mufflers on a skid. The accident employer reported to the Board that the worker described feeling pain in her right foot on August 28, 1994, when she was “using [her] right foot to swing pallet lifter”. The worker laid off the same day.
The worker’s claim to benefits was denied by the Claims Adjudicator  (November 17, 1994), the Decision Review Specialist (July 4, 1995) and the Appeals Officer (July 23, 1996). The worker appealed to the Tribunal.
The employer advised the Board in a letter dated November 1, 1994, that the worker  packed mufflers for most of 1994, and occasionally worked on a job where she pressed a foot pedal about 80 times per eight hour shift to raise and lower a pallet lifter.
The worker felt a gradual onset of pain from about March 1994 and felt extreme pain in her  right foot while operating a pallet lifter in August 1994.
(iii) Medical evidence The medical evidence in this appeal includes reports from treating physicians,  Drs. F. Anello (family physician), J.K. Stapleton (orthopaedic surgeon), and D. Ranney (orthopaedic medicine), from podiatrists D.W.F. Roth and P. Stavropoulos, and from R.C. Chelin (podiatric medicine and foot surgery); opinions from Board medical advisors, Drs. G. Shapiro and A. Malayil; and generic information about plantar fasciitis.
(a) Treating practitioners The worker saw Dr. Anello on August 23, 1994, complaining of right foot pain for about  three weeks. She was seen in follow-up on September 1, 1994, when she reported that her right foot pain was worse. Dr. Anello referred the worker to podiatrists Roth and Stavropoulos who saw her on September 13, 1994, and diagnosed right plantar fasciitis. The worker reported a great deal of discomfort at the medial aspect of her right heel, the area where the plantar fascia inserts into the heel bone or calcaneous, and heel pain aggravated with movement at the ankle, especially dorsiflexion. Examination revealed a “moderate collapse of her [right] arch and hyperpronation evident even though she had difficulty bearing full weight on the foot”. She was seen in follow-up on September 20 and 26, October 4, 13 and 28, November 29 and December 13, 1994, on January 10 and 31, February 14 and 20, March 7 and 13, April 11, May 23, June 13, August 8, and October 31, 1995, and on February 15, 1996. Treatment included ice, stretching, orthotics (arch support, heel cup and custom orthortic), cortisone injections, wearing a non-weight bearing cast for two weeks and ultrasound. The worker returned to work briefly in January 1995, but laid off complaining of increased right foot pain.
The worker returned to work in July-August 1995, but laid off due to right foot pain.
The worker was seen on February 8, 1995, by Dr. Ranney who reported the following  examination findings: low arches (left slight lower than right), normal heel alignment, right calcaneum exquisitely tender inferiorly and medially extending for one inch along the plantar fascia and no x-ray evidence of a heel spur on the plantar aspect. He diagnosed “severe right plantar fasciitis” and prescribed ice applications, several cortisone injections and orthotics.
The worker was seen on April 28, 1995, by Dr. Stapleton who diagnosed “heel pain  syndrome” and prescribed a steroid injection followed by a return to work in one week wearing an orthotic.
The worker was seen on February 14, 1996, by podiatrist Chelin who diagnosed “chronic  plantar fasciitis (heel spur syndrome)”. Dr. Chelin performed an endoscopic plantar fasciotomy on March 16, 1996. The worker was seen in follow-up on March 20, April 1, April 19 (“complaining of pain on lateral aspect of heel since she returned to work four days”), April 29, June 3 (“doing fine today”), September 16, 1997 (“no more heel pain”) and October 8 (“post-op one and one half years. … [Worker] stated that there is no more heel pain and that she only took off one day of work after the first four weeks following her surgery”).
Dr. Chelin stated in a letter dated April 1, 1996, that the worker’s right foot condition was  “a common work place problem that seems to be exacerbated from constant stress upon the foot by repetitive strain”.
The worker was seen by Dr. Roth in April 1996 following surgery by Dr. Chelin in  March 1996, and reported that her heel was “feeling fairly good”. The worker cancelled her June 4, 1996, appointment noting to the receptionist that her right foot felt “fairly good”. The worker returned to work and was seen on June 18, 1996, when she reported that her right heel was “much better”.
(b) Board medical opinion Drs. Shapiro and Malayil provided their opinions to the Claims Adjudicator and the  Appeals Officer respectively concerning the relationship between the worker’s work and her
right foot condition:
Plantar fasciitis is an inflammation of the plantar fascia at its attachment to the heel bone.
 Dr. Harris states that plantar fasciitis (inferior heel pain, stone bruise) is a common condition characterized by pain and tenderness under the heel and that, while the exact cause of the inflammation is unknown, most authorities agree that it is a result of normal aging (degenerative) changes in the plantar fasciitis. He states that it is thought that the persisting pain of plantar fasciitis is the result of constant weight bearing causing new micro ruptures that prolong the healing process. Dr. Harris states that in a few cases, the pain of plantar fasciitis results from a distinct injury such as slipping from a curb or step and landing hard on the heel (“stone bruise”), and, presumably, the injury causes microruptures. But the vast majority arise, he states, quite spontaneously without any recognizable injury.
Page: 6 Decision No. 1044/97
Dr. Harris responded to questions posed by the Tribunal concerning plantar fasciitis:
(iv) ConclusionsThe worker claims that her right foot problem, diagnosed as plantar fasciitis, resulted from  walking on cement floors, and particularly, from pressing a foot pedal on a panel lifter with her right foot and pushing the panel lifter with her right foot.
In considering the cause of the worker’s right foot problem, we must determine whether the  worker’s work for the accident employer, particularly walking on cement and pressing a foot pedal, contributed significantly to the development of the worker’s right foot problem. There is no requirement that the worker’s work be the sole contributing factor, provided that it is a significant one. What is meant by the term “significant contributing factor”? In Decision
No. 280 (1987), W.C.A.T.R. 27, that Panel defined the term as follows:
A “significant contributing factor” is a factor of considerable effect or importance or one which added to the worker’s pre-existing condition in a material way to establish a causal connection.
The worker was 41 years old when she experienced an onset of pain in her right foot in  early 1994 and a sudden onset of more severe pain in late August 1994 diagnosed as plantar fasciitis. The worker’s supervisor confirmed that the worker complained of having a sore foot at various times from March to August 1994. By 1994 she had worked as a press operator, spot welder and packer for about 20 years and performed her work while standing on concrete floors.
Although it was possible to operate the press, the welder and the panel lifter with either foot, the worker used her right foot to do so. As a press operator and spot welder, the worker pressed a foot pedal with her right foot several tho usand times a day. The employer’s estimate and the worker’s estimate of the number of times the worker pressed the foot pedal on the panel lifter differed greatly. We accept that the worker pressed the foot pedal with her right foot about 100 times per day. We also accept that the worker used her right foot to raise and lower the panel lifter and to move it around.
In this case, the Panel is faced with the task of weighing the medical evidence which  represents opposing views about the cause of plantar fasciitis. The Panel in Decision No. 915 7 W.C.A.T.R. 1 (1987) set out several factors for a lay panel to keep in mind when considering
pedal, rather than her left foot”. Mr. Chelin thought that the worker’s right foot condition was a “common work place problem” exacerbated from constant stress upon the foot by repetitive strain. Dr. Anello completed a sickness and accident claim form for the worker responding “unknown” to the question of whether the worker’s right foot condition was due to injury or sickness arising out of her employment.
The Board’s medical advisors provide some support for the worker’s claim. Dr. Shapiro  originally thought that the worker’s right foot condition was compatible with her job, but changed his mind based on a reduction in the number of times the worker pressed the pedal on the pallet lifter and on the fact that either foot could be used. Dr. Malayil stated that it was possible that the worker’s job duties contributed to the development of her right plantar fasciitis if the worker used her right foot to operate the foot pedal all the time.
Dr. Harris stated in his discussion paper that plantar fasciitis is a common condition  characterized by pain and tenderness under the heel which most authorities agree is a result of normal aging changes in the plantar fasciitis and that the pain of plantar fasciitis arises spontaneously in the vast majority of cases without any recognizable injury. He also stated, however, that, in a few cases, the pain of plantar fasciitis results from a distinct injury such as slipping from a curb or step.