Foot Fit for Voting?
Are you ‘foot fit’ for voting? On Wednesday of this week South Africans go to the polls to elect a new government. Foot fitness could be important since the process can involve many hours of extra standing or walking.
Here are a few tips to help you through the day!
Try to get a lift to the polling station – this reduces the walking you have to do.
Take a folding chair or sit on the ground if your feet start to ache.
Wear comfortable shoes with thicker soles – trainers or lace ups are best, because they can be loosened if your feet and ankles start to swell.
Don’t stand in one position for too long – move from foot to foot, wriggle your ankles up and down to keep the circulation going.
Bend gently from the knees up and down a few times.
If you have diabetes and reduced sensation take extra care that you don’t rub a blister from your shoes.
Start talking to the people around you – it helps to pass the time!
(Try to avoid talking politics!).
Have something to eat before you go to vote. (Voting on an empty stomach is as risky as shopping on an empty stomach!).
Sometime it’s a good idea to go later to the polling station, since everyone wants to get there early!
Above all do vote. Remember that it is a Public Holiday, so rush home and put your feet up.
Traction Apophysitis – progress report
I have just seen the 8 year old child with Traction Apophysitis featured in previous posts. Since January 26, when I first saw him, he has followed a strict programme of reduced activity.
He has been fantastic in wearing trainers at school – remember that all the other children are barefoot – and severely limiting or stopping any activity that caused pain. Although, about a month ago we did let him start swinging a golf club at the driving range!
His mother reports that he no longer sits on the side of the bed in the morning rubbing his painful feet. Has no pain after school, even though he has recently started playing some soccer at break time and he is completely pain-free.
Today’s X-rays show a normal appearance of the calcaneal epiphysis (the growth area/point at the back of the heel), and improved bone density.
The plan now is to slowly start activity again and that will be rugby.(He plays barefoot). The trainers must still be worn as often as possible. Follow up will be in 6 months.
The diagnosis of Traction Apophysitis is usually based on the presenting clinical symptoms, as the X-ray findings are often inconclusive. Nevertheless we must never ignore the younger child with painful heels and always consider Traction Apophysitis.
Management is clearly “rest”, by reducing or avoiding those activities that cause pain. A supportive but soft/cushioning trainer is the best footwear. There is a place for short term anti-inflammatories followed preferably by topical gels and plasters.
Whatever we try, there is always the question of ‘what would have happened if we had done nothing?” I believe that that decision can only be made with the individual patient in front of you, so that you can respond with clinical judgement and personal empathy. However there is no doubt that for many children it is a transient condition.
My apologies for not getting the case history on the site as promised.
THE COMPLETE CASE HISTORY WILL BE ON THE WEBSITE SOON.
Foot Pain & Posterior Tibial Tendon Rupture
Never ignore foot pain. A recent case of tibialis posterior tendon rupture is a case in point.
A 76 year old lady was brought to me by her daughter because she could barely walk and was in constant pain. She had been prescribed anti-inflammatories and sleeping tablets for ‘the arthritis.’
At her only previous visit to me in 2003, I had diagnosd the potential for flat foot related problems and made orthotics. The lady never kept any follow up appointments.
This time, the lady described her symptoms as “the left foot is giving me hell. Over the past year, it’s been getting gradually worse and now I can’t wear my shoes.”
When I asked about the previous treatment, she informed me that she gave up with orthotics because they didn’t fit easily into her shoes.
When I examined the foot, it was completely flat and rolled over and the arch was non-existent. The lady was unable to stand for more than a few seconds and she couldn’t manage more than two steps across the room. In addition she was unable to raise up onto tiptoe.
As I traced a path along the inside of the foot up behind her ankle to the lower part of her calf she experienced significant pain. This is the path of the Posterior Tibial Tendon, the main tendon to help form and hold the arch of the foot.
Posterior Tibial Tendon
I immediately sent the lady for X-rays and an Ultrasound scan. The scan revealed a rupture of the Posterior Tibial Tendon.
Referral for surgery has been completed and now we wait for the outcome, except that she has developed a problem with her eyes that needs treating before any surgery can take place.
The moral of this story? Follow up is vital from both sides of the medical equation. Ignoring foot pain can have serious consequences, so managing it is a team effort.
READ THE FULL CASE HISTORY IN [Case Histories->]
A Word On Medical Matters – Talk Radio 702
I’ll be back again as a guest expert on Talk Radio 702 & 567 Cape Talk on Tuesday Feb 17.
The programme is called ‘A Word on Medical Matters’ anchored by Leigh Bennie with host Prof. Harry Seftel and is broadcast starting from 19.00 -20.30.
It’s a live phone-in, plus replies to text massages and emails so this is your opportunity to get the latest current advice if you have any pressing problems.
Traction Apophysitis-feedback
Here’s some feedback on the boy with the traction apophysitis. Did you think the overuse was extreme? What did you think of the training routine?
Firstly, he has wonderful parents! They have followed my advice to wear shoes and avoid all activities that cause stretching of the Achilles tendon. Secondly,they have been surfing the Internet to find out more about the condition. They showed the youngster pictures and explained the reasons why he has to take it easy. This means that he understands that time spent recovering now will enable him to participate again when the condition settles. Thirdly, they have stopped all sport at school.
Fourthly and this is the best bit. His father tells me that he asked his son to rate the pain. If the pain was rated as a 10 when he saw the podiatrist what is the rating today? About 2 or 3 says the boy.
In our sports mad country its refreshing to get such team work going.
At this stage it is imposible to say how long healing will take, but the initial response of the foot to simple rest and supportive footwear is encouraging. Rehabilitation will be very important; in the form of stretching very carefully, accompanied by orthotics or simple insoles.
Traction apophysitis does heal and all the better it seems with lots of TLC (Tender Loving Care).
Keep looking for the full case history – its nearly finished
P.S. Tune in to Talk Radio 702 17 February 19.00
A Sports Injury or Child Abuse?
How much sport is enough for a child? When does too much sport become abuse? Is an over-use injury at a young age, in the pursuit of excellence worth the possible long-term consequences? Consider this:
Last week, an 8 year old boy, barely able to walk, was brought to see me by his mother. He had a severe limp, walking with his foot out and his ankle stiff, to reduce the pain. Three days previously he had spent nearly 5 hours doing athletics at school. His mother told me that the initial pain began more than 6 months ago, after he had played a lot of rugby.
The school under 8 team had been very successful, winning their area age group, so had a long season. Then he moved up an age group to under 9 which extended the season further. Nevertheless he continued with all sports, despite the pain and the fact that he was not running as fast as before. A compounding factor is that athletics and rugby are both done barefoot.
The timetable of sports reads like that of a professional adult, with daily practice depending on the sport and season, with inevitable overlap; plus the fact that the school plays some sports out of season as well.
- Athletics: 1 hour a day, x 5 days, plus meetings
- Cricket: 1 & half hours a day x 5 days, plus club games on Saturdays for a university club junior side
- Rugby: 1 hour a day x 5 days, plus matches
The boy is obviously very good at his sports and according to his mother is always active at home whilst playing. However, this timetable with an injury would cripple most adults.
So what’s the point? How far must we/should we push or allow our children in pursuit of sporting excellence? We try to teach balance in most aspects of life, sleep, study, money etc., but when it comes to sport we seem to make up the rules as we go along.
After requesting X-rays of both feet and discussing them and my diagnosis with two different medical colleagues, it was agreed that the cause of the pain is damage to the growing part of the back of the heel bone, where the Achilles tendon inserts. Clinically called a Traction Apophysitis.
The initial treatment is rest and avoiding any vigorous activity that causes the Achilles tendon to pull on the heel bone. Raising the heel or possibly orthotics may help.
So ask yourself the question – is this youngster suffering an over-use injury or child abuse or both?
A full Case History will be posted during this week.
Sesamoid Fracture – A Holiday Injury
Best wishes for 2009. The first holiday injury came this week. Another sesamoid fracture . A 38 year old male patient returned to the practice for follow up to a visit in December, due to have impressions made for new orthotics.
He told me that on Christmas Eve he had slipped and fallen into a swimming pool with his leg fully extended – ‘straight out in front and under me’. The leg had hit the bottom of the pool with the ball of his foot, jarring it severely.
Over the next few days he experienced varying degrees of severe pain, best relieved with wearing thicker soled shoes. However, with the weight off the foot there was a constant throbbing.
Remembering the young lady I wrote about about towards the end of last year, I sent for X-rays. Result a fracture shows clearly in one of the sesamoids.
Treatment? Take it easy. No excessive activity – but cycling in the gym is OK. Thick and soft soled shoes – probably sneakers. Be patient!
Sesamoid fractures should always be suspected with a history of sudden stamping under the foot. They usually heal well, but may take time.