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

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.

Mobile phone thermography of the toes in patients with systemic sclerosis-a pilot study

Objectives

To investigate the hypotheses that in patients with SSc, the temperature gradient between the dorsum of the foot and toes (distal-dorsal difference [DDD]) is 'more negative' (toes cooler) than in healthy controls, is greatest along the first (great) toe and that the severities of thermographic abnormalities in the feet and hands are correlated.

Methods

Thermographic images of the dorsum of each hand and foot were captured using a thermal camera attached to an iPhone in 40 patients with SSc and 20 healthy controls. DDDs along the fingers (index, middle, ring and little) and toes (great toe and 'others') were measured.

Results

There was a non-significant trend for the great toes to be colder in patients with SSc than in controls. The mean great toe DDD was more negative in patients (right: -2.89°C, left: -2.91°C, mean: -2.90°C) than in controls (right: -2.36°C, left: -2.42°C, mean: -2.39°C) (P = 0.37 for mean values). Patients' great toes were colder than 'other' (lesser) toes (right: -2.58°C, left: -2.63°C), although not significantly. In patients with SSc, finger and great toe temperature gradients were correlated (r = 0.406, ρ = 0.01).

Conclusion

Our findings suggest that the great toe is the coldest in patients with SSc and that patients with the coldest fingers tend to have the coldest toes. Severe RP symptoms in the hands should prompt podiatry assessment and foot care education. Mobile phone thermography is a convenient tool for assessing the digital vasculature but first requires validation in larger studies with a longitudinal component.

The effects of standing foot-transmitted vibration on self-reported discomfort ratings

BACKGROUND

Occupational foot-transmitted vibration (FTV) exposure is common in industries like mining, construction, and agriculture, often leading to acute and chronic injuries. Vibration assessments require technical expertise and equipment which can be costly for employers to perform. Alternatively, researchers have observed that self-reported discomfort can be used as an effective indicator of injury risk.

OBJECTIVE

This study aimed to investigate the effect of standing FTV exposure on self-reported ratings of discomfort, and whether these subjective ratings differed by body area and exposure frequency.

METHODS

Participants (n = 30) were randomly exposed to standing FTV at six frequencies (25, 30, 35, 40, 45, and 50 Hz) for 20-45 seconds. Following each exposure, participants rated discomfort on a scale of 0-9 in four body areas: head and neck (HN), upper body (UB), lower body (LB), and total body.

RESULTS

Results indicated that participants experienced the most discomfort in the LB at higher frequencies (p < 0.001), consistent with the resonance of foot structures. The HN discomfort tended to decrease as the exposure frequency increased, although not statistically significant (p > 0.0167). The UB discomfort remained relatively low across all frequencies.

CONCLUSIONS

The study suggests a potential connection between resonant frequencies and discomfort, potentially indicating injury risk. Although self-reported discomfort is insufficient for directly assessing injury risk from FTV, it provides a simple method for monitoring potential musculoskeletal risks related to vibration exposure at resonant frequencies. While professional vibration assessment remains necessary, self-reported discomfort may act as an early indicated of vibration-induced injuries, aiding in implementing mitigation strategies.

Whole Body Vibration: A Valid Alternative Strategy to Exercise?

Several studies agree that mechanical vibration can induce physiological changes at different levels, improving neuromuscular function through postural control strategies, muscle tuning mechanisms and tonic vibration reflexes. Whole-body vibration has also been reported to increase bone mineral density and muscle mass and strength, as well as to relieve pain and modulate proprioceptive function in patients with osteoarthritis or lower back pain. Furthermore, vibratory training was found to be an effective strategy for improving the physical performance of healthy athletes in terms of muscle strength, agility, flexibility, and vertical jump height. Notably, several benefits have also been observed at the brain level, proving to be an important factor in protecting and/or preventing the development of age-related cognitive disorders. Although research in this field is still debated, certain molecular mechanisms responsible for the response to whole-body vibration also appear to be involved in physiological adaptations to exercise, suggesting the possibility of using it as an alternative or reinforcing strategy to canonical training. Understanding these mechanisms is crucial for the development of whole body vibration protocols appropriately designed based on individual needs to optimize these effects. Therefore, we performed a narrative review of the literature, consulting the bibliographic databases MEDLINE and Google Scholar, to i) summarize the most recent scientific evidence on the effects of whole-body vibration and the molecular mechanisms proposed so far to provide a useful state of the art and ii) assess the potential of whole-body vibration as a form of passive training in place of or in association with exercise.

Occupational Disease as the Bane of Workers' Lives: A Study of Its Incidence in Slovakia. Part 2

The main objective of this article is to monitor the development of the number of occupational diseases related to selected physical factors in the working environment (noise, vibration and dust). Each region of Slovakia has its own specific social and economic conditions. Due to the existence of a strong correlation between the several regional variables observed, principal component analysis (PCA) was used to determine the new variables. Cluster analysis was used to group regions with similar characteristics. A dendrogram was created using the average linkage method, which illustrated the similarity of the regions studied. The value of the cophenetic correlation coefficient (CC = 0.90) confirms the validity of the average linkage method. The result of the cluster analysis is the grouping of the eight regions into five homogenic groups (clusters). An analysis of the data shows that Slovakia’s regional differences significantly influence the incidence of occupational diseases in individual regions. It is shown that, in Slovakia, the development of the number of occupational diseases has seen a favourable trend in the long term.

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.

Biomechanical Response of the Human Foot Model Exposed to Vibrations: A Finite Element Analysis

Prolonged exposure to mechanical vibration has been associated with many musculoskeletal, vascular and sensorineural disorders of the foot from simple Plantar fasciitis and Achilles Tendonitis to complex ones as Tarsal tunnel syndrome (TTS) and Vibration white feet/toes. Foot-transmitted vibrations (FTV) are exposed to the occupants using vibrating equipment’s or standing on vibrating platforms. Prolonged exposure to foot-transmitted vibrations (FTV) can lead to syndromes like vibration white feet/toes may result in tingling sensation, blanching of the toes and even numbness in the feet and toes. A multi-layered two dimensional, plane strain finite element model is developed from the actual cross-section of the human foot to study the stresses and strains developed in the skin and soft tissues. The foot is assumed to be in contact with a steel plate, mimicking the interaction between the foot and the work platform. The skin and the subcutaneous tissue are considered as hyperelastic and viscoelastic. The effects of loading in the form of displacements and the frequency of sinusoidal vibration on a time-dependent stress/strain distribution at various depths in the subcutaneous tissue of the foot are investigated. The simulations indicate that lower frequency vibrations penetrate deep into the subcutaneous tissue while higher frequencies are concentrated in the outer skin layer. The present biomechanical model may serve as a valuable tool to study the response of foot of those who work on a vibrating platform.

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.

Riveting hammer vibration damages mechanosensory nerve endings

Hand-arm vibration syndrome (HAVS) is an irreversible neurodegenerative, vasospastic, and musculoskeletal occupational disease of workers who use powered hand tools. The etiology is poorly understood. Neurological symptoms include numbness, tingling, and pain. This study examines impact hammer vibration-induced injury and recoverability of hair mechanosensory innervation. Rat tails were vibrated 12 min/d for 5 weeks followed by 5 week recovery with synchronous non-vibrated controls. Nerve fibers were PGP9.5 immunostained. Lanceolate complex innervation was compared quantitatively in vibrated vs sham. Vibration peak acceleration magnitudes were characterized by frequency power spectral analysis. Average magnitude (2515 m/s² , root mean squared) in kHz frequencies was 109 times that (23 m/s² ) in low Hz. Percentage of hairs innervated by lanceolate complexes was 69.1% in 5-week sham and 53.4% in 5-week vibration generating a denervation difference of 15.7% higher in vibration. Hair innervation was 76.9% in 5-weeks recovery sham and 62.0% in 5-week recovery vibration producing a denervation difference 14.9% higher in recovery vibration. Lanceolate number per complex (18.4 ± 0.2) after vibration remained near sham (19.3 ± 0.3), but 44.9% of lanceolate complexes were abnormal in 5 weeks vibrated compared to 18.8% in sham. The largest vibration energies are peak kHz accelerations (approximately 100 000 m/s² ) from shock waves. The existing ISO 5349-1 standard excludes kHz vibrations, seriously underestimating vibration injury risk. The present study validates the rat tail, impact hammer vibration as a model for investigating irreversible nerve damage. Persistence of higher denervation difference after 5-week recovery suggests repeated vibration injury destroys the capability of lanceolate nerve endings to regenerate.

Acute Effects of Whole-Body Vibration on Peripheral Blood Flow, Vibrotactile Perception and Balance in Older Adults

Background: Non-invasive application of whole-body vibration (WBV) has the potential for inducing improvements in impaired peripheral circulation, cutaneous sensation and balance among older adults. However, relevant studies have frequently applied high magnitudes of vibration and show conflicting and inconclusive results. Therefore, we attempted to ascertain the acute responses in those parameters from exposure of thirty older subjects to WBV of three different magnitudes, defined according to ISO 2631-1 (1997). Methods: Each subject randomly underwent four sessions of intervention (three bouts of 1 min exposure with 1 min between-bout rests): WBV at 15, 20, or 25 Hz with a peak-to-peak displacement of 4 mm, or control condition. Results: Both during and after intervention, dorsal foot skin blood flow increased significantly under 20 and 25 Hz exposure conditions with greater responses under the latter condition, the magnitude of which slightly exceeded the recommended value. Plantar vibrotactile perception showed significant increases after WBV exposure with overall greater responses under higher frequencies of vibration. In contrast, no WBV-induced change in balance was observed. Conclusions: WBV at 20 Hz with a magnitude within the recommended limit can be effective in inducing enhancements in peripheral blood flow; however, the same magnitude of vibration seems insufficient in improving balance among older adults.

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.

Raising awareness of hand-arm vibration syndrome (HAVS) using posters

BACKGROUND

Hand-arm vibration syndrome (HAVS) is caused by prolonged occupational exposure to hand-transmitted vibration. Although HAVS is preventable, disease awareness and prevention knowledge are lacking in high-risk workplaces; this may contribute to under-diagnosis, delays in seeking care, and poor health outcomes. Posters may be used to increase awareness in the workplace.

OBJECTIVE

To conduct a pilot survey in workers with HAVS about poster use in their workplaces, their recommendations for poster campaigns and training programs, and their evaluation of HAVS awareness and prevention posters.

METHODS

All eligible HAVS patients in the Occupational Health Clinic at St. Michael's Hospital, in Toronto, Canada, were asked to complete a questionnaire on workplace poster use and to evaluate a set of HAVS posters.

RESULTS

Fifty workers participated; almost all were males, aged 50 and older, working in construction. Most indicated having non-HAVS specific awareness posters in their workplaces. There was a positive evaluation of the design, content, and potential usefulness of the posters. The poster depicting finger blanching stood out most. The poster depicting anti-vibration gloves rated highest for relatability and effectiveness at conveying disease importance.

CONCLUSIONS

Participants supported the proposed use of industry-specific HAVS awareness posters in their workplaces. Future research should evaluate the effectiveness of these posters in the workplace.

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.

The effect of vibration exposure during haul truck operation on grip strength, touch sensation, and balance

Falls from mobile equipment are reported at surface mine quarry operations each year in considerable numbers. Research shows that a preponderance of falls occur while getting on/off mobile equipment. Contributing factors to the risk of falls include the usage of ladders, exiting onto a slippery surface, and foot or hand slippage. Balance issues may also contribute to fall risks for mobile equipment operators who are exposed to whole-body vibration (WBV). For this reason, the National Institute for Occupational Safety and Health, Office of Mine Safety and Health Research conducted a study at four participating mine sites with seven haul truck operators. The purpose was to ascertain whether WBV and hand-arm vibration (HAV) exposures for quarry haul truck operators were linked to short-term decreases in performance in relation to postural stability, touch sensation threshold, and grip strength that are of crucial importance when getting on/off the trucks. WBV measures of frequency-weighted RMS accelerations (wRMS) and vibration dose value (VDV), when compared to the ISO/ANSI standards, were mostly below levels identified for the Health Guidance Caution Zone (HGCZ), although there were instances where the levels were within and above the specified Exposure Action Value. Comparably, all mean HAV levels, when compared to the ISO/ANSI standards, were below the HGCZ. For the existing conditions and equipment, no significant correlation could be identified between the WBV, HAV, postural stability, touch sensation threshold, and grip strength measures taken during this study.