Sweaty Feet
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: A Word on Medical Matters: Feet & Podiatry
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
Rheumatology Updates:Fame At Last – An Ego Polished – Silence Broken
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”.
Podiatry and the Child with Arthritis
In podiatry, for the child with arthritis, we find that foot problems are not necessarily caused by the arthritis alone. Before the disease is correctly diagnosed, swelling, pain and lack of mobility are the main signs and symptoms. This usually affects the hands, knees, feet and ankles. Malfunctions of the foot, ankle and leg as a result of painful joints usually respond to medication. However, many structural problems [what podiatrists call biomechanical anomalies] remain, because they were present before the arthritis developed.
I have found that podiatric intervention is necessary and effective during the painful stages at the start of medication and after the disease has gone into remission following medication. The intention is to balance or control foot function, thereby reducing the load on the painful foot joints. This counteracts the effects of these underlying anomalies and aims to protect the feet from long-term damage.
Even children without foot pain but with significant biomechanical anomalies are prescribed foot orthotics. This is at present only an opinion, but we are recording all interventions at our clinic in an attempt to collect some meaningful data.
However, often the initial treatment involves making sure that the footwear is a correct fit. Many children that I see choose to wear soft slippers because their feet are painful and school shoes hurt. Slippers make matters worse as they give neither support or protection to the feet. Fortunately we can request that these children be allowed to wear trainers and so far teachers have been co-operative. For the really poor patients we actually buy an appropriate trainer.
The use of foot orthotics always stimulates debate. There is published research to show the benefits of prescription foot orthotics for adults with rheumatoid arthritis, but to date evidence for children is scarce. By using foot orthotics for all children with biomechanical anomalies with or without pain, we hope to prevent them from developing serious foot function problems as adults.
In some cases, we start by using a very basic treatment of figure 8 crepe bandage to support painful ankle joints. This can be easily taught to family members and starts to get the family involved in treatment – especially when they experience a reduction in pain and improved foot function.
I read in the June 2008 edition of PodiatryNow (the monthly Journal of the Society of Chiropodists and Podiatrists, in the UK), that “a 3-year trial is to commence aimed at reducing pain, stiffness and deformity in the feet of up to 60 children and young people.” The study is a cooperation between academic podiatrists from Glasgow Caledonian University, the Royal Hospital for Sick Children in Yorkhill and the Centre for Rheumatic Diseases at the University of Glasgow.
They have been awarded nearly 90,000 British Pounds, about 1.3 million SA Rands. Is there anybody reading this who would like to fund similar research at our clinic at Chris Hani Baragwanath Hospital in Soweto? (Subject to all the necessary protocols)!!
This type of research will enable us to be much more accurate in our interventions for foot problems in the child with arthritis.
Arthritis Affects Children’s Feet
J.I.A. or juvenile idiopathic arthritis is just one of the manifestations of arthritis in children. Just like adults children get pain, stiffness in the morning that can last for some hours, restricted movement of their joints, swelling of their hands and feet. In other words serious incapacity. Unlike the adult form where we see a pattern of rheumatoid arthritis starting to affect women mainly around the age of 40, in children it can happen anytime.
Awareness is the key for both parents and health care professionals. I have been seeing children with local areas of tenderness or pain under the heels, or at the back of them. Pain along the soles of the feet. Ankles that are painful all the time either when moving or resting. Showing reluctance to run around because of the pain. Complaining of swollen and painful toes. Not wanting to wear their school shoes because they hurt. There are many other signs and symptoms that usually the doctor will identify.
Some of my patients are so badly affected by arthritis that they are only able to wear soft slippers to school. Fortunately a donor has offered to provide appropriate soft but firm footwear for them. Some children are completely pain free thanks to the medication that has been prescribed, but they have structural foot problems and so need some form of support – usually with an orthotic – but often just a decent shoe and some advice is enough.
The secret of success in managing these children is teamwork, and I am lucky to be part of the paediatric rheumatology team at Chris Hani Baragwanath Hospital. The specialist doctors are able to prescribe the appropriate medication which frequently brings relief to the painful joints and removes symptoms.
Don’t ignore the child with a painful foot. It probably isn’t arthritis, but it might be.
Dialysis and the Diabetic Foot
The diabetic foot is often associated with patients who are on dialysis for kidney failure as a result of their diabetes. There is a well known ‘triad’ of eyes/kidneys/feet. What health professionals call retinopathy/nephropathy/neuropathy.
We are managing a gentleman who is suffering the effects of many years of poorly-controlled diabetes, acompanied by smoking. The effect of this has been serious damage to the circulation to his legs. As a result, he has needed arterial bypass surgery and now, three times a week he comes to the hospital for dialysis, because his kidneys are malfunctioning,so his specialist asked us to look after his feet.
On first view we got a real shock – the three outer toes on his right foot were dry, shrivelled and black – typical of dry gangrene. These toes will probably fall off by themselves! The back if the left heel is one large blood blister, fortunately it’s dry and not infected.
The principle of managing cases like this is to keep the areas clean and dry. For the patient they have to do their best to control their blood sugar. The targets for good blood sugar control for a person with diabetes are between 5.5 and 7.0 mmol/litre, so you can imagine my concern at the last visit when I found out that this gentleman was running 15mmol/litre.
Every time the dressings are changed there is the opportunity for bacterial infection and high blood sugar usually worsens the situation. Of course the state of the feet and limbs in an obvious potential cause for the raised blood sugar too.
So what’s the lesson? Mismanage diabetes at your peril! Damage to the nerves and circulation will have a major impact on your life the longer you live. The complications of diabetes are largely preventable, yet vast amounts of money are spent worldwide on managing the complications of diabetes.
Control of blood sugar and not smoking will protect both arteries and nerves from serious damage. Nephropathy or damage to kidneys is life threatening and not everybody can access a dialysis unit. Loss of sensation or neuropathy, where there is no sensation in the feet, allows for injuries to happen without the person noticing.
Don’t become a victim of circumstance – take control of your diabetes now – and avoid dialysis later.
More Foot Pain For South African School Children?
Thousands of South African children go back to school tomorrow. How many with foot pain?
We don’t know the facts, because the research hasn’t been done. But as children grow, so do their feet. So it’s a safe bet that many feet will be pushed into shoes that were bought at the beginning of the school year in January and are too small 6 months later in July.
On the other hand there will be some children who will suffer the discomfort of a brand new pair of school shoes! It’s not true that shoes have to be “worn in.” They should fit properly and be comfortabl from the start.
Most children wont tell their parents that their shoes are too small, because the soft, developing bones can be easily squeezed and squashed into position. In addition, in the current economic climate, the cost of a new pair of school shoes often has to be balanced against food, rent or travel expenses.
Try to look at your children’s shoes as soon as possible after the start of the term. They have probably complained about having to wear them anyway – having not worn them for a month. Get them to stand up in their school socks and you press gently on the end of each shoe to find the ends of the toes. If there isn’t a finger space at the end, they are too short.
Don’t try the other method of pushing a finger down the back of the foot behind the heel. The shoes should fit around the heels and allow the feet to lie nicely in their normal position. Check also for uneven wear on either side of the shoes – this shows flattening or ‘out-turning’. If the shoes are deforming you should get to see a podiatrist for a check up.
A final word on hockey, rugby and soccer boots. If your child complains that the soles of the feet are sore, have a look for red marks over the areas where the studs are. You probably need to put a soft cushion insole inside to limit stud pressure.
Can’t wait for the next school holidays!
More Diabetic Foot Disasters
Two more diabetic foot disasters arrived in the practice and at my Hospital clinic this weekend. Another hot water bottle burn, plus a corn paste induced abscess.
Loss of sensation and lack of foot health education contributed to the elderly lady with Type 2 diabetes burning her left little toe and the lower part of her calf, plus blistering her right big toe. The lower calf is about 2mm deep and the blisters were still covering intact skin.
If you are in any way involved with people with diabetes this winter please warn them of the dangers of hot water bottles, heating pads etc. Remind them of the tips I put out recently for winter foot care.
When diabetes causes loss of sensation in the lower leg then putting hot objects like hot water bottles next to the skin can lead to serious damage.
Medicated corn plasters and pastes have been around for years and are usually used by desperate people who don’t know that a podiatrist can give them relief from their painful corns and calluses.
Sadly my patient is also a Type 2 diabetic, but without complications and therefore was in great pain.
I drained the abscess, applied appropriate dressings and prescribed antibiotics. This lady is booked off work for 3 days plus the weekend and I will see her again on Thursday.
That’s a big penalty in lost working time for a lady who was simply trying to take care of her feet but did not understand the value of taking professional advice until it was too late.
So who is to blame for these disasters? If the patients concerned didn’t know, then I am for not getting the good foot health message across to enough people. On the other hand the patients did know who to come to for help.
SA Men “Push and Bhobhoza” their feet
Men usually escape the painful feet we associate with poorly-fitting shoes. Surely it’s women who are wearing high heels and sharply pointed toes. They were doing it when I was at varsity. However I was amused by an article by Thando Pato entitled ” Men in sharp shoes miss the point” in the Sunday Times Lifestyle section on May 18th.
I checked with my associate Tshidi and sure enough “P&Bs” as they are known, are a real fashion item. Especially amongst black men. Ms Phato expresses her concerns about the growing number of South African men in all situations wearing shoes “so long and pointy that they look like spears.” (The word ‘bhoboza’ means to pierce in Zulu).
She also expresses a concern that I often use as a humour line in foot health talks – that shoes for women are designed by “cruel European men who claim to love women”. The message from Thando Pato is a great – not only are these shoes sold in garish colours, apparently white is cool – but she is also “traumatised” by the damage inflicted on the wearer’s feet.
She uses a great expression to describe corns, bunions, calluses and a host of other foot deformities that we traditionally associate with women; “Hammer Time”. I think this should become part of podiatry terminology. Her description of the pain experienced by one guy she sees is really funny. Thando Pato you must have been a podiatrist in a former life!
If you want to study the effect of high heels on how you walk, get along to the Victory Theatre in Johannesburg and take in The Rocky Horror Show. We went last night and it was a great show. Obviously I went for the anatomical study!
By the way the references for Angiosomes are: Taylor 1991. Plastic & Reconstructive Surgery.102.599. There is a fully illustrated article in Plastic & Reconstructive Surgery. 2006.117. 261-293.
I know these are not 100% accurate but that’s what I wrote down at the congress, so put on your best Google and see what you get!
A Fresh Start At The Practice?
Fresh from the long weekend we welcome Ms Lauretta Zikalala to our podiatry practice. Lauretta is our new receptionist and will be the voice of the practice from today. Back at the practice today, (not exactly fresh!) after a tiring but stimulating weekend at the Diabetic Foot Working Group (DFWG) Congress. Armed with some new knowledge and revision of existing, Tshidi and I feel that we have more to offer our patients with diabetes.
We know that Podiatry and diabetes is not just about managing the serious complications such as foot ulcers. The key issue is the prevention of this complication and research shows that multidisciplinary interventions can reduce both ulcers and amputations. There is a major challenge in South African health care to educate everybody involved in diabetes about the need for proper foot health care.
Just to get patients and professionals to look at feet could prevent many complications. So many patients do not feel pain and are therefore misled into thinking that there is nothing wrong with their feet. Meanwhile they develop blisters from footwear, ulcers from objects like drawing pins, stones and other foreign bodies and burns and scalds from heaters or hot water. It is clear that we will have to develop innovative and cost effective interventions to reduce the numbers of amputations and to improve foot health awareness in South Africa.
For any health professionals reading this; do you know what an angiosome is? I’ll publish some references tomorrow. (I think you will be amazed). For the lay person, angiosomes allow vascular specialists and podiatrists, in the context of patient examination, to accurately assess the quality of blood flow to every part of the lower limbs and feet. This enables really accurate identification of those areas at risk due to inadequate blood supply. Most of us are familiar with the dermatomes which map out the nerve supply, but angisomes are something new. (Well they are to me!).