Worker had predisposition for development of plantar fasciitis but job duties were also a likely contributor to condition: Tribunal
An Ontario worker’s job duties likely contributed to her development of plantar fasciitis in both feet, despite the fact the worker had a predisposition to the condition, the Ontario Workplace Safety and Insurance Appeals Tribunal has ruled.
The 35-year-old worker was a millwright hired in 2006. The position involved making repairs, installations, and performing inspections on various types of pneumatic, hydraulic, and mechanical equipment in a manufacturing environment, while staying on foot most of the time. Often, the worker’s duties included standing on equipment, working at heights with a safety harness, or walking on catwalks and stairs, so a certain level of balance was required.
The worker worked without event until the end of 2014, when she went on maternity leave. She had no medical issues during her tenure or during her maternity leave.
The worker returned to work in September 2015. A couple of months later, in November, she started noticing pain in both of her feet, particularly her heels. She changed her work boots but had to use men’s boots as there were no women’s boots available. However, the new boots were heavy and stiff and her feet continued to worsen, so she returned to her old boots. After no improvement in her pain, she tried using insoles.
On Jan. 25, 2016, she reported the pain to her employer, saying she believed the pain developed from prolonged walking at work. Despite the pain, however, she didn’t miss any time at work.
The worker spoke to the Ontario Workplace Safety and Insurance Board (WSIB) about any possible eligibility for workers’ compensation benefits. She told a WSIB adjudicator that she was on her feet all day wearing work boots, while working on equipment in various positions including balancing on uneven surfaces. In addition, she had to walk up and down several flights of stairs in her boots over the course of the work day, she said
The worker suggested that her foot pain was the result of a change in her work area after she returned from her maternity leave. Before her leave, the worker performed her job in different areas of the plant, but upon her return she was assigned to a specific area that was faster paced. There were more repairs to do in the new area and her old partner retired, leaving her to train a replacement. In addition, she had to stand on an incline a lot of the time, carry tools weighing up to 150 pounds, and travel up and down 20 to 30 flights of stairs per day.
In February 2016, the worker was diagnosed with plantar fasciitis in both feet. She started using orthotics and began physiotherapy treatments. In September, a podiatrist observed “significant biochemical deformities in her lower extremities and feet that would contribute to this problem, however, she has a difficult job where she walks on hard concrete floors and uses ladders and stairs constantly which would also (be) contributive to the problem.” The podiatrist also indicated the worker had an angular deformity in her hip and knee that predisposed her to having plantar fasciitis due to increased stress on the ligaments in her feet.
The podiatrist was of the opinion that the worker’s job demands was “the most probably cause of the worker’s plantar fasciitis,” as she didn’t have to wear work boots outside of work and she didn’t have hard surfaces, many stairs, or heavy carrying to contend with at home.
The WSIB and an appeals resolution officer denied the worker entitlement to benefits. The appeals resolution officer granted a reconsideration based on the worker’s claim of “significant new evidence,” but confirmed the denial of entitlement in January 2017. The worker appealed to the tribunal, arguing that the worker’s job duties included risk factors for the development of plantar fasciitis, the symptoms arose at work and not at home, and the worker didn’t have any non-occupational risk factors such as obesity or age.
An ergonomist’s report in May 2018 that noted the worker’s exposure to factors that could cause plantar fasciitis at work, but it was “hard to say” which factor — the work conditions or the worker’s pre-existing deformities — was the primary cause of the plantar fasciitis, as “both would also aggravate the development of the other.”
The worker continued to work as a millwright but was moved from the area to which she had been assigned following her return from maternity leave. She also worked with some restrictions and reported that her feet were feeling much better.
Convergence of factors could lead to entitlement
The tribunal referred to a discussion paper it had from March 2003 that acknowledged a correlation between prolonged standing and walking and the worker’s condition “had been suggested but that direct causation has not been established.” However, there were cases in which the tribunal had awarded benefits for plantar fasciitis where “a combination of prolonged standing, walking, weight bearing, risk factors, and medical opinions have converged.”
In the worker’s case, her treating podiatrist provided a medical opinion that the worker’s duties were the probable cause of her plantar fasciitis, despite the worker’s pre-existing deformities in her hip and knee. In addition, the worker only developed the pain in her heels after she returned to work and resumed her job duties. This was enough to conclude the worker’s condition was at least aggravated, if not outright caused, by her work — which was enough to provide entitlement to benefits, said the tribunal.
“A significant contributing factor is one of considerable effect or importance. It need not be the sole contributing factor,” said the tribunal. “In this case, although the worker has a predisposition to plantar fasciitis based on her ‘angular deformity,’ her work duties were a significant contributing factor to the development of plantar fasciitis.”
The tribunal allowed the worker’s appeal and returned the matter to the WSIB to determine the nature and duration of her benefits.
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