When a Good Work Shoe Isn't Enough

In industrial workplaces, the proper fitting and comfort expectation is usually more difficult to obtain.

• By Norman L. Klein, D.P.M. (Ret.)
• Sep 01, 2003

IN the occupational health arena, shoe programs are at the core of many safety and health issues. Besides the "steel toe" issues, there are electrical conditions requiring conductive and/or ESD shoes. Also, sole slip resistance is most important and even critical within select environments. Other work conditions could mandate a rubber boot. The shoe criteria "list" can go on.

However, no matter what the actual employee position might entail, this wide variety of specialized footwear must be fit in the best manner possible to the human foot, an appendage that varies more significantly than the shoes themselves. The width and length of the shoe can be selected to address some of these fit issues, but this is an oversimplistic solution.

In the industrial workplace, both because of the specialization of the shoe and enhanced weight-bearing demands, the proper fitting and comfort expectation is usually more difficult to obtain. These two overlapping concepts are easily blended into "comfort" issues, where the goal is not just feeling better, but hopefully the minimizing and/or avoidance of a variety of MSDs as part of the process.

To this end, certain musculoskeletal disorders do appear with much higher regularity and clearly only resolve with more resistance in this type of "overuse" environment. Leading this variable "most wanted" list is plantar Fasciitis and heel pain from heavy heel impact and chronic plantar fascia stress in this area. Ankle, knee, and possible low back symptoms are also common when there is excessive strain on the weight-bearing skeletal system. Very simply, as the joints themselves are strained, pulled, and pushed, the adjacent soft tissue is also involved.

In an honest effort to address the above concerns and conditions, all manner of insoles have been developed and sold to "bridge the gap." The soft, cushion type of device may seem helpful for initial brief periods, but for the most part it is rarely a "problem" solver. Gel products are no different. By design, these devices collectively cannot stabilize the foot. The body collapses into the products as the foot and ankle go through their range of motion. So what do we look for? Is there some meaningful insole product that can, in fact, supplement the shoe fit concerns and also perform as an ergonomic tool?

Evalulating OTC Insoles
Yes, there is. The product category to evaluate is a preformed orthotic type insole. This is not the custom orthotic device made in a lab at a substantial cost. These are worthy, prefabricated devices sold as an OTC (over-the-counter) insole.

The better and proven styles can be provided via your shoe vendor if you prefer not to dispense this type of PPE internally. The price is variable, usually less than $35 per pair, but generally they will last for a year or more. This is a cost-effective solution when you consider the potential benefits.

Inherently, true orthotics are stable (rigid) enough to "control" significantly the Pronation (normal collapse) of the foot. When one understands the biomechanics of the foot, it is not hard to see why this type of device can be a practical and medically sound solution. When we walk, the foot goes through a relative fixed range of motion. This movement can vary greatly from one person to another, but it is reasonably predictable. The excessive and repetitive collapse of the foot in contact with hard floor surfaces can lead to the MSDs we see clinically.

The insole "cushions" we place under our feet are similar to a soft mattress, which is not generally recommended for an ailing back. This is a real and important analogy. A soft insole can cushion, but overall the Pronation (arch collapse) must be structurally stabilized to alter the "wear and tear" on the skeletal structure. This is the orthopedic mattress for our occupational feet.

Is this an answer to all MSDs? No, of course not. There is no such solution. But for a meaningful and consistent reduction in foot, ankle, and low back symptoms, this type of device must be viewed seriously.

Curbing Slips and Falls
This type of insole, when fit to the appropriate work shoe, can have significant impact beyond the original intent. A more comfortable employee will probably be more productive. But note also that this type of insole inherently stabilizes the foot. If we balance the foot, leg, and body, it is not a reach to assume we must positively impact the entire arena of "slip and fall" accidents.

If you are a safety or risk management individual involved with worker's compensation issues or an occupational health professional attending to these conditions medically, this type of orthotic insole should be looked at seriously. These insoles are more ergonomic than most anti-fatigue mats and can in many circumstances supplement or replace those products.

Lastly, I will relate directly to the many firms where MSD concerns seem to be the most evident. This appears to be the case in companies where the extensive use of rubber boots (which afford virtually no support for normal foot function) are used on a regular basis. The attainable increase in comfort and reduction of problems in this type of footwear is a significant recommendation for OTC orthotics. It frankly should be a more common part of any industrial safety shoe program.

As shoe technology becomes more specialized and refined, the "insole part" of the shoe may or may not be enhanced as part of their product design and development. Manufacturers generally only peripherally address this important concept as part of their shoe design.

We need to think outside the shoe box to get foot solutions that are real, meaningful, and even measurable. Evaluate this type of product for a meaningful ergonomic response to the active, weight-bearing occupational workplace.

This article originally appeared in the September 2003 issue of Occupational Health & Safety.