Safety and OSHA News

Did foot blister lead to costly workers’ comp case?

Probably most of us have had a foot blister due to a pair of shoes that didn’t fit quite right. This employee says his steel-toed boots, required at work, led to a costly medical problem. Did he get workers’ comp for the injury?

Earl Sterling worked at a machinist for Eaton Corp. in Mississippi.

In June 2008, he began wearing a new pair of steel-toed boots which were required for his job. He claimed “his feet started immediately throbbing” after wearing the boots.

He developed a blister on his foot. After it popped and began draining, he sought treatment from his family physician. When the doctor saw Sterling, he had a high fever and was delirious, so he was admitted to the hospital.

Things went from bad to worse. Doctors at the hospital determined Sterling had developed a staph infection. Less than a month after he said he started wearing the new steel-toed boots, Sterling’s right leg was amputated below the knee.

Boots at fault?

Sterling claimed the blister was a result of wearing his work boots and had caused his injury and the infection. He requested disability benefits for the injury.

Eaton said the blister didn’t cause the infection, rather it was the other way around: The infection caused the blister. The company said this wasn’t a workplace injury, and therefore Sterling shouldn’t receive workers’ comp benefits.

The case went to the Mississippi Workers’ Compensation Commission (WCC). An administrative judge denied Sterling’s request for comp benefits. On appeal, the WCC upheld the judge’s decision.

Next, Sterling took his case to the Court of Appeals of Mississippi.

Medical evidence is key

The WCC had ruled that Sterling failed to make his case that his injury was work-related based on the medical evidence. This is where the appeals court focused in its review of the case.

Sterling’s family physician opined that the blister from the boot caused the infection which led to the leg amputation.

Both other doctors disagreed. The surgeon who amputated Sterling’s leg said tests performed in the hospital showed the worker was a “poorly controlled diabetic.” Sterling’s hemoglobin test indicated his blood sugar had been “abnormally high” for 90 days before his hospitalization.

Sterling’s surgeon certainly had experience with this sort of case. He worked in a wound-care center and treated diabetics on a daily basis.

Another doctor, an expert in infectious disease, said Sterling’s blister wasn’t in a spot on his foot where friction blisters due to shoes would normally form — it was in between his toes. Also, a blister caused by chafing normally doesn’t continue to grow after the source of friction is removed. Sterling testified he stopped wearing the boots after a week.

The infectious disease expert agreed that in this case, the the infection caused the blister, not the other way around. He also pointed to Sterling’s poorly controlled diabetes and noted that staph is one of the most common organisms that infect diabetic patients.

One more point: Sterling didn’t help his own case. The administrative judge and WCC noted that his testimony was inconsistent. He was confused about the exact date of his injury. He also didn’t report it to his employer before seeing his doctor.

The administrative judge and WCC found the surgeon’s and infectious disease expert’s testimony were more credible than that of Sterling’s family physician. The appeals court agreed, and for that reason, it upheld the WCC’s decision: Sterling would not receive workers’ comp because medical evidence indicated this wasn’t a work-related injury.

Diabetes and foot care

An estimated 25.8 million children and adults in the United States (8.3% of the population) have diabetes.

So, almost one in ten of your workers is probably diabetic.

Foot ulcers are the most common reason for hospital stays for people with diabetes.

In this case, Sterling waited a week, possibly longer, after discovering his foot blister before seeing a doctor. He ended up with an amputated leg.

You can remind your employees as part of a wellness program that if they have diabetes, they should call their doctor if they have any of these signs and symptoms of infection:

  • redness, increased warmth, or swelling around the wound
  • extra drainage
  • pus
  • odor
  • fever or chills
  • increased pain
  • increased firmness around the wound, or
  • the foot ulcer is very white, blue, or black.

(Sterling v. Eaton Corp., Court of Appeals of MS, No. 2011-WC-1320-COA, 3/5/13)

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  1. we had an employee with a similar situation. Reported to work sick and went to first aid. They took his blood sugar and found it to be sky high. As he was undressed in the ER a blister or sore was found on his foot. The part time employee did not have medical insurance so the ER doctor said that his work boot had caused the blister and it was infected and the infection caused his to fore date undiagnosed diabetes. With the ER doctors diagnosis workers comp paid the claim and all medical. Employees leg was amputated. Current count $1.4 million. Then the insurance company who botched the claims management dropped us. It does not pay to own a small business in the US

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