Orthotic prescription for workers using ladders and scaffolding

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Lately presented with a 22 y.o. female who's occupation is in restoration works in cathedrals, churches etc. She describes a plantar bilateral pain extending from the midfoot (plantar surface) extended to the hind foot, heel area.

She explains that in her work she is continuously climbing ladders, and spending a lot of time on scaffolding . She uses safety shoes during work which she describes as quite rigid.

I have conducted a biomechanical examination where I found the patient to have very high arches with no evidence of any pronation for both feet. Foot posture index resulted as +1 for both feet. No indication of hallux rigidus.

As a treatment I was deciding on prescribing a rigid type orthotic to help keep her foot stable while she climbs ladders. I do intend to cover the orthotic with a good cushioning to help ease pain during long working hours.

My questions would be to the more experienced practitioners:

1. Do you agree with my aim of orthotic prescription?

2. would you also prescribe the insole to support the patients high arch? Or would the insole be aimed as just an additional support in the shoes?

Cheers

David M

 

Hi David,
l would address the problem that may lay with in the shoe type been worn.
First port of call, is the shoe a lace up?
Second does the shoe have a strong enough shank for ladder climbing? you said they are quite rigid, but in the right place?

Most people climb and stand on a ladder using the mid foot and if you do enough of it you end up with problems like you have described.

The rigid orthosis will add to the strength of the shoe also helping to prevent further and continued injury.
Be sure the arch cavity on the underside of the Orthosis is filled with a hard EVA, other wise the fore foot part of the boot will bend away (as the midfoot section is pushed up) from the MPJ's creating more pressure on the arch.

A rigid insole may imped your clients ability to climb the ladder unless it is 3/4

Hope it helps

 

Hi David.............Very useful info.........Thanks a million!!!!

Dav

 

Hi David

I thought I would chip in here- and give an opinion from a non-biomechanist view point!

You say in your post that she describes the shoe as rigid , I assume then that you havent seen the shoe yet? This would be my first move as it seems to me that most work shoes I have seen are very rigid and have deep toe boxes and I am guessing that they are made on a mens' last. Could it be that the shoe is just way too big for her an thus allows her foot to move around? Have you considered a soft filler insole that will tighten the shoe on her foot and provide cushioning? When I trained, the best we could offer people with high arches was as much cushioning as possible and good man -made soles , particularly airwalk. I cannot see how a rigid insole is going to help, but as I say, I am no expert in biomechanics, so I stand to be corrected.

I was having a think about the ladder climbing, since I was decorating last weekend. Most of the going up and down is done with the forefoot- for balance , I think. I concede that if you stand for a longer time it would be on the mid foot with your weight leaning against the ladder, but I dont think any of us do that for long as it becomes uncomfortable on the arch- maybe if she has developed this habit she needs to try and change it!
As for the scaffolding- is that a red-herring? I am sure that health and safety demands that she does not stand on the actual scaffolding but on scaffolding boards, which is just a flat surface , so not curved as it would be if she was on the scaffolding poles.

An interesting post-

Cornmerchant

 

Hi I really appreciate your input on this subject.............Thanks !!!
daV

 

In one of my past lives I set up a specialist high access company with 40 plus people on etriers, ladders and twin rope system set ups......lots of people standing on narrow rungs, you could try a simple carbon fibre plate, flat or rockered, you can get both commercially....it is very likely just very poor pressure distribution due to narrow rungs and boots not stiff enough.
regards Phill