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The Biennial Congress of the South African Podiatry Association took place this last weekend.
The first two days were a Biomechanics Boot Camp taught by renowned Australian podiatrist Craig Payne and today there were presentations by local podiatrists on rheumatology, diabetes, paleo-anthropology and education.
Most podiatrists routinely perform biomechanical examinations on their patients – but this Boot Camp was something else – it has changed my thought paradigms and will alter the way I examine my patients and any orthotic treatment I decide to use. (I know this is true for every one else who attended the Boot Camp).
There was another interesting development at the Congress, I was elected Chairman of the South African Podiatry Association for the next two years.
This is a real privilege and challenge as podiatry in South Africa needs to have a much higher profile and take a more prominent place in the South African health care scene.
Expect to see much more about feet and foot care in the future.
Many older people suffer a fall with consequent injury such as a fractured shoulder, wrist, hip, ankle or foot. In the UK there is an active falls prevention initiative, promoted by the National Health Service. Not so in South Africa, although we are aware of the problem.
Have you ever thought how the state of your feet could contribute to a fall? Podiatrists should be involved in preventing falls and your visit to one could help to prevent one.
Hazel Tomkins, a British podiatrist, writing in Podiatry Now has detailed how your feet can cause a fall.
So, if you want to stand on your own two feet here's what to look out for.
Any corn, callus, ulceration, painful nail condition alters the way your foot hits the ground. This usually makes walking uncomfortable and unsteady. With age, the cushioning fatty pad on the soles of the feet thins out – giving less protection to the bones and joints underneath.
Changes to the basic shape of the feet alters the ability to walk evenly. Often the cause of these changes is reduced muscle strength. On the other hand, any change in posture – quite common as we age – is associated with weakening of our muscles, so there is the potential for loss of balance or unsteadiness.
Watch out for changes to the length of your legs after hip or knee replacement surgery. The pain has gone but you really do need to do all the physiotherapy to restore muscle strength and balance.
At the same time there are many changes to hearing and eyesight which affect the ability to balance and see clearly what is going on around us.
If you have any nerve changes associated with diabetes (neuropathy), you are disadvantaged, because you have a reduced ability to respond to the sensory stimuli around you. On the other hand, arthritis can cause deformity as well as stiffness, making movement difficult, slower or unsteady.
Research into barefoot walking showed a 19% worse performance when barefoot compared with even a least unstable shoe. Going barefoot or stocking feet dramatically increases the falls risk.
Simple you might think, I'll wear slippers or shoes. Well this is an area of some dispute. There is good scientific evidence that if you change to a lower or flat heel after a lifetime of wearing high heels, you have a greater risk of falling! At the same time there is research which suggests that the most important feature of footwear in preventing falls is the grip of the sole on the ground. Added to that is the need for good fit and thicker soles.
So what to do?
Keep mobile – exercise regularly – start walking, even if you use a walking aid. Maybe you need to start using one? Make sure that you can see and hear as well as possible.
A visit to a podiatrist for a biomechanical assessment is an important way to identify any underlying structural and functional problems. Treatment of any painful foot condition, such as corns and calluses, is essential and information on the best shoes for you, will be provided.
Avoid higher heels, barefoot walking and slippers. Consider wearing trainers with a rippled sole. A word of warning though, some trainers have really 'grippy' soles and that can cause a fall!
Try to remove all loose carpet runners and potential hazards that you could trip over. Make sure the lighting in your home is adequate (most falls occur at home!).
It takes team work to prevent falls, so get any advice that you can, or share it with those who you know are at most risk of a fall.
I recently had an enquiry by email which brought home to me the advantages that we have in this day and age because the patient included some photographs of his condition.
It also illustrated the importance of making regular inspections of your feet which are a frequently neglected extremity of our bodies.
His story went like this: "Until recently, toenail number 2 used to look like number 4, i.e. a bit of white at the base of the nail that I put down to left over soap from the shower when I glanced at it from a great height.
(Click the photos to Enlarge)
When the edge of the nail is pressed back from the front edge it appears that the nail is cracked across about half way down the length as though it has had an impact. As a result it curves down from mid point towards the front. I don't have any shoe problems that might cause this so if an impact rather than constant pressure has caused this then I was unaware of it. (or maybe aware at the time but not of the ongoing effect.)
Left foot is normal."
From the written description it might be difficult to understand what might be happening. But the inclusion of the photographs (not difficult in this age of digital cameras) made the diagnosis much easier.
The description and the appearance is typical of Onychomycosis = fungal infection.
The 4th toe shows the typical crumbly? yellow, patchy discolouration the 2nd is a classic presentation.
An alternative diagnosis is psoriasis; with this, developments like you describe are more associated with stress; however,normally there is a history of the underlying condition (psoriasis), which I don't think you have.
Mycoses or fungal infections are usually picked up from communal shower facilities – gyms, change rooms, boarding school – they develop in a warm, moist environment -closed shoes, stockings, central heating, high humidity in summer.
They are contagious and spread easily when the growth conditions are optimal. (Like mushrooms).
Simplest treatment: Tea Tree Tincture or Oil twice daily.
Use an emery board to GENTLY abraid the nail, this creates a rough surface, then drip on the solution and wipe away the excess. Does not matter if solution gets onto the surrounding skin.
Commonly prescribed treatment: topical anti-fungal agents, some of which are over the counter. Or prescription oral agents if there is multiple toe involvement.
Warning: watch out for any rash in your groin or the soles of your feet. That indicates surface Tinea i.e. fungal infection.
Just be patient and observant for more toes getting it.
In an otherwise healthy person the development of this fungal infection of Onychomycosis is easily passed over as happened in this case until it had a good hold. So keep a careful eye on your extremities.
- Image via Wikipedia
Chilblains are associated with cold winter conditions, often worsened by wet weather.
So as I go off to the Cape for a few days I'll give you some suggestions to protect against 'winter feet'.
Chilblains affect all age groups and both sexes, but girls and women do seem to suffer more.
Keep your feet warm and dry. Avoid socks with synthetic fibres, that can make your feet sweaty and cold.
Some modern fibres 'wick away' sweat, but you can get cold. Try a pair of mohair socks – Visit the Cape Mohair website.
If you are sitting for some time, try wrapping your legs in a loose-fitting blanket(think of the bottom of a sleeping bag).
Do wriggling and waggling exercises to keep the circulation moving in your leg muscles. Don't sit for long periods, because if you have a sluggish circulation it makes it worse.
STOP SMOKING! The spasm or constriction of your blood arteries from ONE cigarette lasts 6 hours.
Take regular walks in well-fitting shoes. Tight shoes press the blood out of your toes. Thicker sole are important to protect your feet from the cold and wet. Boots are good but high fashion ones often don't keep your feet warm.
Chilblains are the result of a defective response to a cold stimulus. For example: when you take the chicken out of the deep freeze, the nerves in your fingers send and receive a message which causes the nerves to the blood vessels to shut down to protect the fingers from the cold.
When you have the chicken out on the kitchen worktop and you are back in the normal temperature the reverse messages happens, and you get a bit of a tingling feeling as the blood flow returns to normal.
If this system has a delayed response – for whatever reason – the fingers remain cold, because the blood is lacking oxygen. Soon the body recognises this as abnormal and tries to fix it with an inflammatory response.
This can settle things with just a little swelling and pain in the fingers, but usually this process ends up with red, painful, swollen fingers, which look like cocktail sausages.
In some cases, this process is the result of a significant vascular disease, for example – Raynauds Syndrome(or Phenomenon). If you suffer from this you will know and should be havinr treatment – it is characterised by spontaneous spasm of the blood vessels of the hands – where you get an unexpected cold finger or fingers, at any time of year, but especially in winter.
Treatment for chilblains is difficult and usually centres around prevention. Shoes, socks and footwear as I have said.
There are some medicines prescribed by doctors called Vaso-dilators, but often topical preparations such as Thrombophob or Reparil Gel are tried.
Some Homeopathic preparations include Vitamin A and Nicotinic Acid which act as circulatory stimulants. Getting into a warm bed helps – but don't sleep with your feet up against a hot water bottle!
As I write this in Hout Bay, I'm happy to report that it has been a beautiful sunny and dry day.
Take care of your pair. No more smoking. Regular exercise. Keep chilblains away this winter.
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