At the end of last week, a 60-something lady was brought to me complaining of a very painful ankle, three weeks after she tripped and fell whilst walking in the Bush.
She was uncertain which way her ankle had bent when she fell, but said there was a lot of swelling and bruising, which was only now starting to go down. Whilst in the Bush she had managed only basic First Aid with a bandage, to keep the swelling down so that she could get her foot into her trainers, but walking was extremely painful.
During my examination I isolated a point of severe pain over the tip of the lateral malleolus. [That's the bit of your fibula that sticks out on the outside of your ankle joint]. The area was also swollen and hot to touch. Moving the ankle caused pain and the lady walked with a stiff-legged limp. The provisional diagnosis was to eliminate a fracture as the ankle joint is very stable and usually the injury in these situations is of severe ligament damage. However, because of the local symptoms I was thinking fracture. The obvious thing to do was send for X-ray.
The X-ray report confirmed a fracture of the tip of the fibula bone, only slightly displaced, fortunately. However, perhaps more importantly, the radiologist reported the appearance of 'low bone density' and therefore the possibility of osteoporosis.
The lady is now wearing a "Moonboot" below knee walker – with some difficulty – and was referred to her GP for investigation into the low bone density, which is now underway.
Now I know this isn't really podiatry, but when questioned further, before I referred her, the lady revealed that she had never had a mammogram or bone density test. These tests are as important for older women as the prostrate examination is for men.
So if you have a fall or trip, don't just put it down to a sprained ankle and put up with pain; monitor the pain, bruising and swelling. Also, ladies, don't wait for the next time you need an X-ray to check your bone density.
Remember: podiatrists don't just treat feet, we treat people.
You may also find these articles interesting linked to osteoporosis and bone density loss.
- Women not getting bone treatment (news.bbc.co.uk)
- Coeliac bone loss link uncovered (news.bbc.co.uk)
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Image via Wikipedia
Athletes Foot is the name used to describe a fungal infection of the skin of the foot. Characterised by an itchy, blistering rash on the skin in the arch of the foot – which rapidly spreads to between the small toes and even the heels, it can ruin your Christmas.
Tinea Pedis is the medical name for this condition. It is worse in the hot summer months when feet are either trapped in their usual dark, sweaty environment, or exposed to areas where someone with the infection has walked.
Usually communal showers at the gym, in hotels, airplane carpets – the fungal spores are everywhere – just waiting for the perfect dark, moist environment to enable them to grow.
A fungal infection can also be spread by your favourite leather sandals, as the spores can live in the leather for ages!
Try to prevent Athletes Foot by following a few simple steps.
AFTER WASHING ALWAYS DRY YOUR FEET THOROUGHLY, ESPECIALLY BETWEEN THE TOES
WEAR CLEAN SOCKS EVERY DAY
AVOID SYNTHETIC OCCLUSIVE FOOTWEAR IF POSSIBLE
WEAR SLIP-SLOPS IN ANY COMMUNAL SHOWERING AREA
USE AN ANTI-FUNGAL OR ANTISEPTIC FOOT SPRAY
EXAMINE YOU FEET FOR SIGNS OF A RASH, SMALL BLISTERS IN THE ARCH OR WHITE ITCHY SKIN BETWEEN YOUR TOES
BAREFOOT AND FRESH AIR IS GOOD, UNLESS THERE IS A MEDICAL REASON NOT TO BE
If you have a fungal infection treatment with oral medication can be costly, so start simple:
GOOD FOOT HYGEINE
SPIRITUS PEDIBUS FOOT SPRAY OR PROPRIETARY ANTIFUNGAL SPRAYS
TOPICAL ANTIFUNGAL CREAMS
HOWEVER, A COURSE OF ANTIFUNGAL TABLETS MAY BE NEEDED
Unfotunately, the fungal organisms that cause Athletes Foot tend are very difficult to kill off. So even when your foot looks clear continue with the treatment for at least two more weeks.
One final word of warning. Not all rashes, or areas of itchy, moist skin are fungal infections. In the arch you might have a dermatitis. Between the toes it might be because youe toes are stiff and bent. Or you might need a good wash!!!
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The visual delights of high heels were the subject of a post on this website on 24 March 2008 – go back and have a look. Recently however, the "high heels issue" was the subject of a motion at the UK Trades Union Congress (TUC), in September this year.
High heels
The Society of Chiropodists and Podiatrists (SCP) tabled a motion calling on employers who promote the wearing of high heels………..to examine the hazards involved. They suggested further that employers should not be able to insist on the wearing of high heels by female workers as part of a dress code.
It received massive media coverage, even pushing Prime Minister Gordon Brown off the the early pages of some newspapers.
The dangers of long term (even short term) wearing of high heels are of back, hip and knee pains caused by the change in natural lower limb alignment. The forces placed on the metatarsals (balls of the feet) are estimated to increase sevenfold as the heel height increases. In addition there is an increased risk of falling or tripping.
Needless to say there was intense debate of the issue. With one newspaper calling it 'raucous."
If you compare your gait (way you walk) barefoot or in low heeled shoes, with your gait in high heels, you can easily see that in heels your knees don't extend, the heel can't hit the ground first followed by the rest of the foot going over it – 'heel over toe walking' – so the muscles act differently and the joints get stressed. High heels shorten stride and cause a jarring to the joints.
There is evidence of the use of lower heels on airplanes, when female cabin crew use lower heels for their in-flight duties when they often spend long periods on their feet.
However, when we look back at the post of 24 March 2008, we get to see that high heels are all about image! The hunter and the hunted. The allure of a long leg attached to a 9cm stilleto heel and the associated 'rock & roll' of the hips, arms, shoulders and anything else, is why high heels are worn by women and men will watch whilst women endure!
So until your bunions get really painful, your feet look like the front of a bricklayers trowel, the varicose veins resemble a set of train tracks, your corns are hard and yellow and your joints ache all the time due to arthritis. Ladies strut your stuff and visit your podiatrist regularly.
On the other hand, according to the SCP, this is a serious health and safety issue in the UK, with 'two million days lost each year to ilness resulting from lower limb disorders.'
Ultimately, it comes down to the right to choose. Or should that be Jimmy Choo's!
Neglected feet can become a serious problem. So to0 can neglected patients or visitors using this website. Welcome back to all of you – feet as well as people!
Good time management has never been one of my strengths and over the past 2 months I have had a struggle to make time for this fascinating communication channel with my blog visitors as well as the core professional duties of my daily practice and some additional duties on behalf of the podiatry profession.
So, look out for replies to all the comments posted. Do keep posting comments – the warning is only there because one person posted a comment with too much personal detail – failing to realise that what you post EVERYBODY reads.
Anyway, what has been going on? The "chairpersonship!" of the SA Podiatry Association(SAPA) is proving to be an enormous task; fortunately the Executive are really dedicated people and have taken up the challenge of a new (& very different chair with enthusiasm). We are developing a new website that will be more interactive for podiatrists and public. You should see podiatry visibilty in future.
Podiatry has been featured on SABC 3 with Noleen, Talk Radio 702 with Redi, chai fm community radio in Johannesburg and I understand there is something in the November edition of ELLE magazine.
The University of Johannesburg has also been active, honouring the top achievers of 2008 – guess where the top podiatry student is – yes, you're right, emigrated to Australia!
By the way, it's not too late to apply for a place on the course for 2010. However, tomorrow sees the start of the exams – more time pressure as I am an examiner and moderator for a couple of subjects.
Then come some big events. First up is the birth of our second grandchild, due in 2 weeks, followed by a trip to Harrogate in the UK for the Society of Chiropodists and Podiatrists Annual Conference – I am presenting a Poster on the work we have done at Chris Hani Baragwanath Hospital, Paediatric Rheumatology clinic.
Meanwhile, in the practice recently a lady with a classic case of neglected feet was brought in by her daughter. The lady lives in Limpopo Province north of Johannesburg; she had no idea how she damaged her foot so badly that the tendons were showing through the top of her foot! She felt no pain either (undiagnosed neuropathy?).
X rays revealed the bones inside were infected and had collapsed to create a very fat, swollen shape. (Charcot neuroarthropathy). As there was no pain it had been left under the care of the patient and her GP. Basically because the lady had poor access to health care, but more importantly no insight into her diabetes what would you expect? A classic example of poor communication all round.
Talking of communication, look out for activities associated with World Diabetes Day on November 14th. Check what your local podiatrist or clinic is doing. There is a big event in KZN, with a SAPA presence, there are events in Cape Town too.
As the Southern Hemisphere is into "exams fever," I'll leave you with this thought from a postcard that I bought in Oxford some years back.
Why study?
The more I study, the more I know.
The more I know, the more I forget.
The more I forget, the less I know.
So why study?
