Chilblains

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.

Ingrown Toe Nails

More people are complaining about their ingrown toe nails as winter comes and closed shoes are being worn more.

The most common cause of  an ingrown toe nail is poor self-treatment, but  there are numerous other factors, divided into intrinsic and extrinsic.

Common intrinsic(internal) factors are the basic shape of the nail – especially at the edges – we all have different curvatures and angles and some nails have increased curvature  on one side only.

Another factor is the structure and function of the foot (the biomechanics). If a flexible foot rolls or flattens excessively toes can rub against each other, causing pressure. Other factors can be sweaty feet and thin skin, caused by age, medication or circulation.

However, it is the extrinsic factors that really produce the problems – poor self-cutting and shoe pressure top the list. (Sometimes even health care professionals and therapists can cause ingrowns!),  tight socks and injuries can also be added to this list.

In the clinic, the appearance of  ingrown toe nails varies from a small pink swelling, to an inflamed growth or ‘proud flesh’, like a small cherry, lying over the nail plate. The pain seems to depend on the individual’s pain threshold more than the condition itself.

The offending nail can be just a small ‘shoulder’, pressing into the sulcus or a sharp spike of nail which penetrates the skin. The skin tries to heal itself when a spike penetrates it and that process leads to the formation of ‘proud flesh’ or hypergranulation tissue. Of course if the toe becomes infected then pus is also present.

Treatment for ingrown toenails varies with the cause and duration. The simplest treatment is correctly cutting out the offending portion of nail. In the more painful and complicated cases this is done under a local anaesthetic.

The permanent solution under local involves an operative procedure where the complete side of the nail including the matrix, is cut out and the matrix space is destroyed with a strong caustic. After about a month the side where the nail was looks normal – the cavity heals completely. This is a procedure that podiatrists do very well as an outpatient procedure.

Obviously avoiding  ingrown nails is the best, but nobody should suffer with them when skilled podiatric care is available.