After months of searching I am very pleased to be able to inform all my Johannesburg patients that their files will be taken over by Louise Stirk, who practises in Woodmead. Louise has a wide range of fields of interest and they dovetail nicely with my own.
Contact Louise on 011 844 0400
Sadly the Wits Donald Gordon Medical Centre has not been able to offer even sessional rooms to any podiatrist, despite attempts by colleagues. Therefore, there is no longer any podiatry service available there.
For details of my current practice locations in Cape Town and Hout Bay please click here for my Contact page.
Walking in the Bush can be one of the joys of living in Africa. However, it does have its drawbacks apart from the animals you may encounter!
Last week a young man came in as an emergency, telling me that whilst walking in the bush, a thorn had gone into the inside of his left ankle. The thorn was removed completely and initially there was no pain, but about 4 hours later it was excruciating. The thorn was from a tree called in Afrikaans Kameeldoring, one of the Acacia species, certain of which are poisonous.
A local Doctor prescribed antibiotics for 10 days, but now, the foot was still very painful and only relieved by taking an anti-inflammatory every 8 hours.
Examining the site of entry(parallel to the ground and straight into the medial malleolus – that’s the lump on the inside of your ankle), – there was no inflammation, but lower down towards the arch there was some swelling and inflammation.
Standing on tip-toe was painful so initially thought of damage to the Tibialis Posterior Tendon. However, the pain was described as …”burning and running over the bridge(arch) of my foot.” As I palpated down the foot towards the sole, it was possible to create the pain, which also went “into the foot”.
A Sonar scan was ordered which showed some fluid collection around the tendon when compared to the right foot. No other pathologies were detected, such as a foreign body, thrombus, tendon tear etc.
So what is the provisional diagnosis? Possible trauma to the Tibial nerve. The diagnosis is based on the nature and site of the pain described, plus the fact that the Tibial nerve runs in the area where the thorn penetrated the foot. For the time being the treatment is local ice and continue with the anti-inflammatory.
World Diabetes Day takes place every November 14th. Diabetes is a serious chronic disease. It is estimated that 250 million people worldwide have diabetes (about 6% of the adult population between 20 -79 years). This number is expected to reach 380 million by 2025, (7.1% of the adult population)
Every 30 seconds a leg is lost to diabetes somewhere in the world!
Many diabetic foot ulcers and amputations can be prevented
Starting this week podiatrists nationwide will be promoting foot health awareness in various ways as their contribution to preventing the complications of Diabetes.
Check your local press for details of free screenings, talks, fun walks etc., often with Diabetes SA.
In our practice free screenings can be booked via Lauretta. 011 726 6363.
Nationwide contact the South African Podiatry Association; 011 7943297
Screening is a short observation of key signs to identify the risk level of your feet.
Not every person with diabetes is at risk, but some are and have no idea that they are.
If you know that you are at risk, the podiatrist will become a key person in your life.
Act now – your life might depend on it!
Take this opportunity to finf out your risk status.
Last week I was invited to the Headquarters of ESKOM our Electricity Supply Commission, to talk about footwear selection and the effects of high heels, amongst other things!
From the outset it was clear that ESKOM is very concerned about safety – we were briefed on where and how to get out of the venue should there be a ‘problem’ – before the talks began.
It seems that the greatest cause of occupational injuries at Eskom HQ is Slips, Trips & Falls, nothing to do with electricity at all! So they decided to do something about the problem by discussing it. There were two scientists from the National Institute for Occupational Health also presenting and they showed some of the scary activities that employees do in incorrect footwear. Like climbing ladders, wearing high heeled shoes on slippery floors, or wet floors.
Even with the current fashion for lower heeled shoes amongst women, there was a slipping incident at ESKOM recently.
Flooring was identified as a major cause of slips at work, but also there is the choice of inappropriate footwear as I pointed out previously. Amongst other causes are uneven floors, poor lighting.
Having a spare pair of shoes at work is one solution, so that when you have to go to meetings or interact with clients you can put on your more fashionable ones.
However, perhaps the most basic concept is to be aware of your surroundings. For example, how many of us have fallen on our backsides at sometime in our lives, when at the poolside? In other words look where you are going!
Responsibility for foot health safety rests with employee and employer.
The Health & Safety legislation is designed to protect everybody. Including the forklift driver who says he must wear tekkies instead of safety shoes, because the safety shoes hurt. Fine, but remember that if you get hurt, there is no compensation.
However, I do blame employers who budget for only the cheapest safety footwear, when being distracted by uncomfortable footwear could lead to an accident at work. There is a real need to look to buy the best safety footwear the company can afford. It’s people’s health after all.
On the other hand, the beautiful corporate HQ with imported tiled floors, may actually be an accident waiting to happen.
Paying attention to where you are walking and what you are doing is another important measure in preventing slips, trips & falls. What do I mean? The dreaded cellphone! Walking & talking can be just as dangerous as driving and talking.
We had a good discussion about high heels!
On my way through the campus I noticed a beautiful young woman tip-toeing along past a wet floor [it was well-marked by the cleaning staff with warning boards] on what I guess were 7cm high heels. Her strides were very short and she wobbled along to keep from slipping on the tiled floor.
As I’ve pointed out before, a high heel shortens your stride and reduces your ability to walk normally. Add to this a shiny floor and there is an accident waiting to happen.
In the ESKOM HQ and many others I’m sure, the floors are spotlessly clean and shiny. Usually tiled and very smooth. This means that there is little grip between the sole of your shoe and the floor. An ideal situation for a slip, trip or fall.
Foot Health and Safety at work is everyones business and responsiblity.
Walking is probably the easiest and cheapest form of exercise available to us. The 702 Walk the Talk takes place on 25 July and 50,000 entrants are expected to hit the streets of Johannesburg.
Podiatry students from the University of Johannesburg will be walking aswell as offering foot care advice and screening at their Caravan Clinic. Some podiatrists will also be joining them. Some to walk and others – like me – to talk!
There are many benefits of walking; improved circulation, increased energy, longer life, being happier and stronger bones, are just a few.
30 minutes a day and 3 times a week is recommended! Where to find the time? You may ask. Well it doesn’t have to be all at once. Just think about your day and see if you aren’t already doing some walking.
The important thing is – BRISK – not strolling to check out the neighbours new extension!
Brisk means just that and starts by moving around more quickly with everything you do. Start by taking the stairs when possible. Obviously it’s a bit silly to walk up 15 floors, but you can work up to it. I used to work in a building where I gradually worked up to 7 floors. When I was in there again recently, I could still do it, but slowly! I need to walk more.
Start slowly by putting in say 10 minutes [distance doesn’t matter] every day. Set targets and slowly increase. If you rush out and do 30 minutes or try to get kilometres in under a specific time, I look forward to treating you for shin splints, plantar fasciitis, blisters etc.
Become familiar with your normal speed and pace and maintain it. Sudden rushes and surges only increase the risk of injury.
Try to walk with someone. especially someone you can talk to. As you get better, one of the tests of improvement is being able to hold a converstaion with your walking partner.
You must wear a decent tekkie/trainer. After a few weeks if you do develop pains that won’t go away, look at whether the shoes are deforming in any way. That could suggest a biomechanical problem. Then you need to see a podiatrist for advice.
Sometimes, starting a walking programme reveals an underlying condition. Specifically there is a condition called intermittent claudication which is felt as a cramping or tightening of the muscles at the back of the lower leg. It occurs every time an afflicated person walks a specific distance at their regular pace OR when they walk up a slope or incline. The distance will vary with individual physical status, but it occurs regularly at the same distance.
Basically, what is happening is that the muscles are starved of oxygen because the arteries are hardened and narrowed – usually by cholesterol plaques. If this does happen, then beware, it could also be happening to another muscle your heart! Pay your doctor a visit for a check up.
So if you want to:
Start walking. No excuses! We’ve had a month sitting watching football.
Now fight the winter chills, improve your health and WALK.
Verrucae are caused by the human papilloma virus (HPV), which commonly infects the skin. It affects the lower layers of the skin and causes a change in the growth pattern of the skin which results in a small tumour. However, this tumour is BENIGN!
Traditionally, podiatrists were taught that verrucae affect the younger patient, but it is quite clear that they can affect any age group. I have recently treated a 70 yearold lady!
Warts occur on any part of your foot and even under the toe-nails. They also appear differently as they develop. Often starting as a small puncture mark they can develop to look like a cauliflower growing in the skin.
Plantar warts are the most common – that is on the sole of your foot – growing anywhere, including on weight-bearing areas, where they are really painful.
Diagnosis is a big problem, podiatrists believe that many hard corns are misdiagnosed as plantar warts – with resulting surgical excision – which is wrong and leaves painful scar tissue in many cases.
Recognising clinical appearance is very important and difficult. Although it starts as a small spot, later the skin striations are usually pushed aside in a wart. The growth looks like a cauliflower, with black dots in the middle. Often there is a group of them, not just a single growth. They can grow on any skin surface including the knees and hands. Pain like a pin- prick is common on pressing and also throbbing when the foot is lifted off the ground.
Treatment is variable! Some of us will freeze with Liquid Nitrogen. We also use Acids in pastes or solutions. Excision is the last resort (in my opinion), but electro-dessication under local anaesthetic does work. Although you have to get used to the smell of a bad braai whilst doing this treatment! The dead tissue always needs cutting off. This is not usually too painful.
Plantar warts are my worst nightmare and I tell my patients that I call them “reputation ruiners”, because they can take weeks to clear and often new ones grow during treatment. They also spread quickly in boarding school and some families – and sometimes they don’t!
That’s traditional treatment. If you don’t like the sound of it try some ‘home remedies’. Rubbing it with liver. Kissing a toad. Rubbing with various medicinal herbs (this works). Shouting at the moon, or finally, hoping that the Golden Lions rugby side wins one game in next years Super 14 competition!
So what to do
Over the past few weeks, I have seen an increasing number of patients of all ages complaining of Heel Pain – usually diagnosed as Plantar Fasciitis (PF).
The pain is usually persistent and occurs under the heel pad and around the heel. Often it only affects one foot, but after questioning and examination, they admit to “a bit of discomfort in the other foot.”
This extremely painful condition also called Plantar Fasciitis (PF), but strictly speaking PF causes pain into the arches and soles too, rather than just the heel.
In 1979, one of the founders of Podiatric Sports Medicine, Dr Steve Subnotnick, devoted an entire chapter to heel injuries, in his book Cures for Common Running Injuries. He was probably the original ‘running foot doctor’ when the surge in road running began to take off worldwide.
The pain is usually worse in the morning when taking the first few steps and then gets less with continued movement. This pattern is repeated if you sit for a while later in the day – say in a meeting, classroom, lecture or tea-break – and stand up to walk again.
Patients always point to the exact site of pain. This is right in the middle under the heel pad. On the inside (very common) or outside of the heel and at the back.
Overuse is the phrase we use to explain PF! It’s a bit like saying stress. The basic cause is the malfunctioning of the person’s foot and lower limb structure, what we call your Biomechanics. The normal -for you – rocking and rolling movements are exceeded and the tissues get strained and inflamed at the very point where the plantar fascia is attached to the heel bone.
This can be caused by too much exercise such as increasing your distance and not getting enough rest. Changing the surface you run on; for example: running on a treadmill, starting running without the correct preparation, suddenly running more quickly.
Another common cause as we get older is being overweight. Or a change of occupation where more walking or standing is required. Old worn shoes for day wear or exercise. Arthritis, a pinched nerve. All these and many more causes need to be identified.
With difficulty to be honest! You must let your podiatrist see a good selection of your shoes. Frequently we can provide relief from the symptoms by padding, taping and some anti-inflammatories.
The basis of treatment is the biomechanical assessment to identify what goes on as you walk/run. Orthotics may be necessary, but current therapy is team-based, so I might send you to a Physiotherapist or Biokineticist for strengthening of other muscle groups in your body.
We talk of core strengthening, to improve posture and alignment above the lower limb. If the pain is at the back of the heel gentle stretching plus raising the heeel helps. Nearly always lifting and cushioning the heel gives some relief. Wearing a higher heeled shoe also helps sometimes.
Yes, but not always. If you can diagnose the problem yourself then stop doing what caused the PF. We often get heel pain on holiday after a day of sightseeing or playing on the beach or more likely shopping!
Never let your trainers get badly worn, especially if they bulge on the inner side. Keep your weight under control. If you know you are going to have to do a lot of standing or walking, consider wearing your more comfortable shoes and change into your fashionable ones later.
At the first sign of pain seek professional help and advice – a proper biomechanical examnation will identify whether plantar fasciitis is the problem. Remember the basic First Aid of treating any inflammation of the soft tissues of your feet.
“Warning: toxic leather shoes sold here” This scary headline appeared on page 5 of today’s The Sunday Independent, over an article about the potential danger to the environment from the toxins/chemicals used in the tanning process of many of the leathers used to make our shoes.
Chrome tanning has been the method of choice for years now and the article describes a report from the Swedish Society for Nature Conservation and its partners, expressing their concern at their findings. The major concern is the amount of chromium the could spread to the wearer and into the environment. This, coupled with the various dyes used in tanning is the source of the society’s concern.
As a podiatrist, I occasionally see a patient with a skin rash that is clearly associated with the patient’s footwear. Called contact dermatitis, it shows as a clearly demarcated rash at all sites where the skin has been in direct contact with the shoe. It is frequently associated with leather sandals and it shows the patient’s skin is irritated by the chemicals in the leather. However, there are numerous other causes of contact dermatitis, as any Dermatologist will tell you.
For example, with the need to produce shoes at lower cost, synthetic materials are more widely used. This also brought its own problems of skin sensitivity, increased sweating and sometimes burning feet. Environmental experts frequently point out that Plastic is of course another blight on the environment.
From a foot health point of view, we recommend the use of natural materials, such as leather, because we believe it ‘breathes’, absorbs natural foot moisture (sweat) and is altogether more healthy. Unfortunately, all leather shoes are expensive and over time become dry and cracked due to the cycle of moisture and dryness associated with the normal foot. [which is on reason why leather is tanned in the first place].
So don’t panic, rather read the article and if possible the original report, before throwing out or burning your shoes; the smoke is also toxic! We are polluting our environment with far worse things than leather shoes.
Try to alternate your shoes from day to day. Keep them clean and polished to preserve the leather [if they are leather]. wash and dry your feet carefully to prevent the build-up of bacteria which cause smelly feet. Socks of natural fibre will protect your feet from direct contact with the materials used in manufacture, if you are sensitive.
If you do develop a rash or an itchy foot, after wearing a particular pair of shoes. Stop wearing them and see your podiatrist or doctor as soon as possible, because their are tests that will be done usually by the skin specialist – Dermatologist – to identify the exact cause and what you are sensitive to.
Whilst I think this particular article is a bit sensational, it does appear to be based on research evidence. Perhaps the take home message should be a timely reminder that we should all be doing more to re-cycle paper, plastic, metal and household refuse than we are.
Foot problems can spoil our holidays, because they are so unexpected. If you click on Foot Health Articles on this site, you can get some tips on holiday care for people with diabetes, I also wrote about a patient who suffered a holiday foot injury when he fractured his metatarsal as a result of a swimming pool fall! Also, check out the post on Holidays: Sore feet and sun back on 13 December 2008.
If you have been spending lot’s of time in the pool you might have felt your feet burning. Watch out for the surface of the pool – if it is a bit rough -rubbing the skin on your soles away. [This happened to a little girl I know recently]. You get red-raw skin because the protective outer layer is worn away. Just treat the area with antiseptic and a plaster, to keep the ‘bugs’ out and avoid an infection.
You can get a similar effect after that first, long-awaited barefoot walk along your stretch of beach! Our feet are usually protected in shoes and the skin is quite soft; our soft city-dwellers’ feet need a gentle introduction to the great outdoors!
Even regular runners can get burning soles after that early morning barefoot ‘quick 5 kays’ along beach! So don’t be afraid to wear your tekkies on the beach.
Sunburn is probably the most obvious holiday foot problem. Mostly to the tops of our feet and the front of the ankles. Use a high SPF cream or spray and re-apply during the day and if you go in the water.
Shoe rubbing is very common on holiday, as we spend more time in sandals. So look out for pressure or friction points that cause blisters – often made worse when there is sea sand added to the mix.
If you are somewhere exotic this New Year, try not to let sea anemone spines, puffer fish or jelly fish spoil your fun – but who really sees them coming anyway?
Then there are always the snakes! Whenever you go into potential ‘snake- country’, think ahead and be prepared. Make sure at least one person in your group is equipped to deal with a snake bite.
Unfortunately, this time year produces a number of common injuries like cuts from hidden glass and metal, plus aches and pains from too much walking, golf or frisbee! So don’t worry too much about that new heel pain, achilles tenderness or arch pain. It should settle down – if not – see a podiatrist.
The same goes for that itchy rash – could be fungus!
However you celebrate the New Year – from where I am, I’ll get a free fireworks show on Kleinleeuwkoppie at Hout Bay, courtesy of Sol Kerzner – I wish you and your families all the best for 2010.
At the end of last week, a 60-something lady was brought to me complaining of a very painful ankle, three weeks after she tripped and fell whilst walking in the Bush.
She was uncertain which way her ankle had bent when she fell, but said there was a lot of swelling and bruising, which was only now starting to go down. Whilst in the Bush she had managed only basic First Aid with a bandage, to keep the swelling down so that she could get her foot into her trainers, but walking was extremely painful.
During my examination I isolated a point of severe pain over the tip of the lateral malleolus. [That’s the bit of your fibula that sticks out on the outside of your ankle joint]. The area was also swollen and hot to touch. Moving the ankle caused pain and the lady walked with a stiff-legged limp. The provisional diagnosis was to eliminate a fracture as the ankle joint is very stable and usually the injury in these situations is of severe ligament damage. However, because of the local symptoms I was thinking fracture. The obvious thing to do was send for X-ray.
The X-ray report confirmed a fracture of the tip of the fibula bone, only slightly displaced, fortunately. However, perhaps more importantly, the radiologist reported the appearance of ‘low bone density’ and therefore the possibility of osteoporosis.
The lady is now wearing a “Moonboot” below knee walker – with some difficulty – and was referred to her GP for investigation into the low bone density, which is now underway.
Now I know this isn’t really podiatry, but when questioned further, before I referred her, the lady revealed that she had never had a mammogram or bone density test. These tests are as important for older women as the prostrate examination is for men.
So if you have a fall or trip, don’t just put it down to a sprained ankle and put up with pain; monitor the pain, bruising and swelling. Also, ladies, don’t wait for the next time you need an X-ray to check your bone density.
Remember: podiatrists don’t just treat feet, we treat people.