Cumulative industrial trauma as an etiology of seven common disorders in the foot and ankle: What is the evidence?

The concept of cumulative industrial trauma as an etiology of orthopaedic d isease has recently generated considerable-attention in both the medical an d legal communities. To clarify the current state of knowledge about the is sue as applied to the foot and ankle, we critically reviewed the literature on the etiology of seven foot and ankle disorders commonly involved in com pensation litigation in the practice of the senior author: hallux valgus, i nterdigital neuroma, tarsal tunnel syndrome, lesser toe deformity, heel pai n, adult acquired flatfoot, and foot and ankle osteoarthritis. Koch's postu lates were appropriately modified and used as a logistic framework to analy ze the potential for cumulative industrial trauma to cause foot pathology. In none of the disorders analyzed could cumulative industrial trauma reason ably satisfy even one of Koch's three postulates. We conclude there is curr ently no unequivocal literature support upon which to invoke cumulative ind ustrial trauma as a clear etiology of these disorders of the adult foot and ankle. The superb evolutionary adaptation of the human foot to prolonged a mbulation and the absence of industrial demands that significantly differ f rom this task likely account for this dramatically reduced vulnerability of the foot to industrial repetitive motion disorders compared to the upper e xtremity.