A worker developed a blister on his foot after a shift at work that involved repeated activities outside of his usual routine. He decided to take matters into his own hands and popped the blister. He later developed a serious infection that required a few surgeries and even the partial amputation of his toe. At issue, for workers’ compensation purposes, was whether the popping of the blister caused the infection and subsequent surgeries, or if there was a connection between the work-related blister and the infection even if he had not intervened by popping it.

Steve Dunteman worked for Caterpillar, Inc. as a driver and he typically drove an automatic truck. He had been warned about his high blood sugar levels in 1999 but did not undergo any treatment beyond improving his diet. He was diagnosed with type II diabetes in 2009 and began taking Metformin. His doctor, Dr. Smith, said that his blood sugar levels had started to get under control and he went off Metformin after about a year.

He had an occupational injury in 2011. His automatic truck was being serviced so he was asked to drive a manual truck, which required him to hit the clutch 200 times a shift. The clutch was sticky so he testified he really had to force the clutch with his left foot, and when he exited the truck to work, which he did 30 times a day, he had to get out onto a metal corrugated step, stepping with his left foot on the same part he was striking the clutch. His shoes were rubber soled and by the end of his shift he noticed the pad of his foot was sore. He worked nine or ten more days of 12 hour shifts, his pain growing worse until he said he was walking with a limp. He noticed a blister on his left foot and used a sterilized needle to pop it, cleaning it with peroxide after he had drained it. He had done this kind of thing many times before with no problem and said no doctor ever told him that he should not pop blisters like that.

On June 28, 2011, a few days after he popped the blister, he went to see Dr. Smith who put him back on Metformin. On July 1^st he called the doctor worried about a sore on his foot. By July 4^th his foot was red and swollen and he went to the hospital with chills and a fever.  The physician at the hospital, Dr. Anderson, noted that he had diabetes and after an exam determined that he would need several surgeries for cellulitis. He underwent one surgery July 5^th and the other July 6^th. He left the hospital but came back August 2^nd where the doctor found his third toe to be “gangrenous”, and so he had surgery to partially amputate his toe. He went back to work in September of 2011 with no restrictions.

Dr. Anderson thought that his work-related activities caused the original ulceration because of the nature of the movement and the repetitiveness of the movement. He had an IME with Dr. Coe, who testified that there was a causal relationship between his work activities and the injuries to his foot. If he had never developed the blister he never would have developed the infection. When his employer requested an IME with Dr. Chiodo, the physician said there was no relationship between the blister and the infection, rather it was his diabetes that led to the infection.

He filed for workers’ compensation and initially received medical expenses, temporary total disability (TTD) and permanent partial disability (PPD). This was reversed by the Illinois Workers’ Compensation Commission, who said that his self-treatment was an intervention between the work-related blister and the infection, and it broke the “chain of causation” between the two. They determined that popping the blister led to the infection, so his own actions led to the injury not his employment. Dunteman appealed to the state’s appellate court, who reversed that finding. They said there was a “but-for” relationship between his occupational injury and the following medical conditions. As long as the work-related injury was one of the factors in a medical condition developed later on, the employer is responsible for that employee’s compensation expenses.