- Image by Donnie Ray via Flickr
Sore feet or sunburn could ruin your holiday. Whether you are going to the coast, mountains or bush, you need to pay special attention to protecting your feet this summer.
As the holiday season gets going, many of us will be exposing our feet to the African sun for longer periods than usual. Remember that if your feet are usually covered by shoes and socks, they will need as much protection as your face and shoulders. (Or your bald head). Despite the fact that we spend a lot of time barefoot or in sandals in South Africa, during holidays the time is often extended.
The most vulnerable part of your feet is the skin on top of your arches. However you can also get sunburn on the soles of your feet if you like to indulge in serious 'sun-worship.' Obviously any part of your feet that is exposed is at risk. Initially you might not feel too much discomfort from sunburn, but when you put closed shoes on there will be pain.
Usually, sunburn is confined to a patch of inflamed, sensitive skin, which responds to protective after-sun preparations. The end result is skin dryness and peeling after a week or so and little harm is done. In severe cases however, the inflamed area starts to blister and itch. This is when scratching or opening the blisters can lead to infection.
Always apply sunscreen on top of your feet before you go to the beach, shopping or walking. You might need to re-apply after swimming, depending on what you use, or suits you. If you are spending a long time lying face down with bare feet protect the soles. After showering, treat your feet as you would the rest of your body with your choice of after-sun preparation.
Another common holiday foot problem is burning the soles of the feet. Here again it is usually because the soles of our feet are not as tough as we think and so we forget that the beach sand burns. The same thing applies to the patio tiles or paving.
Don't do crazy things like walking barefoot over the car park. We all know that it's thought to be very 'macho', to run around barefoot on holiday, but there is nothing 'macho' about peeling, blistered soles.
Unfortunately wherever you are, at the beach or around the dam your bare feet are not protected from broken glass, cool drink cans, palm thorns, bits of charcoal from the braai, even rubbing from your new sandals! Watch out for those beach thongs rubbing between your big toe and second toe too.
Always wash sea sand off your feet before you walk any distance, because it can chafe and irritate skin between your toes.
You might even get painful feet from all the extra walking that you do. This can be a big problem if you are walking along a beach where the sand is rough, or if you spend time jumping around in the sea on rough sand. It can also happen if you are enjoying the sights of a chilly Northern Hemisphere winter, as you spend more time walking around.
Finally, as you lie on that soft, sandy beach preparing to enjoy the warm Indian Ocean, remember it's not just the sharks that can get you, look out for sea anenomes, puffer fish and coral!
So just think ahead. Protect your feet and those of your family, but above all, relax and enjoy putting 2008 behind you. Don't let sore feet or sunburn spoil your holiday, but if it does, go and see a podiatrist.
TAKE CARE OF YOUR PAIR
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Regular visitors to the website will have noticed that recent blogs have suddenly disappeared. New visitors will wonder why nothing has appeared for over a month. Well, the administrative cyberstars behind the webmaster decided to carry out a major restructuring of 'their systems'. As a result, in some remote part of cyberspace concerned with the management of the website the blogs have disappeared. Despite all attempts to find the blogs they seem to have phoned home like ET.
Please be patient and there will be new information up within the next few days.
At present the practice is very busy, which is just as well in view of the recent press release by the registration body in South Africa, the Health Professions Council of South Africa(HPCSA), which basically has recommended that the guideline for fees in future should be the Nationl Health Reference Price List(NHRPL). This is a backdown from the HPCSA position of accepting that a practitioner may charge up to three times the NHRPL.
Since the government took over control of what is usually 'the Medical Aid Rates', they have consistently ignored the recommendations of health economists appointed by them to adjust the fees of Health Care Professionals in South Africa.
What this means is continued problems for providers and consumers when dealing with Medical Aids (Insurers). Personally I think that people who value and receive quality healthcare will still be willing to pay for it, IF the financial crisis is not too severe.
Consider this: for spending 30 minutes performing skilled clinical removal of a corn or ingrown toenail,for example, the NHRPL fee is 57.10 SA Rands. Current exchange rates are R1.00 = USD 10.22 and GBP 15.00. Do the maths and see if you can see the value in that. (Of course there are other fees added for consultation and materials), but it is the principle that matters.
I was guest speaker at the graduation ceremony of the podiatry department at the University of Johannesburg, only 5 graduates, the other 12 are deferred until they have finished their research projects. And guess what? The top student is emigrating to Australia!
Look out for Your Career in Podiatry in South Africa, coming to this space soon.
In the meantime if it's not broken don't fix it, or you might get beaten by technology!
The case of the sesamoid fracture that I referred to the other day, has had an interesting development. You will have read that we ended up using an Aircast below knee walker. Unfortunately this was only successful for about one day. By the end of the day the pain was increasing.
I advised my patient to get advice from an orthopaedic surgeon who I know. The advice was really simple! Wear thick-soled soft trainers and take pain-killers until it is better. (Obviously only take the pain-killers as often as really necessary). This will allow normal movement – remember this condition is not treated by immobilisation in a cast – but not over use.
So what's the lesson here? Simple treatments are often the most effective. Never ignore foot pain in the ball of your foot. Have it accurately diagnosed – it might be a sesamoid fracture.
I diagnosed a sesamoid fracture in a young woman this week. The presenting complaint, on Wednesday, was of "pain in the ball of the foot under the big toe joint for nearly 9 months, but 3 days ago (Sunday), whilst doing a long day shift the pain got really bad and only stops when I take weight off the foot."
The ball of the foot was noticeably swollen, but not inflamed. However, when I applied light finger pressure to the area the pain increased and was particularly bad at one spot. The lady has a high-arched foot (pes cavus), but it is flexible not rigid. She is not overweight, but is very active everyday of the week -including some weekends – working long hours. She told me that she usually wears a low heeled shoe or sandal, but it had become impossible to wear slip-ons or 'push-ins' because of the pain. The only relief was to wear trainers with a thick sole. When the weight was removed by sitting or resting in bed there was no pain.
By applying a protective pad to the sole and the arch, with a cut-out around the painful area, painfree walking was possible. An X-ray was requested; both feet for reasons that I'll explain shortly and a follow-up appointment was arranged for Thursday morning.
We met on Thursday and the X-ray showed a clear break in the lateral sesamoid. The pain was also worse because the padding had slipped backwards and out of position. By repositioning the pad, the pain was relieved again. I instructed her to use trainers as often as possible and suggested that she do the replacement padding herself. In addition I arranged for her to be fitted with an Aircast below knee walker, which she could borrow from the practice on Friday after work.
The treatment for this condition is mainly patience and removal of pressure. Which is why I decided on the Aircast. When we fitted the Aircast walking was immediately painfree. Now we both have to wait for the bone to fuse as one or even two bones.
There are two sesamoids under the ball of each foot. They allow a particular muscle to pull the foot down during standing and walking; they also survive a lifetime of bending at the ball (the first metatarso-phalangeal joint). In some people, one of the sesamoids is naturally bifurcate and can look as if it is fractured – called a normal variant -that is why I asked for both feet to be X-rayed. This fracture may heal in two parts also, which won't be a problem.
Pain in this part of the foot is quite common. It is caused by excessive amount of shearing, compression or tensile stress over the joint. It can be associated with sports like golf and tennis. Starting running or training and doing too much or running in old trainers. Wearing old worn shoes, where the inner sole gets a deep imprint. It can be associated with rheumatoid athritis, or even standing on a ladder for long periods, when you aren't used to doing that! Nearly always it affects people with a high arched foot who have over-used their feet.
Initially the bone and the joint under them become inflamed and that is called sesamoiditis. Ignore this and a sesamoid fracture may result.
