Lower Extremity Injuries Sustained While Farming

This article was downloaded by: [Ohio State University Libraries]On: 05 December 2014, At: 12:38Publisher: Taylor & FrancisInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH,UK

Journal of AgromedicinePublication details, including instructions forauthors and subscription information:http://www.tandfonline.com/loi/wagr20

Lower Extremity InjuriesSustained While FarmingJanice A. Neil RN, PhD aa East Carolina University, School of Nursing , Rivers#115, Greenville, NC, 27858, USAPublished online: 11 Oct 2008.

To cite this article: Janice A. Neil RN, PhD (2002) Lower Extremity Injuries SustainedWhile Farming, Journal of Agromedicine, 8:2, 45-55, DOI: 10.1300/J096v08n02_08

To link to this article: http://dx.doi.org/10.1300/J096v08n02_08

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all theinformation (the “Content”) contained in the publications on our platform.However, Taylor & Francis, our agents, and our licensors make norepresentations or warranties whatsoever as to the accuracy, completeness,or suitability for any purpose of the Content. Any opinions and viewsexpressed in this publication are the opinions and views of the authors, andare not the views of or endorsed by Taylor & Francis. The accuracy of theContent should not be relied upon and should be independently verified withprimary sources of information. Taylor and Francis shall not be liable for anylosses, actions, claims, proceedings, demands, costs, expenses, damages,and other liabilities whatsoever or howsoever caused arising directly orindirectly in connection with, in relation to or arising out of the use of theContent.

This article may be used for research, teaching, and private study purposes.Any substantial or systematic reproduction, redistribution, reselling, loan,sub-licensing, systematic supply, or distribution in any form to anyone is

http://www.tandfonline.com/loi/wagr20

http://www.tandfonline.com/action/showCitFormats?doi=10.1300/J096v08n02_08

http://dx.doi.org/10.1300/J096v08n02_08

expressly forbidden. Terms & Conditions of access and use can be found athttp://www.tandfonline.com/page/terms-and-conditions

Dow

nloa

ded

by [

Ohi

o St

ate

Uni

vers

ity L

ibra

ries

] at

12:

38 0

5 D

ecem

ber

2014

http://www.tandfonline.com/page/terms-and-conditions

Lower Extremity InjuriesSustained While Farming

Janice A. Neil, RN, PhD

ABSTRACT. Today’s complex farm environment can pose many threatsto the lower extremities of all people especially those with chronic dis-eases that affect the lower extremities. The purpose of this study was toinvestigate the incidence of injuries to the lower extremities amongfarmers and to rank the importance of these incidents in order to plan pre-vention programs. One hundred farmers were surveyed at a large farmshow in the southeastern United States. An average of 4.86 injuries perfarmer were reported. Blisters from work shoes or boots, followed by in-juries from animals stepping on the feet were the most common injuries.Since those with chronic illnesses are especially prone to injury and dis-ability, regular foot assessments, evaluation, and education about thehazards of farming are mainstays of prevention. [Article copies availablefor a fee from The Haworth Document Delivery Service: 1-800-HAWORTH.E-mail address: <[email protected]> Website: <http://www.HaworthPress.com> 2002 by The Haworth Press, Inc. All rights reserved.]

KEYWORDS. Lower extremity, injury, chronic illness

It is well known that farming is one of the most hazardous occupations.Farm injuries come with significant costs when a person is unable to performthe work required on the farm. Today’s complex farm environment can posemany threats to the lower extremities of all people, especially those with

Janice A. Neil is affiliated with East Carolina University, School of Nursing, Rivers#115, Greenville, NC 27858.

Previously presented as a poster: Neil, J.A. (2002, February). Lower extremity inju-ries acquired while farming. Poster session presented at the 16th Annual Conference,Southern Nursing Research Society, San Antonio, TX.

Journal of Agromedicine, Vol. 8(2) 2002http://www.haworthpressinc.com/store/product.asp?sku=J096

2002 by The Haworth Press, Inc. All rights reserved. 45

Dow

nloa

ded

by [

Ohi

o St

ate

Uni

vers

ity L

ibra

ries

] at

12:

38 0

5 D

ecem

ber

2014

chronic diseases that affect the lower extremities. Farmers risk foot injuriesthat include lacerations, punctures, crush injuries, traumatic impact blows, andbites from farm animals, insects, and reptiles. They also can sustain burns,falls, skin rashes and traumatic amputations. This paper reports the results of astudy that explored lower extremity injuries sustained while farming.

Farming costs are high when a person is unable to perform the work re-quired on the farm especially in large crop production situations when timeli-ness is important. Planting and/or harvesting delays during these critical timescan be devastating.1 The multifaceted farm environment poses serious threats,which have increased with mechanization.2 Injury and wound threats have in-creased with confinement buildings designed for poultry, hogs and cattle.Since even a minor break in the skin can result in a chronic wound in those withchronic diseases such as diabetes mellitus and peripheral vascular disease,these risks of farming can be serious.3

When people have peripheral vascular disease, ischemia may result becauseof inadequate perfusion. This leads to cellular death as a result of the lack oftissue oxygenation. An injury to the lower extremity may only compound theproblem. For farmers with diabetes who have neuropathy, and especially thosewho have lost the sensation in their feet (insensate), the risks of foot injuriesare high. Hyperglycemia impairs the host defenses against infection by dullingthe inflammatory response and causing abnormal action of the phagocytes.This causes wound healing to be slowed and may result in more severe and/orantibiotic resistant infections. Infection of chronic ulcers is a major cause ofgangrene and, potentially, amputation. Ulceration, infection, and gangrene areleading causes of hospitalization with an annual cost of one billion dollars inthe general diabetic population.4 The actual numbers of farmers in this figureis unknown.

Farmers who are on medications are at higher risk for farm injuries. Oftenthose who have developed vascular problems are on cardiac and circulatorysystem medications. Pickett et al. found that there are increased numbers of in-juries to farmers associated with the regular use of circulatory medications andthose who used medications in combination with other medications.5 Ofcourse those with decreased visual acuity can be predisposed to farm accidents,such as those with diabetic retinopathy.

Awareness of potential foot injuries and strategies to prevent chronicwound complications in farmers and farm workers with diabetes and otherchronic illnesses is vital to maintain their health and function as productive in-dividuals. As outlined in a previous article by Neil, there are many potentialcauses of lower extremity injuries that can occur while farming or while rais-ing livestock.3 These categories were used to construct a questionnaire thatwas used in a pilot study to investigate the number of lower extremity injuries

46 JOURNAL OF AGROMEDICINE

Dow

nloa

ded

by [

Ohi

o St

ate

Uni

vers

ity L

ibra

ries

] at

12:

38 0

5 D

ecem

ber

2014

that occurred in a group of 100 farmers who attended a large farm show in thesoutheastern United States.

The potential injury causes identified from the literature and in interviewswith farmers that were used for the construction of this questionnaire were:

Livestock: A recent summary of farm accidents from 15 states indicates thatanimals were a factor in about one of every eight injuries reported. The largestnumber of injuries came from cattle and hogs and occurred in farm buildingsand adjacent lots. Working with cows and bulls whose behavior is unpredict-able poses a great hazard for foot injuries because they often kick, push andstep on workers’ feet and legs. Also, hogs can bite with tremendous force, andthey have enough weight to cause crush injuries if they step on feet. Likewise,sheep and rams can cause butting injuries.6

Chemicals: Modern farming involves the use of many chemical productsincluding herbicides, fungicides, insecticides, rodenticides, and pesticides.Farmers usually prepare their own equipment and are exposed to a variety ofsolvents and fuels. Many of these products can cause serious skin reactionsleading to contact dermatitis.7 Skin that is irritated or itchy becomes a primetarget for wound development and cellulitis. Chronic wounds often developfrom these areas of irritation, especially in people with diabetes who have im-paired healing abilities. Scratching irritated skin allows the normal skin florato invade and cause wound infections.

Tractors and farm machinery: Injuries related to farm machinery are a lead-ing cause of morbidity and mortality among farmers.8 Farm machinery can beresponsible for crush injuries and laceration wounds. Feet, leg, hands, andarms accounted for 50% of the farm injuries in a study of 980 workers in1989.9 There are many parts of a tractor that become extremely hot. Brakesand bearings, exhaust systems, and hydraulic lines and pumps can cause sig-nificant burns.

Shoes and work boots: It is estimated that shoes cause 80% of foot ulcers.For high-risk groups, a blister often leads to a chronic wound and permanentdisability. Farm boots are especially rigid and can cause blisters when they arenew, and have the potential for increased shear when they are wet.

PURPOSE

The purpose of this study was to investigate the incidence of injuries to thelower extremities sustained by farmers and to rank the importance of these in-cidents in order to plan prevention programs. Another purpose was to identifyinjuries that have a high probability of becoming chronic wounds in vulnerablepopulations and to explore the kinds of assistance that can be tested to promotepreventive practices in farm settings.

Reviews, Case Histories, and Research 47

Dow

nloa

ded

by [

Ohi

o St

ate

Uni

vers

ity L

ibra

ries

] at

12:

38 0

5 D

ecem

ber

2014

No studies were found in the literature that addressed this important issue oflower extremity injuries incurred by farmers. This paper describes the resultsof a study that investigated the incidence of lower extremity injuries in a groupof 100 farmers who were surveyed at a large farm show in the southeasternUnited States.

METHODS

Setting and Participants

This study used a descriptive, non-experimental design. It was a purposivesample of 100 adult men and women who attended the Southern Farm Show inRaleigh, North Carolina. A purposive sample is a sample of subjects selecteddeliberately by the researcher because he or she thinks certain characteristicsare typical or representative of the population. All of the participants in thisstudy identified themselves as farmers. The farm show targeted farmers andwas held at a time of year that farmers were inactive in actual farming due tocold weather. There are also meetings of tobacco growers, credit agencies thatsponsor farmers, and tractor driving and horse pulling contests. Vendors con-cerned with all areas of farming populate most of the booths, and farmers usu-ally attend this show to make purchasing decisions related to their specificareas of farming.

The study was conducted at a booth rented by the Agromedicine Consor-tium from a rural southeastern university. The objectives of this booth in-cluded research, education about health and safety issues, and awareness of theAgromedicine Institute. The large booth was constructed to be inviting andprovide strong visual identification of the Institute. There were zones for inter-active activities related to safety, registration for a toy tractor drawing and a ta-ble for research related surveys.

The population in this study represented crop production in the areas of corn,soybeans, sweet potatoes, vegetables, fruit, peanuts, grain, tobacco, cotton, andlandscape and nursery. Livestock producers raised beef, swine, horses and poul-try. The sample represented farmers from a three state area that visited the boothon two days of the farm show. Total attendance at the show was over 10,0000,and 720 people from 41 counties visited the booth. Potential subjects were ap-proached as they stopped by the booth and asked if they were farmers and if theywould participate in a short survey related to leg and foot injuries while farming.The Institutional Review Board at East Carolina University approved the study.

Instrumentation

The questionnaire created for this study targeted specific injuries that mayoccur while farming. Items on the questionnaire had been previously validated


Dow

nloa

ded

by [

Ohi

o St

ate

Uni

vers

ity L

ibra

ries

] at

12:

38 0

5 D

ecem

ber

2014

by farmers and educators from the Agromedicine group. When farmers cameto our booth, they were asked to check the boxes of injuries sustained whilefarming on the one-page questionnaire. Incentives to complete the question-naire, including pencils, buttons, bumper stickers and a chance to win a toytractor, attracted farmers to the booth.

Data Analysis

Data analysis and interpretation included frequency distributions and means.Injuries were grouped into two categories, (1) acute injuries without long-termconsequences and (2) injuries with potential long-term consequences with orwithout medical care.

RESULTS

Demographics

One hundred participants were surveyed. Eighty-five men and fifteenwomen participated (Table 1). There were 93 Caucasians, five African-Ameri-cans, and two of Hispanic origin. The mean age was 46 years (range 18-75).Five reported having diabetes and two currently had foot ulcers.

Foot and Leg Injuries

The participants checked items on a list of possible farm injuries that theyhad sustained in all their years of farming. The results are displayed in Table 2.There were a total of 486 injuries reported with an average of 4.86 injuries perfarmer. Of the 100 farmers surveyed, 83% had experienced a blister or theirfoot or leg from shoes or boots followed by 73% who had their foot stepped onby a large farm animal. A snakebite (venomous or not) to the foot or leg oc-curred in only 7%. The remaining eight items on the questionnaire of foot orleg injuries included “burned leg on machinery (22%)” and “fall, injuring legor foot (56%).” The differences by age were not significant (Table 3) with thehighest reported injuries in the age range of 21-30 years. The 71-80 year agerange reported the fewest number of injuries.

Injuries by Category

The injuries were divided into categories to further assess the potential fortime lost from farming.

Acute injuries without long-term consequences: (Figure 1) These items mea-sured incidents that would probably not cause chronic conditions or disability.


Dow

nloa

ded

by [

Ohi

o St

ate

Uni

vers

ity L

ibra

ries

] at

12:

38 0

5 D

ecem

ber

2014

They generally do not need medical attention. These items included: (1) “droppeda heavy object on your foot,” (2) “animal stepped on your foot,” and (3) “re-ceived a deep bruise from a falling object.” There were 182 reports of these in-juries.

Injuries with potential long-term consequences with or without medicalcare: (Figure 2) These items have potential for long-term disability whether ornot medical care is sought. The items included: (1) “heavy farm equipment ran


TABLE 1. Demographics of 100 Respondents

Sex NumberMales 85Females 15

RaceCaucasian 93African-American 5Hispanic origin 2

Age of participants18-20 1121-30 931-40 1741-50 2751-60 1261-70 1771-80 7

Currently have diabetes?Yes 5No 95

With diabetes: foot ulcer?Yes 2No 3

TABLE 2. Foot Injuries Reported by Farmers (%), N = 100

Blister on foot from work shoes or boots 83%

Animal stepped on foot 78%

Fall: injured foot or leg 56%

Dropped heavy object on foot 54%

Severe bruise on leg or foot 50%

Deep cut on leg or foot 41%

Animal bite on leg or foot 39%

Spilled chemicals or pesticides on leg or foot 38%

Heavy farm equipment ran over foot 27%

Burned leg or foot on machinery 22%

Snake bite on leg or foot 7%

Dow

nloa

ded

by [

Ohi

o St

ate

Uni

vers

ity L

ibra

ries

] at

12:

38 0

5 D

ecem

ber

2014


7

6

5

4

3

2

1

0� 20 21-30 31-40 41-50 51-60 61-70 71-80

age groups

num

ber

ofin

jurie

s

TABLE 3. Average Number of Injuries Reported by Farmers by Age

heavy object dropped on foot

animal stepped on foot

deep bruise from falling object

0 20 40 60 80 100

%

FIGURE 1. Percentages of reported acute injuries without long-term conse-quences.

fall

animal bite

blister

spilled pesticides

foot run over

snake bite

burn from machinery

deep cut

0 20 40 60 80 100

%

FIGURE 2. Percentages of injuries with potential long-term consequences.

Dow

nloa

ded

by [

Ohi

o St

ate

Uni

vers

ity L

ibra

ries

] at

12:

38 0

5 D

ecem

ber

2014

over your foot, (2) ”spilled chemicals or pesticides on your foot,” (3) “got ablister from work shoes or boots,” (4) “animal bite on foot or leg,” (5) “injuredfoot or leg from a fall,” (6) “got a deep cut on your leg or foot,” (7) “burned legwith machinery” and (8) “got a snake bite on your leg or foot.” There were 303such incidents.

DISCUSSION

Farming is often an occupation where people work on the same farm andgrow the same crops and livestock for their entire working lives. However, ex-posures change over time through the introduction of new chemicals, newequipment, and new agricultural practices.9 The potential for injury to thelower extremities remains high. Table 4 displays the management and preven-tion of lower extremity farm injuries.

The results of this study revealed that foot and leg injuries occurred in al-most all farmers at some time in their careers. As chronic disease becomesmore prevalent, especially diseases that affect the lower extremities such asvascular disease, diabetes mellitus and arthritic conditions, the possibilities ofpermanent disability become greater. It was surprising to note that the oldestfarmers, those in the 71-80 year age group reported the fewest injuries. Per-haps after years of farming, injuries to the leg and feet fade from memory, oryears of experience contribute to avoidance of injury.

The item related to injuries with potential long-term consequences with orwithout medical care had 303 incidents reported. These items have the poten-tial for becoming chronic conditions, especially in those with circulatory im-pairment. Getting blisters from farm shoes was the most frequently reportedincident (83%). Since the majority of foot ulcers are caused by shoes, this highpercentage is alarming. For high-risk groups, a blister often leads to a chronicwound and permanent disability. Safety shoes should be standard equipmenton any farm. The metal-toed shoes with rugged soles can afford some protec-tion against animal hooves, dropped items, and sharp objects. However, thestiff nature of new work boots puts farmers at high risk for blister develop-ment. In achieving proper shoe fit, the shape and size of the foot must be con-sidered. Areas of high pressure and foot deformities must be cushioned. Oftenthere are foot deformities from bony changes and fatty tissue loss. Toe amputa-tions also cause change in foot configuration. Shoes with pressure relief onprominent areas also reduces the shock, or vertical pressure on the bottom ofthe foot caused by weight. Shoes with laces are preferable, with a 3/8 to1/2-inch space between the end of the shoe and the longest toe.10 Ulceration isoften due to the magnitude of the pressure as well.11 Extra care must be taken


Dow

nloa

ded

by [

Ohi

o St

ate

Uni

vers

ity L

ibra

ries

] at

12:

38 0

5 D

ecem

ber

2014

to examine the foot for pressure areas, especially when wearing new footwear.Care must be taken to avoid wet feet, to check feet frequently, and to changework shoes and socks when they become wet. Wet feet are at high risk for fun-gal development and encourage bacterial growth. Also, there is increasedshear associated with wet feet, which can cause blisters.


TABLE 4. Lower Extremity Farm Injuries: Management and Prevention

Injury/Cause Acute Concern Delayed Complications Prevention

Heavy objectdropped on foot

Crush injury,laceration

Impaired sensory and motorfunction

Proper handling of heavyequipment

Large animalstepped on foot

Crush injury,laceration

Secondary infection,barnyard microbe infections,impaired sensory and motorfunction

Proper handling, multipleanimal handlers, avoidanceof confined spaces with largeanimals

Falls Fractures, softtissue trauma,lacerations, jointdislocations

Impaired sensory and motorfunction, bone deformity,muscle weakness,secondary wound infection,chronic wounds

Proper lighting, properfootwear, proper orientationto environment

Animal bite Laceration,puncture wounds

Cellulitis, secondaryanaerobic infection, chronicwounds, rabies

Multiple animal handlers,avoid confined animalspaces

Blister Acute wound,increased sheer,fungal infection

Secondary infection, chronicwound

Proper footwear, avoidgetting feet wet, changingboots midday

Spilledpesticides

Skin reactions,dermatitis, itchingpeeling skin

Secondary infection, chronicwounds

Proper handling, protectiveclothing and footwear

Foot run overby machinery

Entanglement,pinned bymachinery,crush injuries

Impaired motor and sensoryfunction

Safety devices, properhandling of machinery

Deep bruisefrom fallingobject

Tissue trauma Sensory and motordysfunction

Proper handling and storageof heavy objects

Snake bite Severe allergicreaction,anaphylaxis,pain, edema,tissue necrosis

Cellulitis, secondaryinfection, tissue necrosis,gangrene, limb loss, death

Avoidance of known snakehabitats, proper clothing andfootwear

Burn frommachinery

Tissue infiltrationfrom injected oilat high pressure,acute burns

Secondary infection, sensoryand motor dysfunction,scarring, need for skingrafting

Avoidance of brakes,bearings, hydraulic lines, andexhaust systems.

Deep laceration Hemorrhage, softtissue trauma

Cellulitis, secondaryinfection, gangrene, limb loss

Proper footwear, propermanagement and storage ofsharp objects

Dow

nloa

ded

by [

Ohi

o St

ate

Uni

vers

ity L

ibra

ries

] at

12:

38 0

5 D

ecem

ber

2014

CONCLUSIONS

Farm safety factors that prevent leg and foot injury include adequate spaceand good lighting. Keeping the noise level as low as possible can avoid star-tling farm animals. An adequate number of handlers when working with ani-mals can also help avoid injury. Agricultural workers must be encouraged towear protective clothing, even in hot weather, to practice good personal hy-giene, and to wash pesticide or chemical contaminated clothing immediatelyto avoid unnecessary delayed skin contact. Determining the most frequentlyoccurring injuries will help prioritize the development and teaching of practi-cal preventive interventions. Education is an essential component in the pre-vention of foot problems among persons with chronic disease or those with thepotential for developing chronic disease. Hazards related to daily farmingpractices should be emphasized. Many farmers are not aware of the specialhazards that farming poses to their feet and legs, as well as their upper extremi-ties.

Foot injuries should never be ignored. Any injury or pressure area should bedealt with promptly by careful washing with soap and water, drying and ban-dage protection. The American Diabetes Association ascribes 50% of amputa-tions to preventable events, and has set prevention of inappropriate foot carebehavior as a goal for education.12 A major goal of education is to reduce prob-lematic situations that later result in amputations. Regular foot assessment,evaluation, and education are the mainstays of ulcer prevention in farmers andfarm workers in order to prevent chronic wounds and permanent disability.

REFERENCES

1. Shutske J. Costs associated with farm injuries. Department of Biosystems andAgricultural Engineering. 1996: University of Minnesota Annual Report.

2. Pratt S. Occupational health and the rural worker: agriculture, mining, and log-ging. J Rural Health. 1990;6:399-417.

3. Neil, J. Farmers with Diabetes: Risks for lower extremity injury and disability. JAgromedicine. 2000;6:59-68.

4. Doan-Johnson S. Diabetic foot ulcers: A point prevalence survey. Advances inWound Care. 1998;11:248-249.

5. Pickett W, Chipman ML, Brison RJ, et al. Medications as risk factors for farminjury. Accid Anal Prev. 1996;28:453-462.

6. University of Maryland. Farm Occupational Safety. Safety with Animals. 1992.Available: <http://www.inform.umd.edu/edres/topic/agrenv/hdd/occsafe/safety_with_animals.html>.

7. Oehme FW. Risks from chemical use on the farm. Kansas State UniversityResearch and Extension. 1999. Available: <http://www.vet.ksu.edu/links/agromed/oehmemorning.htm>.


Dow

nloa

ded

by [

Ohi

o St

ate

Uni

vers

ity L

ibra

ries

] at

12:

38 0

5 D

ecem

ber

2014

8. Cohen M, Moll M, Maley P, et al. Statistical description of agricultural injuriesin the U.S. In J Dosman and D Cockcroft (Eds). Principles of Health and Safety in Ag-riculture. Boca Raton, FL: CRC Press, Inc., 1989, pp. 311-315.

9. Hoppin JA, Tolbert PE, Flagg EW, Blair A, Zahm SH. Use of a life events cal-endar approach to elicit occupational history from farmers. Am Journal Ind Med1998;34:470-476.

10. AOFAS Online. Shoes and Orthotics for Diabetics. 1998. Available: <http://www.aofas.org/diabeticshoes.asp>.

11. Lavery LA, Vela SA, Fleischli JG, et al. Reducing plantar pressure in theneuropathic foot. A comparison of footwear. Diabetes Care. 1997;20:1706-1710.

12. American Diabetes Association. Diabetes Foot Care. Alexandria VA: Ameri-can Diabetes Association. 1990.

RECEIVED: 05/28/01REVISED: 04/01/02

ACCEPTED: 05/09/02


For FACULTY/PROFESSIONALS with journal subscriptionrecommendation authority for their institutional library . . .

Please send me a complimentary sample of this journal:

(please write complete journal title here–do not leave blank)

If you have read a reprint or photocopy of this article, would you like tomake sure that your library also subscribes to this journal? If you havethe authority to recommend subscriptions to your library, we will send youa free complete (print edition) sample copy for review with your librarian.

1. Fill out the form below and make sure that you type or write out clearly both the nameof the journal and your own name and address. Or send your request via e-mail [email protected] including in the subject line “Sample Copy Request” andthe title of this journal.

2. Make sure to include your name and complete postal mailing address as well as yourinstitutional/agency library name in the text of your e-mail.

[Please note: we cannot mail specific journal samples, such as the issue in which a specific article appears.Sample issues are provided with the hope that you might review a possible subscription/e-subscription withyour institution's librarian. There is no charge for an institution/campus-wide electronic subscriptionconcurrent with the archival print edition subscription.]

I will show this journal to our institutional or agency library for a possible subscription.Institution/Agency Library: ______________________________________________

Name: _____________________________________________________________

Institution: __________________________________________________________

Address: ___________________________________________________________

City: ____________________Return to: Sample Copy Department,The Haworth Press, Inc.,

10 Alice Street, Binghamton, NY 13904-1580

State: __________ Zip: ____________________

Dow

nloa

ded

by [

Ohi

o St

ate

Uni

vers

ity L

ibra

ries

] at

12:

38 0

5 D

ecem

ber

2014

Documents

Lower Extremity Injuries Sustained While Farming