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As winter approaches the southern hemisphere, the risks of damage to the feet of people with diabetes increase. The weather turned nasty in Johannesburg last weekend – wet and cold – as a result I saw my first Autumn diabetic foot disaster yesterday. A burn on the big toe of a lady who went to bed with her 'barley bag'. It doesn't have to be barley, rice, lentils, in fact anything that can be heated in the microwave.
After heating the bag in the microwave this lady put it into the bed to warm it up. Her big mistake was, that when she went to bed she didn't remove the bag from the bed. During the night her foot came to rest on the bag and burned her big toe, leaving a blister along the whole length it.
When she saw me, the blister had broken and the base was infected. So now she is under treatment for a foot ulcer. The sad thing is that I spent months in 2007 succesfully healing an ulcer on this lady's other big toe.
So what's the message? You could say the ulcer is a result of a failure of diabetic foot health education – we didn't get the right message across – but it does highlight the fact that everybody involved in diabetic foot care has to be constantly alert to potential dangers. In this case we have a high risk patient with peripheral vascular disease and diminished sensation who made a mistake with serious consequences. So what are the key messages for winter protection for the diabetic foot?
- wash and dry your feet thoroughly
- remove any heating bags or hot water bottles before getting into bed
- turn off any heating pads or electric blankets when you get into bed
- make sure your winter socks are not too tight on your feet and around your legs
- take care that you can wriggle your toes in your shoes when you have thicker socks on
- remember that a thicker-soled shoe will keep your feet warmer
- if you live in a winter rainfall area, dry your feet as soon as possible after they get wet
- try wearing loose-fitting cotton or woollen socks in bed
- if your feet swell during the day, remember to allow for it when you wear your winter shoes or boots
- STOP SMOKING!
Take care of your pair and see a podiatrist
High heels – of course they damage your feet. But women still buy them. Just take a look at an outrageous South African blog: Google- Shoegirl South Africa and see what you get!
Apparently a new fashion trend is to wear socks with your high heels. Socks with high heels? Almost as bad as socks with sandals for men.
Even better is the website for FitFlops, yes you read correctly. I saw them with my wife at a Johannesburg shoe store last Saturday. What about footwear advertised as: The flip flop with the gym built in! Cushioned heel absorbs 36% more shock than regular footwear. Micro wobble-board midsection slows eversion rate by requiring 15% more energy to walk. Firm toe area promotes faster toe-off.
And the result? Firmer buttocks and leg muscles. One wearer says she does feel like she has just done a workout after wearing them.
They are available through one string of outlets – I'm not advertising them! Check the website. www.fitflop.com
I'm dying to know more about them.
Here's another idea, from Bignews page 14 January 2008.(This is a local business newspaper.)Transparent shoeboxes.(Very politically correct in SA today!). Boitunelo Mofokeng has obtained the rights to exclusively distribute Shoebby, a transparent shoe box manufactured in the United States.
So no more searching for 'that' pair of shoes, because all your pairs are visible in these neat transparent boxes. For the guys it could mean the end of sifting through that disorderly pile of assorted shoes in the bottom of the wardrobe! Contact Mofokeng at 082 453 8692.
Goodnight!
'Walking on sunshine.' 'Sexual heeling.' 'Toeing the line.' All headlines for articles recently printed in the South African press taken from The Telegraph, The Sunday Times and The Times respectively, all from London. Toeing the line is all about the Chinese tradition of foot binding and I'll pick up on that later this week.
The other articles are all about the benefits and effects of wearing high heels! Both suggest that wearing high heels is sexy and in 'sexual heeling' the research of a University of Verona urologist, Dr Maria Cerruto, is reported where she tackled "bizarre" theories about the effects of wearing high heeled shoes. The idea of sexual heeling refers to the Dr Cerruto's assertion that pelvic floor activity is affected.
Traditionally we have blamed high heels for a variety of ailments, such as bunions, stress fractures, knee pain, lower back pain and increased risk of arthritis. South African research by Drs. Zipfel and Berger of The University of the Witwatersrand in Johannesburg showed scientific proof that wearing shoes had bad effects on the wearers when compared to unshod people. (I know this was on old bones but they have the proof). Dr. Cerruto's evidence is due to be published in the journal European Urology. Since I am concerned with your foot health, I'll leave that train of thought for you to follow.
However, in the article there is a comment from a UK fitness instructor who runs classes in London for women with high heels called Sweat and Stilletos. These sessions are designed to help women wear stilletos more comfortably. Whilst she agrees with the effects of muscle toning in the buttock region, she says that there must be compensation somewhere else and therefore her classes help with postural alignment.
Now as podiatrists we spend a lot of time dealing with and correcting the effects of postural malalignment. A personal trainer to some celebrities was quoted as saying that" the knees and metatarsals are put under strain, the hips are out of position. It can lead to long-term health risks."
For me the evidence is there that the movement of the body's centre of gravity forward causes increased loading and pressure. There is an increase in callus formation and the calf muscles shorten over time. This will lead to deformities of the toes. I agree however that exercises specifically to strengthen the intrinsic muscles of the foot will resist these deformations.
In "Walking on sunshine" they report on a New York sports therapist who holds classes for women to strengthen their foot muscles to cope with wearing high heels. Yamuna Zake also gives some good advice on foot care. She has been working with dancers for 25 years and those of you who struggled to get your (or your child's) feet into the basic ballet positions without them falling flat will appreciate this. The essence of ballet is to be able to get your foot extended down from the ankle as far as possible and have almost 90 degrees of flexibility at the big toe joint.
So what's the bottom line? Let me quote from the articles. 'It's a way to appeal to the male species. I have men who say heels have saved their marriage.' Yamuna Zake says, 'my husband is a freak about high heels. He thinks they're very sexy.' During my recent tutorials with Wits University medical students I was demonstrating the possible effect of rheumatoid arthritis on the way a person walks. I asked on of the girls to walk across the room in her high heels and then again barefoot to show the difference in patterns of healthy person. Guess what she said before walking barefoot? 'Oh please I'll walk like a boy!'
I wonder if walking in high heels will become an Olympic sport?
Read the articles:
Walking on sunshine. Melissa Whitworth. The Telegraph, London. In The Sunday Times (Johannesburg)Lifestyle section. [not sure when, towards the end of 2007].
Sexual heeling. Roger Dobson & Steven Swinford. The Sunday Times, London. In The Sunday Times (Johannesburg) Lifestyle. February 24 2008. Page 17.
Eschewing shoes may save your soles. Gill Gifford. The Star, Johannesburg. Friday October 26 2007.Page 6.
Having legs of different length is recognised as a common cause of low back pain; but as I said the other day usually the body compensates for the difference. These compensations or adaptations place increased stress on various joints throughout the body and hence the pains.
Not surprisingly this condition affects growing children and they can show some funny signs when you examine them. For example one of the basic observations that we do is to look at the relative heights of the knees with the child lying flat on his/her back; a higher knee means a longer leg in the thigh(femur bone) segment.
Usually the bone on the inside of the ankle is also lower on the longer leg when you have the legs stretched out. Easy! there is a subjective dianosis based on clinical examination and suspicion. That's fine until you see that it's the other leg that is actually longer at the ankle!!! So what's the message here? Be very careful about jumping to conclusions with any patient but especially with children.
This simple example shows why the definitive test is the X-ray called the scanogram, because the radiologist views and measures the lower limbs (yes both) from hips to toes. The first place to look is in the hip joints to assess the alignment of the hip joint which is made up of the head of the femur and a cavity in the side of each hip called the acetabulum.
As podiatrists we are able to prescribe the local treatment based on biomechanical and gait analysis. This is only part of the team approach I referred to though. In younger people regular re-asssessment is needed to see if any correction has occured and then the local foot therapy will change. In older people the foot therapy is usually permanent. This is the situation in many people who have had hip replacement surgery. Which reminds me of a story.
I have a patient who has been a very successful ballroom dancer for more than 50 years. When she required hip replacement surgery she did her research and was distressed to find out that she might end up with a shorter leg, like some of her friends. As a result she threatened her surgeon – who happens to be "the hip expert of Johannesburg" – that she wanted a guarantee that her legs would still be equal after the operation. Believe me when I tell you that she is still dancing!
Take care of your pair – see a podiatrist
