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20 Canadian Occupational Safety | www.cos-mag.com on concrete for long periods of time, she wants a shoe that has cushioning support, such as one with polyurethane in the midsole, says Greulich. Workers with some medical conditions, such as diabetes or chronic ankle instability, may need to pay special attention to certain comfort consider- ations and seek out boots that are best suited to their condition. INSOLES Arch support is one of the most critical compo- nents in ensuring safety footwear is comfortable — and this is where insoles come in. The insole might be a custom orthotic made after a consul- tation with a foot doctor for workers with more severe issues, or simply an after-market insole. Most of the linings that come with safety footwear are removable and can be replaced with a more supportive insole. "If you're slightly flat footed, your foot tends to go to the inside, pronate, then you can put in an insole that offers arch support and holds the foot in its natural position and doesn't allow it to pronate," says Greulich. "Therefore, you will be comfortable for a much longer period of time and reduce the risk of injury at the same time." Insoles can do much more than provide arch support. For example, some keep feet dr y and cool with an aerated design, provide extra shock absorption or specialize in anti-fatigue. Insoles can also help alleviate pressure points. The 3D imaging machine at Red Wing Shoes maps the worker's foot, identifying pressure points, and associates recommend suitable insoles. Many ven- dors have some type of pad or kiosk that workers can step on to help them identify the proper insole. A caution when it comes to cushioning: More is not always better. A lot of people think they need something softer if they are having heel or foot pain, but that is a misconception, says Sonnema, adding jamming a bunch of soft cushioning in the shoe creates instability. "I see a lot of guys come in and they will have three layers of insoles in their boots. But when you rip out all those insoles and put in a solid orthotic that controls the foot and gets it functioning better, all of a sudden everything falls into place and the pain goes away," Sonnema says. "It's kind of counterintuitive but cushioning is not always the answer to everything." Many employee health benefits plans, including Purolator's, offer coverage for orthotics. Cassidy strongly recommends that his workers visit a podi- atrist and have their feet evaluated. "It's part of prevention and looking after our health," he says. "Our feet are probably one of the most important pieces of equip- ment we have and why not get them checked out and get a specific recommendation, just like our teeth?" PURCHASING To make sure workers are selecting the right safety boots, you may want to bring the boots to them. At some of Purolator's locations, a footwear truck comes to the site with knowledgeable associates who can help workers make the right selection. Mister Safety Shoes goes directly to work- places with its mobile stores and it also has retail outlets. When it is working with a company on a managed safety footwear program, it meets with health and safety managers to determine what boots would suit their needs. "We usually do a walk-through with these managers at their companies to get a sense of what their employees are doing all day, what they are wearing currently and then we come back with a recommendation," says Hampton. With a managed program, all employees' names and numbers for a particular company are registered electronically in the vendor's system, so when a worker goes to the store, all of his footwear requirements pop up on the screen, says Greulich. This eliminates the need for vouch- ers or cards. How the boots are paid for is something health and safety professionals need to consider. Workers at Purolator are required to purchase the footwear and then they are reimbursed up to $125 annually. This type of annual subsidy is a common approach. However, it comes with some risk because employ- ees have to pay out of pocket and it might take some time to be reimbursed, says Hampton. "They can make the decision to buy a poorer quality boot that fits within their own budget and then they are at risk," he says. The other option is to be part of a managed pro- gram with a retailer where the company is billed directly once or twice per year and there are no out-of-pocket costs for workers. The employer would still pre-determine a maximum amount per worker and if a worker wants to choose boots that exceed that, then he would chip in for the remain- der. To further encourage choosing a comfortable shoe or boot, this remainder can be paid through a payroll deduction program, which the employer can set up with the vendor. With an aging workforce, comfortable and sup- portive footwear is of the utmost importance. "What generally happens to our feet with age and gravity is that people who have arches that aren't particularly good, (the arches) tend to fall or have problems," says Hampton. When a worker has been in the workforce for 30 years, it starts to take its toll, says Orvitz. Proper foot support is needed to prevent strain and stress on the body as well as long-term problems, such as reduced circulation, arthritis and degenerative joint disease. Health and safety managers first need to make sure the boots and shoes their workers wear meet all necessar y safety requirements, but comfort should be a close second. Ultimately, Cassidy from Purolator says it best: "The more people feel com- fortable and feel good in their safety footwear, the more likely they are to wear it." KICK YOUR HEELS In May 2016, a former employee of Joey Restaurants told CBC News she was required to wear high heels as part of the dress code, but they left her feet bloodied on her first day of training. She was told to buy a better pair of heels, but at the end of her second training shift, she could no longer stand. "My feet were bleeding and swollen. I lost a couple of toenails. I was just in tears," the worker told CBC. In April 2017, the government of British Columbia banned employers from forcing employees to wear high heels in the workplace. High heels bring a risk of physical injury from slipping or falling as well as possible damage to the feet, legs and back, the government said. Walking in high heels (typically greater than 1.5 inches high) has been shown to significantly reduce ankle muscle movement as well as balance control. High heels have been shown to result in musculoskeletal injury, particularly ankle and foot sprains and strains. According to WorkSafeBC's guideline on footwear, when employers are deciding whether certain footwear is appropriate, they should ask the following questions: • Does the toe box allow for normal foot function and natural toe positioning or does it squeeze toes together unnaturally? • Does this footwear distribute body weight over the whole foot or does it place more weight on the forefoot? • Does the heel make sufficient contact with the walking surface to provide a stable base for good musculoskeletal alignment and balance or does it detract from them? If the answer to the first part of any of these questions is "no" and the answer to the second part is "yes," that footwear is likely not appropriate, says WorkSafeBC.