Raynaud's phenomenon in the feet of Arctic open-pit miners

The literature on Raynaud's phenomenon (RP) in the feet is scarce, especially in the occupational setting. The primary aim of our study was to investigate the occurrence of RP in the feet of miners. As part of the MineHealth project, written surveys and clinical examinations were completed by 260 Arctic open-pit miners working in northern Sweden and Norway (participation rate 53.6%). Data on RP were collected using standardised colour charts and questionnaire items. Clinical examination included assessing the perception of vibration and pain in both feet. There were eight women and three men who reported RP in the feet. Four also had RP in their hands but none acknowledged any first-degree relatives with the condition. Nine reported exposure to foot-transmitted vibration and one to hand-arm vibration. Seven showed signs of neurosensory injury in the feet. To conclude, the occurrence of RP in the feet of miners was 4.4%. Most cases with RP in the feet did not report the condition in the hands and were exposed to vibration transmitted directly to the feet. There were no reports of a hereditary component. Most cases with RP in the feet also had clinical findings suggestive of peripheral neuropathy in the feet.

The Effects of Altering the Center of Pressure in Standing Subjects Exposed to Foot-Transmitted Vibration on an Optimized Lumped-Parameter Model of the Foot

Many workers are exposed to foot-transmitted vibration, which can lead to the development of vibration-induced white foot: a debilitating condition with neurological, vascular and osteoarticular symptoms. To design effective prevention mechanisms (i.e., boots and insoles) for isolating workers from vibration exposure, continued model development of the foot’s biodynamic response in different positions is necessary. This study uses a previously developed model of the foot–ankle system (FAS) to investigates how altering the center of pressure (COP) location can change the biodynamic response of the FAS to standing vibration exposure. Formerly published experimental responses for apparent mass and transmissibility at five anatomical locations in three COP positions were used to optimize the model. Differences occurred with the Kelvin–Voigt elements used to represent the soft tissues of the foot sole: at the heel, the distal head of the metatarsals and distal phalanges. The stiffness increased wherever the COP was concentrated (i.e., forward over the toes or backward over the heel). The variability of the model parameters was always greatest when the COP was concentrated in the heel. This suggests future FAS models need to more clearly address how the soft tissue of the plantar fat pad is modelled.

Effect of the Shoe Sole on the Vibration Transmitted from the Supporting Surface to the Feet

Vibration transmitted through the foot can lead to vibration white feet, resulting in blanching of the toes and the disruption of blood circulation. Controlled studies identifying industrial boot characteristics effective at attenuating vibration exposure are lacking. This work focused on the evaluation of vibration transmissibility of boot midsole materials and insoles across the range 10–200 Hz at different foot locations. Questionnaires were used to evaluate the comfort of each material. The materials were less effective at attenuating vibration transmitted to the toe region of the foot than the heel. Between 10 and 20 Hz, all midsole materials reduced the average vibration transmitted to the foot. The average transmissibility at the toes above 100 Hz was larger than 1, evidencing that none of the tested material protects the worker from vibration-related risks. There was a poor correlation between the vibration transmissibility and the subjective evaluation of comfort. Future research is needed to identify materials effective for protecting both the toe and the heel regions of the foot. Specific standards for shoe testing are required as well.

Four degree-of-freedom lumped parameter model of the foot-ankle system exposed to vertical vibration from 10 to 60 Hz with varying centre of pressure conditions

Modelling the foot-ankle system (FAS) while exposed to foot-transmitted vibration (FTV) is essential for designing inhibition methods to prevent the effects of vibration-induced white-foot. K-means analysis was conducted on a data set containing vibration transmissibility from the floor to 24 anatomical locations on the right foot of 21 participants. The K-means analysis found three locations to be sufficient for summarising the FTV response. A three segment, four degrees-of-freedom lumped parameter model of the FAS was designed to model the transmissibility response at three locations when exposed to vertical vibration from 10 to 60 Hz. Reasonable results were found at the ankle, midfoot, and toes in the natural standing position (mean-squared error (ε) = 0.471, 0.089, 0.047) and forward centre of pressure (COP) (ε = 0.539, 0.058, 0.057). However, when the COP is backward, the model does not sufficiently capture the transmissibility response at the ankle (ε = 1.09, 0.219, 0.039). Practitioner summary The vibration transmissibility response of the foot-ankle system (FAS) was modelled with varying centre of pressure (COP) locations. Modelling the FAS using three transmissibility locations and two foot segments (rearfoot and forefoot) demonstrated reasonable results in a natural standing and forward COP position to test future intervention strategies. Abbreviations: COP: centre of pressure; DOF: degrees-of-freedom; FAS: foot-ankle system; FTV: foot-transmitted vibration; HAVS: hand-arm vibration syndrome; LDV: laser Doppler vibrometer; LP: lumped-parameter; VWT: vibration-induced white-toes; WBV: whole-body vibration.

Vibrotactile sensitivity testing for occupational and disease-induce peripheral neuropathies

The International Standard Organization (ISO) standard 13091-1 describes methods and procedures for performing the vibrotactile perception threshold (VPT) testing to diagnose changes in tactile sensory function associated with occupational exposures. However, the VPT test also has been used in the diagnosis of peripheral neuropathies associated with a number of disorders. This review examines the VPT test, variations in procedures that have been used, as well as disorders and diseases in which this test has been reliable for the detection of sensory changes. Mechanisms potentially underlying the changes in VPTs are also discussed along with procedural and subject/patient factors that may affect the interpretation of test results. Based upon the review of the literature, there are also suggestions for where additional research might improve the administration of this test, depending upon the subject/patient population and interpretation of data.

Standing centre of pressure alters the vibration transmissibility response of the foot

Vibration-white foot as an occupational disease has underscored the need to better understand the vibration response of the foot. While vibration transmissibility data exist for a natural standing position, it is anticipated that weight distribution will affect the response. The purpose of this study was to determine the effects of changes in centre of pressure (COP) on the foot's biomechanical response. Twenty-one participants were exposed to vertical vibration of 30 mm/s, with a sine sweep from 10-200 Hz. Z-axis (vertical) vibration was measured at 24 locations on the right foot, with the COP shifted forward or toward the heel. A mixed model analysis at each location revealed significant differences (p < .001) in the transmissibility response when the COP was altered to the forefoot and rearfoot. In general, the peak frequency of the average vibration response increased for a region of the foot when the COP was shifted toward that region. Practitioner Summary: Altering the centre of pressure location resulted in changes in the transmission of vibration through the foot. The forward lean position was associated with the greatest amplitude of vibration transmissibility at the toes. This information is relevant for clinicians studying vibration-induced white-foot and engineers designing protective equipment.

Biomechanical response of the human foot when standing in a natural position while exposed to vertical vibration from 10-200 Hz

Exposure to foot-transmitted vibration (FTV) can lead to pain and numbness in the toes and feet, increased cold sensitivity, blanching in the toes, and joint pain. Prolonged exposure can result in a clinical diagnosis of vibration-induced white foot (VIWFt). Data on the biomechanical response of the feet to FTV is limited; therefore, this study seeks to identify resonant frequencies for different anatomical locations on the human foot, while standing in a natural position. A laser Doppler vibrometer was used to measure vertical (z-axis) vibration on 21 participants at 24 anatomical locations on the right foot during exposure to a sine sweep from 10-200 Hz with a peak vertical velocity of 30 mm/s. The most notable differences in the average peak frequency occur between the toes (range: 99-147 Hz), midfoot (range: 51-84 Hz) and ankle (range: 16-39 Hz). Practitioner Summary: The biomechanical response of the human foot exposed to foot-transmitted vibration, when standing in a natural position, was measured for 21 participants. The foot does not respond uniformly; the toes, midfoot, and ankle regions need to be considered independently in future development of isolation strategies and protective measures.

Systemic Effects of Segmental Vibration in an Animal Model of Hand-Arm Vibration Syndrome

OBJECTIVE

Epidemiology suggests that occupational exposure to hand-transmitted (segmental) vibration has local and systemic effects. This study used an animal model of segmental vibration to characterize the systemic effects of vibration.

METHODS

Male Sprague Dawley rats were exposed to tail vibration for 10 days. Genes indicative of inflammation, oxidative stress, and cell cycle, along were measured in the heart, kidney, prostate, and liver.

RESULTS

Vibration increased oxidative stress and pro-inflammatory gene expression, and decreased anti-oxidant enzymes in heart tissue. In the prostate and liver, vibration resulted in changes in the expression of pro-inflammatory factors and genes involved in cell cycle regulation.

CONCLUSIONS

These changes are consistent with epidemiological studies suggesting that segmental vibration has systemic effects. These effects may be mediated by changes in autonomic nervous system function, and/or inflammation and oxidative stress.

Health effects associated with occupational exposure to hand-arm or whole body vibration

Workers in a number of different occupational sectors are exposed to workplace vibration on a daily basis. This exposure may arise through the use of powered-hand tools or hand-transmitted vibration (HTV). Workers might also be exposed to whole body vibration (WBV) by driving delivery vehicles, earth moving equipment, or through use of tools that generate vibration at low dominant frequencies and high amplitudes, such as jackhammers. Occupational exposure to vibration has been associated with an increased risk of musculoskeletal pain in the back, neck, hands, shoulders, and hips. Occupational exposure may also contribute to the development of peripheral and cardiovascular disorders and gastrointestinal problems. In addition, there are more recent data suggesting that occupational exposure to vibration may enhance the risk of developing certain cancers. The aim of this review is to provide an assessment of the occupations where exposure to vibration is most prevalent, and a description of the adverse health effects associated with occupational exposure to vibration. This review will examine (1) various experimental methods used to measure and describe the characteristics of vibration generated by various tools and vehicles, (2) the etiology of vibration-induced disorders, and (3) how these data were employed to assess and improve intervention strategies and equipment that reduces the transmission of vibration to the body. Finally, there is a discussion of the research gaps that need to be investigated to further reduction in the incidence of vibration-induced illnesses and injuries.

Changes in the peripheral blood flow in legs in response to the cold: own studies using plethysmography

The thermal environment in the workplace is an important factor which affects workers' health. During 2011 in Poland, 14,781 workers were exposed to a cold working environment, i.e., 3.8% of persons employed in hazardous work conditions. The aim of this study was to determine the cardiovascular response to continuous (4 °C for 60 min) and intermittent (10 min at 4 °C and 10 min at room temperature alternately) exposure to the cold in 30 healthy men aged 20-27 years. Peripheral blood flow was assessed with impedance plethysmography. Heart rate and arterial blood pressure were monitored with the Holter system. Having assessed the results, it is difficult to say which kind of exposure has a more severe impact on the cardiovascular system. Longer observation and a more detailed analysis would be necessary (e.g., Doppler echocardiography).

Vibration induced white-feet: overview and field study of vibration exposure and reported symptoms in workers

BACKGROUND

Workers who stand on platforms or equipment that vibrate are exposed to foot-transmitted vibration (FTV). Exposure to FTV can lead to vibration white feet/toes resulting in blanching of the toes, and tingling and numbness in the feet and toes.

OBJECTIVES

The objectives are 1) to review the current state of knowledge of the health risks associated with foot-transmitted vibration (FTV), and 2) to identify the characteristics of FTV and discuss the associated risk of vibration-induced injury.

PARTICIPANTS

Workers who operated locomotives (n=3), bolting platforms (n=10), jumbo drills (n=7), raise drilling platforms (n=4), and crushers (n=3), participated.

METHODS

A tri-axial accelerometer was used to measure FTV in accordance with ISO 2631-1 guidelines. Frequency-weighted root-mean-square acceleration and the dominant frequency are reported. Participants were also asked to report pain/ache/discomfort in the hands and/or feet.

RESULTS

Reports of pain/discomfort/ache were highest in raise platform workers and jumbo drill operators who were exposed to FTV in the 40 Hz and 28 Hz range respectively. Reports of discomfort/ache/pain were lowest in the locomotive and crusher operators who were exposed to FTV below 10 Hz. These findings are consistent with animal studies that have shown vascular and neural damage in exposed appendages occurs at frequencies above 40 Hz.

CONCLUSIONS

Operators exposed to FTV at 40 Hz appear to be at greater risk of experiencing vibration induced injury. Future research is required to document the characteristics of FTV and epidemiological evidence is required to link exposure with injury.

The primary vascular dysregulation syndrome: implications for eye diseases

Vascular dysregulation refers to the regulation of blood flow that is not adapted to the needs of the respective tissue. We distinguish primary vascular dysregulation (PVD, formerly called vasospastic syndrome) and secondary vascular dysregulation (SVD). Subjects with PVD tend to have cold extremities, low blood pressure, reduced feeling of thirst, altered drug sensitivity, increased pain sensitivity, prolonged sleep onset time, altered gene expression in the lymphocytes, signs of oxidative stress, slightly increased endothelin-1 plasma level, low body mass index and often diffuse and fluctuating visual field defects. Coldness, emotional or mechanical stress and starving can provoke symptoms. Virtually all organs, particularly the eye, can be involved. In subjects with PVD, retinal vessels are stiffer and more irregular, and both neurovascular coupling and autoregulation capacity are reduced while retinal venous pressure is often increased. Subjects with PVD have increased risk for normal-tension glaucoma, optic nerve compartment syndrome, central serous choroidopathy, Susac syndrome, retinal artery and vein occlusions and anterior ischaemic neuropathy without atherosclerosis. Further characteristics are their weaker blood–brain and blood-retinal barriers and the higher prevalence of optic disc haemorrhages and activated astrocytes. Subjects with PVD tend to suffer more often from tinnitus, muscle cramps, migraine with aura and silent myocardial ischaemic and are at greater risk for altitude sickness. While the main cause of vascular dysregulation is vascular endotheliopathy, dysfunction of the autonomic nervous system is also involved. In contrast, SVD occurs in the context of other diseases such as multiple sclerosis, retrobulbar neuritis, rheumatoid arthritis, fibromyalgia and giant cell arteritis. Taking into consideration the high prevalence of PVD in the population and potentially linked pathologies, in the current article, the authors provide recommendations on how to effectively promote the field in order to create innovative diagnostic tools to predict the pathology and develop more efficient treatment approaches tailored to the person.