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Babies do not need footwear. Anything that you put on a baby's feet will constrict and damage it. Don't be persuaded to buy 'pram shoes' they should be hanging from the rearview mirror of your car!
As children develop they are all action and this is part of the normal growth pattern so it is essential that they are allowed freedom of movement at every opportunity.
There can also be damage from clothing that we put our babies in. Romper suits (called a Babygro when my children were small) are often too small or tight and restrict the very important kickiing activity the all growing babies need. In South Africa there is a trend to cover babies when in the pram or stroller. DON"T. Any covering that reduces the normal developmental reflex movements will cause harm. Those beautiful knitted bootees from Aunty Tshidi – watch them – they must allow the wriggling, growing toes to keep doing just that.
If you look at 'pram shoes' you will see very little of their shape matches the baby foot, especially at the toes wher usually they are too narrow. It could be the equivalent of you or I wearing a shoe one size too small. Even the fastening around the ankle, although it may look OK has the potential to press into baby's foot.
During the first 6 months total freedom should be the aim. This allows the unhindered development of the neuromuscular responses. Just take a moment to look at the feet of the newborn and infants before they start walking. What you will see is a range of curling, wriggling, turning in and out, twitching and so forth which need to bee allowed without being enclosed in footwear of any sort.
Barefoot is best. Loose covering obviously to keep warm. Yes keep the sun off, but don't constrict the feet. Throw away the 'pram shoes'n the only footwear you need for babies is bare skin.
Sweaty feet affect everybody at some time of their lives. The complaint can be seasonal -worse in the warmer months – but can be present at any time of year. The medical term is hyperhidrosis (excessive sweat production) and if there is an accompanying bad odour, it is called bromidrosis.
There are many causes. The most common is poor foot hygiene associated with footwear with a high synthetic material content. Socks, stockings or tights made of nylon also cause the feet to sweat excessively. In teenage years glandular changes are a frequent cause amongst males and is made worse by poor hygiene and footwear. Occasionally, there is a systemic problem which shows in increased sweating of the hands and other body parts. Whenever we exercise, we develop sweaty feet, which is is quite normal, but it does lead to the smelly foot and shoe syndrome.
An excessively sweaty foot is susceptable to the development of fungal infections and because it is important to differentiate between sweating and fungal infections, I'll write in detail about fungal infections in the future.
Treating sweaty feet needs patience and perserverence. Daily washing with soap and water is essential. Then dry feet thoroughly. Try to avoid wearing shoes with synthetic uppers and soles. Make sure your socks contain high percentages of cotton or wool. Read the labels to see what the socks are made of. Try using an anti-perspirant under the arches of your feet. There are some products advertised specifically for this application. Podiatrists usually recommend 'Spiritus Pedibus' also called Foot Spirit. It contains 3% Salicylic Acid in Ethyl Alcohol. Occasionally a weak solution of Formalin can be prescribed. Obviously any opportunity to have your feet bare in fresh air will help. So wear sandals whenever possible. However, beware of plastic and synthetics, go for leather if you can. If the condition is really severe, a change of socks may be necessary during the day.
There is a surgical procedure called a sympathetomy – which must be performed by a specialist surgeon – for very severe sweating of the hands and feet.
Smelly feet are usually caused by the bacteria which live on our feet normally, not being washed off thoroughly. They can of course be caused by the materials themselves, especially some rubbers. Washing and drying is a good start followed by any of the above treatments. Naturally if you favourite trainers make your feet smell, but your normal shoes don't, you have a hard choice to make!
Powder is often used for sweaty feet, but be careful since it tends to solidify between the toes.
Sweaty feet are a common complaint and they can be embarassing. However, treatment is often very simple, starting with an intensive foot hygiene routine.
Talk Radio 702 in Johannesburg and 567 Cape Talk present a nightly series of talk shows devoted to specific topics. On Tuesdays it is A Word on Medical Matters and this coming week the topic is going to be feet. Hosted by Leigh Bennie and Prof. Harry Seftel, the programme is broadcast from 7.00 pm. For this programme I have been asked to be the guest on the show!
Anything can happen as it is an open line phone-in programme linking the sister stations of 702 & 567. It is great fun although a bit scary since you have no idea what questions are coming until you see them on the computer screen in front of you. Nevertheless it is an excellent forum for publicising the role of the podiatrist in providing health care in South Africa.
Maybe that role will become more recognised and change for the better, now that we have a new Minister of Health. Perhaps now we can also get a sensible line of communication to the Minister concerning the scale of fees payable for our services.
Today was another busy day in the practice culminating in the latest visit of the patient I wrote about with gangreous feet and undergoing dialysis. Well, the toes are still attached although black and dry – but the gentleman is really unwell. I have arranged for his wife to do some dressings, so that he could reduce the number of visits he needs per week. This is an important factor of the International Consensus on the Diabetic Foot, where the patient, family and health care professionals get involved in care. The intention is to develop an interactive and educated team.
Yesterday was another Paediatric Rheumatology clinic at Chris Hani Baragwanath – every week there is something new and we are beginning to have success in managing the painful foot complaints of some of the children. Incorrect footwear is still one of the main obstacles to achieving success though, because I can't put an orthotic into a shoe that is already 2 sizes too small. This happened yesterday; the shoes in question were a pair of stylish Lacoste sneakers – bought at considerable cost by a loving mother but they were too small after a few months. With the result that the toes were buckling and painful – nothing to do with arthritis of course.
As summer approaches there has been an increase in 'sweaty foot disorders' so in the next week I'll give some advice on how to recognise, treat and possibly avoid them. But if you can't wait, listen to A Word on Medical Matters on Tuesday 30 September where the topic is Feet ard Podiatry, because the question always comes up.
In the meantime – TAKE CARE OF YOUR PAIR
Fame is a passing thing, but all things come to those who wait! The Rheumatology Updates were originally planned for Febuary in Nairobi, Kenya. My ego was nicely polished by being invited to participate as a speaker at a 3-day workshop for Allied Health Professionals. The trip to Kenya was postponed twice due to the political unrest in that country. However last Wednesday I received confirmation that the trip is on.
The event is an initiative of AFLAR (African League of Associations for Rheumatology). The full title is The Regional Rheumatology Symposium and Workshops, Eastern African Region "Rheumatology Updates."
Running from the 6th – 10th October there is a 3-day workshop for Allied Health Professionals, a Public Lecture (to be presented at the Holy Family Basilica Hall -the Cathedral) and the Rheumatology Updates will take place on the 8th & 9th at the Grand Regency Hotel.
I have to give three oral presentations plus two practicals at the workshops and (here's the ego polish!) I have been invited to speak at the more formal updates on The Foot in Arthritis.
As far as I am aware, there is only one qualified Rheumatologist in Nairobi – possibly in Kenya. When I went there last year as part of a team from the Department of Rheumatology from the University of the Witwatersrand, for an AFLAR Congress, the hunger for knowledge was immense, but the resources very few. The intention is to not only impart knowledge but also to train people to provide better care to people with Arthritis.
I have also found out that there is only one podiatrist in Kenya too. A graduate of the University of Salford. Quite by coincidence I was a lecturer there in the 1970's.
Sorry for the silence and lack of input to the site for the past month. Reasons? My associate got married and was on honeymoon, so I had to work harder! The winter respiratory dryness got me and I succumbed to a chest infection. Also got in a brief visit to my granddaughter in Hout Bay and the biggest time taker of all was setting year end examinations for the podiatry students at the University of Johannesburg.
However I can't wait for the Rheumatiology Updates in Nairobi. As I said "fame at last, an ego polished and silence broken".
