Monthly Archives: December 2007

You And Your Feet

I’ve just come across an article I wrote a while ago for the South African Journal of Natural Medicine and thought it might be useful as a reminder as we embark on another year.

We need to take care of our lives, our relationships and our bodies as we renew our efforts in the New Year – and that includes our feet. 

Take a look now at You and Your Feet

Are Bunions The Bane of Your Life?

Bunions are among the most common and frequently most painful of conditions affecting the foot.

Remembering that your feet carry ALL of your weight ALL of the time that you are standing or walking then it is not surprising that the complex structure of your feet sometimes suffers re-alignment as they strive to accommodate our lives and activities.  Sometimes we do not help matters by forcing our feet into unsuitable or badly fitting shoes.

Go to the Foot Health Articles section for some useful advice on bunions.

Foot Blisters Spoiling Your Holiday?

Foot blisters are one of the most painful conditions imaginable. Blisters are also one of the most common foot problems that people experience. A blister is the result of the separation of the superficial layers of the skin. This creates a space which gets filled with fluid. Depending on the pressure applied to the area this fluid is either blood or clear ‘water’. (We call this water serous fluid).

I’ve just written up some advice for blister sufferers in the Articles section that I hope will help.

Happy (and blisterless) Holidays!

Foot Care For The Elderly-Podogeriatrics

For podiatrists, podogeriatrics – care of the feet of the elderly – is a daily cause for concern, for a variety of reasons. I know that it is a part of our professional work that is often not looked at with much enthusiasm. There are more "old" people around because we are living longer. The foot care required by the older person is usually considered ‘routine.’ There are often financial considerations, due to lack of funds.

However, in a seminal piece of research published by the Disabled Living Foundation (UK) in 1983, is was found that the elderly (people of pensionable age), were occupying 85.9% of the National Health Service (NHS) podiatrists’ clinical time. There have been many changes in NHS policy and the provision of foot care since then and also to the way podiatry is practised in the UK, but one wonders just how we are doing in South Africa.

I would guess that the majority of our elderly people don’t have access to adequate foot care from a podiatrist. This is largely due to the inbalances in the structure of health care in the country, where the majority of the older people only have access to State care not private. Hence the proliferation of other "foot carers" such as nurses, health care assistants,beauty therapists and others, all of whom have responded to specific needs.

Getting older should not be a punishment for living longer and I believe there exists a desperate need for quality foot care for the older person. Podogeriatrics is not and should not be a case of regular cutting a filing of nails plus some callus reduction, carried out in quick time for a small fee.

Today I was visited by a few "oldies". Mary has just retired from a lifetime of teaching and came complaining about her painful left foot, where she was concerned that "there is a small piece of a fixation pin poking out under my foot, because there is a sharp pain in the callus and my surgeon told me after he had removed the pin originally, that there was still a piece that he could not get out".

By carrying out a simple biomechanical examination of Mary’s feet, I was able to analyse the possible source of the problem and treatment included reducing the painful callus and at the point of greatest pressure, enucleating the corn and recommending appropriate non-adhesive padding. In the long-term a simple cushion insole will probably be necessary.

80 year-old Harry also visited me for the first time asking if I could help him with his increasingly painful left foot and salvage his old but comfortable sandals. Again a careful, but simple, assessment of the structure and function of Harry’s feet (Biomechanical assessment), led to me inserting a pair of preformed moulded insoles (orthotics), into his shoes. To further improve function I added a piece of felt at a strategic spot under the insole – an immediate sense of support and noticeable improvement of foot alignment.

The advice for the sandals was to take then to a local African kerbside shoe repairer with instructions to replace the soles appropriately.  The lesson here is that podiatric care can be a major benefit to the elderly and that it extends far beyond simple nail cutting. (Although that IS all that is required).

Nevertheless, I don’t want to spend all my days cutting and filing toe nails!! What I do enjoy is seeing results of simple care plans. What we need in South Africa is evidence of the real and perceived need for foot care amongst this age group. Then we can lobby Government for improvements in the provision of podiatry services for the elderly nationwide for all our people. 

Hot Foot Out Of Johannesburg?

A long weekend – the wonderful South African tradition of ducking off work to celebrate something – this time it’s very important -RECONCILIATION- we will all go shopping on Monday!

At last the weather is behaving like summer, although today felt more like a humid Durban day. Lovely day today, half a day’s consulting then off for a long lunch at Johannesburg Country Club, with my receptionist Pearl and our former doctor neighbour and his receptionist, plus friends. (He’s the member, not me). A moment of travel into gracious living as we dined under the oaks! (How awfully English). We are also enjoyingOf course today also marks the beginning of that great South African tradition – "the Builders’  Holidays" – also known as SA shuts down for a month! Rather like Paris in August.Johannesburg is empty, most restaurants close and you can’t get anybody to do anything but chill.Those of us who remain here have the roads to ourselves and gloat when we go away in February when everybody else is back at work.

Of course this holiday time means not only ‘hot foot out of Johannesburg’, but also hot feet in general as people get into the mountains, by the sea, into the desert or whatever. Hot sweaty feet are quite normal, but they need a good wash at the end of the day. If you are hiking you probably know how to protect your feet, but keep your socks clean and dry as often as possible. During overnight stops or long rest periods give you feet lots of air & sunshine and dry between the toes. Watch out for hot beach feet with sand getting inside your trainers or sandals, again always wash off’ "the sand of the day" and dry carefully.

One danger of hot beach feet is the banana palm thorn, sea anenome spike and assorted puncture wounds from hidden glass and metal. Remove the foreign body flush with clean water and get medical help quickly, this will reduce the risk of tetanus and infection. At the same time, hot wet feet need particular care because they look like shrivelled spaghetti if you don’t wash, dry and air them. Always avoid wearing nylon and occlusive materials for long periods to avoid this. Finally, that cool hotel may give you a fungal infection so watch your feet for a few weeks after returning home. ENJOY YOUR HOLIDAY AND BRING YOUR FOOT PROBLEMS BACK TO A PODIATRIST IN 2008!

To continue the saga of the back – it is very much better and I am sticking to the exercises and have taken fewer anti-inflammatories today. I must give credit to my outstanding physio – Judy. I’m beginning to realise that the physiotherapy profession is also often misunderstood & underutilised, but what they have achieved is a large volume of post-graduate research which gfives credibility to their treatments.

How about this for an "only in South Africa" story. A patient of mine was at a recent big horse racing event in Johannesburg and since she has difficulty walking long distances used her wheelchair to get down to the parade ring to see her horse. Having got out of the wheelchair to meet & greet etc., she turned round to get back into it to return to her seat. Yes, you guessed it! The wheelchair had been stolen. She tells me that the replacement wheelchair is painted in her racing colours, which include a nice bright yellow.

Have a great weekend

South Africa’s New Podiatry Graduates

Today I managed to survive my day in the practice, but I am amazed at the number of times that I had to twist and turn my back just to perform my daily tasks. But it was good to remember to turn my whole body, use the full support of my chair plus the variety of positions available in the patients’ treatment couch. I am definitely going to look after my back from now on.

Hopefully the 10 new podiatry graduates of the University of Johannesburg will do the same as they commence their careers. This afternoon I attended the ceremony at the University where the newly graduated podiatrists swore the Hippocratic Oath as recognition of the completion of their studies and the commencement of their careers.

This is the first time that this has been done in South Africa and although a small event it was a very significant moment for the graduates and I believe the podiatry profession in South Africa. In the academic field this has been a bad year for podiatry and the University of Johannesburg is engaged in revitalising the BTech Degree with new staff and renewed enthusiasm for 2008.( Some might say desperation as I have been accepted as a part-time lecturer for 2008!).

Goodness knows where these new colleagues will find work, but some of them have bursary commitments, so the State will have to place them somewhere. It really is a disgrace that there is such neglect by the State in recognising the role and status of the podiatrist as a member of the health team. In some regions there are good posts while in others they don’t even know what a podiatrist is.This means that most graduates are forced into private practice immediately, an expensive option that is not usually possible for them, so they end up working part-time in shoe shops, for other podiatrists, emigrating or even leaving the profession.

The podiatrist doesn’t feature much in some South African cultures, so it is up to the profession to become much more visible (dare I say aggressive in marketting itself to the public).  The role in the management of chronic disease is quite well established, as it is in sports. But there is a massive and unmet need in Occupational Health for example. How many people are suffering foot discomfort that distracts them from efficiently operating machinery or standing and walking in their safety footwear?

The solution lies with the podiatrists themselves – we must research and then write and publish our findings for scientific scrutiny. Discussion amongst the podiatrists will also give birth to more evedence based practice as well as best practice based on experience.

Certainly my hope is that these new graduates will find a meaningful place in the South African health community and be – proudly podiatrists!

Low Back Pain And Your Feet

What’s the connection? Personally I have just had 5 days of hell and bed rest, interspersed with sessions at the physiotherapist, to help with my back that I injured moving a lightweight box last Thursday. Heavy boxes and furniture were no problem, but on Thursday I bent forward and sideways and damaged my right side sacro-iliac ligament pulling a small lightweight box out of the way. Bed rest, some exercises and Voltaren injections seem to have fixed it, so back to the practice tommorrow.

Walking upright is still difficult, but is much better in a supportive shoe. Apparently the muscle spasm was so bad that my pelvis was being pulled out of alignment. At last I have experience of why we all need to keep ‘Back Fit’ and not let those once rippling abs! hang over our pants. My abs never rippled (Look at rapper Usher for great abs!), but neither do they hang loose, but they are very weak compared to what my physio wants for the future. Walking in my new crocs is fine but I do feel my toes clawing, so barefoot around the house is OK, but my trainers give the best support. For work it will be a firm formal shoe as in the afternoon I am going to the 1st Annual Podiatric Awards Function at the University of Johannesburg.

So please watch out as you hitch your caravan/boat or children! to the car for the summer vacation. Feet well planted on the ground and turn fully to face whatever your are going to lift, with back straight and knees bent. Leaning over is best for pool or snooker, but watch out! Gait analysis and posture checks are what most podiatrists can provide and in conjunction with physiotherapeutic exercises are so important. Leg length imbalances are another contributing factor to back ‘stress’ as is overweight, so after the holidays pay your podiatris a visit to get your feet and body into good shape for 2008. 

Keep Moving!

Well we are installed so to speak. I treated the first patients at the new rooms this evening and then continued emptying boxes – where does all the "stuff" come from? At least it is a good reason to throw away some things, but what about keeping them -‘just in case?!"

Standing & moving makes you realise just how many muscles are needed to keep the body going all day, and what it takes to give you sore feet. At this holiday time remember that you are likely to do much more walking than usual, even if it is following family or your significant other around the shops! Aching soles could probably be a painful condition called plantar fasciitis, where the pain is in the heel and/or the arches of one or both feet. This will go away if you rest or start to wear Tekkies to give better support to your feet, but if you are on the coast with only your ‘Speedo’ and slip-slops you’re in for a tough time. Plantar fasciitis could also develop as a result of playing increased amounts of sports, so take it easy. Although walking barefoot on the beach is supposed to be therapeutic, watch out for the burning sensation you get due to friction of your soft city-slicker’s feet with the rough sand.[If you are in Zanzibar then no problem because the sand there is like icing sugar!]. Another source of irritation can be the thongs of your sandals between the big toe and second one, so choose your footwear carefully.

I hope you read the articles in The Star and The Weekender newspapers (Oct 26th and Nov 10-11 respectively)  quoting my colleague Dr. Bernhard Zipfel’s research into the benefits of going barefoot and the damage that wearing shoes appears to be doing. The full research paper was due for publication in the Novenber edition of the  journal The Foot. Have a look, what do you think? 

Best Foot Forward? We Have Moved!

No communication for 2 months is atrocious blogging form. I suddenly lost the ability to be creative or informative.Then we had World Cup Rugby – we all know who won that – then there was the news that my rooms were to be relocated at the beginning of November. Plus my inability to beat the technology that will publish a whole raft of foot health pages – look for those elsewhere – I’m still battling.

Now, it is a well known fact that on the ‘human stressometer’ moving house, marriage, divorce & having a baby enter your life, all register HIGH. So imagine how we feel in the practice as we only started to move about 4 hours ago! ( Yes, it is December). Hopefully tomorrow will see the boxes & equipment safely shifted and we can unpack easly. Also throw out accumulated clutter! Add to this Telkom’s helpful contribution of only connecting the phone again on 20 December!

Anyway the blow has been softened by the arrival of a free pair of Crocs!!! The label says Beach, Pearl White.They are really comfortable, but they do stink, (yes, I mean stink) of rubber, I wonder how long that will last? I am wearing them around the house with socks (very Touristy), I’ll try barefoot later.

Sadly, I am not the only podiatrist on the move. At least I am only going across the road, I know of young colleagues who are on their way to Canada and Australia and others who are finding it difficult to succeed in private practice in the current economic climate. 

 However a weekend in Hout Bay visiying my granddaughter will be the ideal antidote.