Effects of Social Determinants of Health and Diabetes on a Lower Extremity Workplace Injury: A Disablement Model Case Study

Abstract

This clinical case study involves a 36-year-old male patient who injured his right lower leg while working in the kitchen at a county correctional institution. The mechanism of injury involved the patient getting his foot caught under a wooden pallet, losing his balance, and then catching himself on his right leg in a twisting motion. The injury led to the patient seeking care in the emergency department and was diagnosed with a nonspecific strain of the right triceps surae muscle group. Upon discharge, the patient was referred to outpatient athletic training services within the hospital system. Follow-up care provided by athletic trainers and athletic training students consisted of an injury evaluation, plan of care discussions, and therapeutic interventions, including moist heat packs, low-level laser therapy, desensitization massage, fluidotherapy, and electrical stimulation implemented over six weeks. During the six weeks of therapeutic intervention, the patient sustained an additional injury resulting in a right ankle sprain with a possible ankle avulsion fracture. Following six weeks of intervention, this patient demonstrated no symptom improvement. Due to the complexity of this patient case, an intentional effort was made to approach care using the International Classification of Functioning, Disability, and Health (ICF) disablement model to better inform the involved clinicians on areas of social determinants of health (SDoH), chronic disease, and acute rehabilitation. In this case, the SDoH and environmental factors contributed to poor patient outcomes, resulting in this patient continuing to seek care from other healthcare disciplines. Overall, this case demonstrates the effects of social and environmental factors on the rehabilitation process of a lower extremity workplace injury.