The overlooked risk in shoe manufacturing: an evaluation through five cases of toxic polyneuropathy

This case series presents five Turkish shoe factory workers who developed toxic polyneuropathy due to occupational n-hexane exposure. The patients, aged 22-48, experienced subacute onset of symmetrical distal weakness, numbness and impaired ambulation following 1-4 months of adhesive-related tasks, such as glueing, stitching and sole pressing. None had appropriate personal protective equipment or adequate ventilation at the workplace. Electrophysiological findings confirmed demyelinating sensorimotor polyneuropathy, and 2,5-hexanedione testing was negative, likely due to delayed sampling. Neurological symptoms partially improved following removal from exposure and neurorehabilitation. All cases originated from the same factory, highlighting systemic lapses in occupational safety practices. The study underscores the importance of strict enforcement of industrial hygiene measures, biological monitoring and worker education in preventing neurotoxic solvent exposure. Increased clinical awareness and early recognition of occupational neuropathies are essential, particularly in small-scale industries with poor regulatory oversight.