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Any UPS drivers suffer from TTS?

Posted by Craig on 2/21/03 at 21:10 (110257)

I am a UPS driver and am suffering from Tarsal Tunnel Syndrom. I have been to see a podiatrist and a Orthapedic Surgeon. Both agree on the diagnosis. The problem is I am trying to claim it as work related and the company is giving me a hard time about that. They say it is an illness not an injury. So I want to know if anyone else working for UPS has either had this surgery and was it claimed as work related. I have had to deal with the pain for many years now and would really like to get it taken care of.

Re: Any UPS drivers suffer from TTS?

Ed Davis, DPM on 2/21/03 at 22:21 (110264)

Yes. Repetetive motion can be the culprit. Going in and out of the truck, coming down on one foot.

Think very carefully about how you get in and out of your vehicle. You and your docs will need to be good 'detectives' in order to identify the motion that may be causing TTS.

There is a distinction made between work related injuries and work related diseases. Acute injuries are usually easily accepted by Worker's Comp carriers. Cumulative trauma disorders such as carpal tunnel syndrome and tarsal tunnel syndrome are generally classified as work related diseaes and carry a higher burden of proof. There is a lot of documentation on carpal tunnel syndrome but much less on the work relationship of tarsal tunnel syndrome.

You will need docs who are wiling to stand behind you on this and probably a good worker's comp. attorney.

Re: Any UPS drivers suffer from TTS?

lara t on 2/22/03 at 08:14 (110285)

I'm just a patient, not a doctor so probably can't take what I have to say very far. But I am convinced it is the 'flexing' motion of moving/walking (not flexion position, the extension position) that most aggravates my TTS. I have also noticed (supporting this hypothesis) that if I have long drives (like when we go on college visits, not around town driving) that my feet get worse. I've explained this to myself (and my doctor) as I think that my foot is pretty steadily in the extension position when driving. It comes on slowly, but it comes. I think if I was driving all day my feet would be worse at the end of the day.

Re: Do you have a problem with this?

Sharon W on 2/22/03 at 09:16 (110289)


I think most people probably DO have trouble driving when they have TTS, although in my case I think it is the flexed position that bothers me most, not the extended one. The difference might be whether there is tighness in the achiles tendon or not. In any case, it seems likely that for many of us, repeated 'flexing' motions aggaravate this condidion...

I wonder how many others here have noticed a problem with it?


Re: Any UPS drivers suffer from TTS?

Marty on 2/22/03 at 11:35 (110323)


What does your doctor say about this? Is he behind you? In and out of trucks while carrying weight up to 70 pounds and more seems liable to me.

Re: Any UPS drivers suffer from TTS?

Craig on 2/22/03 at 13:58 (110364)

Two of the doctors that I have been to have agreed that my job is the reason for this. One said that because there is very little known about this type of injury he is unable to prove that my job is the only reason. Meaning genetics could be a big player in deciding who gets this and who doesn't. So to answer your question yes two out of three doctors so far are behind me and agree that surgery is the answer to getting rid of the pain.

Re: Any UPS drivers suffer from TTS?

Craig on 2/22/03 at 14:02 (110367)

The main reason for writing this is to find out if anyone else in the company has been treated for this as a work related injury. If so, then there is evidence that they have covered this before and should this time too. The company so far feels its a disease and not repetative and that I should take care of it on my own instead as a work related injury.

Re: Do you have a problem with this?

lara t on 2/22/03 at 15:26 (110393)

Perhaps then it has to do with the cause of the TTS, and I'm not imaging that driving makes it worse. (I presume) The tunnel changes shape (slightly, but significantly) as the foot flexes (from flexion to extension position) - like a flexible tube would change shape if stretched and relaxed, changing the amount of 'free space' around the tibial nerve. Depending on the cause of the TTS (varicose veins in your case, unknown for me) the position of the foot (from flexion - right angle- to extension - straight) would alter exactly when and where the tibial nerve has maximal impingement. For you, maximum impingment was the flexion position, for me the extension position.

Re: Any UPS drivers suffer from TTS?

Marty on 2/22/03 at 19:27 (110416)


There might be someone out there on this board that is a ups driver but this condition is a bit rare. Many who have this because they have some sort of entrapment other the just a breakdown in the flexor retinaculum (tendon like material) such as a cyst or varicose veins. If this is your case then it's not work related.

Good luck, wish I could be of more help.


Re: Any UPS drivers suffer from TTS?

BrianG on 2/23/03 at 21:22 (110562)

Hi Craig,

I have PF, which I believe I got from work. I was in the Security dept, of a large company. After a number of years, I was no longer able to work (barely able to walk). I met with a lawyer (in MA.) who told me the whole case rested on how I first reported the injury. It's not fair, but I was told that if I did not report the PF as a work related injury, the very first time I sought medical attention for it, I would not be elligble. Tell me that doesn't suck! Most people start out with a minor pain, which they do not attribute to work. Shortly you are in world of hurt, but it's too late for a workeman's comp case. Nobody said life would be fair!

In the end, it worked out OK for me, as I won my SSD case. The lawyer told me that my case was moved along faster than usual, as they did not have to deal with other lawyers for workman's comp, or long term disability. I'd talk to a couple different lawyers, and make sure you had 100% backing from your doctor!

Good luck

Re: Any UPS drivers suffer from TTS?

Ed Davis, DPM on 2/24/03 at 14:23 (110610)

There is not good documentation of exactly which repetetive motion or positions cause TTS so your situation is just as plausible as any other.

Re: Any UPS drivers suffer from TTS?

Ed Davis, DPM on 2/24/03 at 14:34 (110612)

The advice you first got from the attorney has some merit to it. Nevertheless, patients often need to go back after the fact to argue cause and effect. That is where it gets difficult but the right doc and the right attorney can often help -- depends on how hard they are willing to work on it. It appears that many worker's comp cases are not sufficiently 'big ticket' items to adequately motivate attorneys to take on a big fight. Of the hundred of attorneys in my area, I know a handful who would take on such a proposition and if I am convinced the patient is right, I never turn down a good fight.

Re: Any UPS drivers suffer from TTS?

Ed Davis, DPM on 2/24/03 at 14:39 (110614)

I am really not sure why some attorneys will fight so hard on some worker's comp. cases while others will not. My guess is that some are willing to take a loss on some cases in order to support their reputations as top notch worker's comp. attorneys. If I have to take time off from work to go to court or to a hearing, it is a financial loss for me but something I gladly do to support a patient whom I believe in.

Re: Massachusetts Workmans Comp reporting

BrianG on 2/24/03 at 22:36 (110653)

Hi Dr. Ed,

I took a quick look at the Mass Gen Laws, concerning the reporting of Workman's Comp injuries in Massachusetts. According to this statute, you have 7 days, not counting Sundays, or holidays. Like I said before, if your injury is slight at first, but continues to get worse, it's entirely possible not to report it on time, or not in the correct manner. Below is a copy of that reg.


PS: I would imagine different states have different laws.





Chapter 152: Section 6. Notice of injuries; forms; additional reports; statistical summaries.
Section 6. Within seven calendar days, not including Sundays and legal holidays, of receipt of notice of any injury alleged to have arisen out of and in the course of employment which incapacitates an employee from earning full wages for a period of five or more calendar days, the employer shall furnish notice of the injury to the division of administration, the employee and insurer. The notice shall be submitted on a form prescribed by the division and shall contain the name and nature of the business of the employer, the name, age, sex, and occupation of the injured employee, and the date, nature, circumstances and cause of the injury and such additional information as the division shall prescribe.
The commissioner may require employers with those standard industry codes with the highest number of injuries or claims to provide proof of insurance coverage as required by this chapter. The commissioner may utilize information provided by the division of employment and training and the department of revenue to ascertain the addresses of the employers with such industry codes.
Additional reports may be required from employers, insurers and medical services providers with respect to such injury and of the condition of such employee, including copies of medical, hospital, and rehabilitation reports and records, and the payments made or to be made for compensation shall be filed with the division of administration at such times and in such manner as the division may prescribe.
The division of administration shall prepare statistical summaries of reports filed under this section.
The provisions of this section shall apply also to the head of each employing board, commission and department of the commonwealth and of the several counties, cities, towns and districts subject to the provisions of section sixty-nine and copies of the report hereby required shall be furnished to the appropriate retirement board, if any, and to the agent set forth in section seventy-five or the insurer, if any.
Any person who violates the provision of this section three or more times in any year shall be punished by a fine of one hundred dollars for each such violation. Each failure to pay a fine within thirty days of receipt of a bill from the department shall be considered a separate violation.
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Re: Massachusetts Workmans Comp reporting

Ed Davis, DPM on 2/26/03 at 17:31 (110908)


I would think that would apply to acute injuries. As you know, the 'letter' of the law and interpretation can be two different things -- that is one reason why there are a lot of attorneys.

Lets look at some scenarios. I see a modest number of patients involved in auto accidents. A typcial scenario ... an individual slams on the brake and collides with a car in front. The individual is stunned, everything hurts. That person goes to the ER where immediate attention is given to the neck. The person may be immobilized, bedridden. The patient gradually recovers and becomes ambulatory but notices that it is hard to walk. Six to eight weeks later, I see the patient and they have foot pain that they are noticing more and more as the limiting factor as the more severe and acute injuries subside. The sudden backward motion on the brake stretches and possibly tears the plantar fascia and may cause an impingement of the tissues in front of the ankle. We render a diagnosis and the patient is reporting that specific injury a couple months later.

I used that example because it is not always possible to realize when an injury occurs for a number of reasons. TTS only occasionally starts as an acute injury but is often due to a repetitive motion disorder or cumulative trauma disorder. It is really not possible or practical to attach a date to when a CTD started and, as such, I would assume that that law make allowance.