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.
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!
SA podiatrists ‘bitten’ by Crocs
At the recent meeting of the Northern Branch of the South African Podiatry Association (SAPA), local podiatrists learned more about this interesting and controversial footwear. Because Crocs have been around a while, the consensus amongst SAPA members was "try them before you dismiss them". (Remember the negative UK podiatry opinion in my Post of 16th September).
Gareth Kemp of Crocs SA showed us some of the many styles available in SA, including ‘All Terrain’, ‘Georgie’ – bright gumboots – and even ‘The Hydro’ which they say can function as a flipper! (Just right for Survivor). The medical styles have an enclosed forefoot – removing previous complaints – and the concerns about static electricity build-up are being addressed. There is also one style for people with at risk feet due to diabetes.
So do yourself a favour, visit www.mycrocs.co.za or if you can’t wait go and buy GENUINE Crocs. (I’m waiting for a free Trial pair, but not in pink!
Children’s Feet Take 18 Years to Grow!
The feet of a newborn child are usually perfectly formed and lovely to look at. Unfortunately many parents easily forget that those feet need nurturing and protecting as they grow to maturity.
It’s going to take up to 18 years for that child’s foot to fully develop. Nevertheless, the newborn foot resembles the adult foot in every respect; it has normal contours and arches and fat padding, but when the foot bears weight it will look abnormally flat – this is one reason why all babies should be allowed to develop at their own pace and parents must resist the desire to get them up on their feet before they are ready.
A newborn foot is usually triangular in shape, broadest at the toes with a narrow heel. The shape and position is also very important, giving clues to any underlying neuromuscular or skeletal pathology. Podiatrists involved in managing children’s feet look for altered shape, restricted movements, stiffness and deviations in different parts of the feet.
For the first 6 months of life the feet are mostly cartilage, so they can be easily deformed by an ill-fitting sock or ‘babygro’ or sleepsuit. The feet and lower limbs of a baby are meant to move, stretch, kick and wriggle as part of normal growth. Freedom of movement is the keyword at this time, which means that any tight fitting devices, pram and cot blankets must be avoided.
Obviously, throughout the entire process of development and growth, correctly fitted footwear is essential for the child, as is the diagnosis and management of any disorder or anomaly, so if you are concerned about your child’s foot health, have their feet checked by a podiatrist.
You can read more about children’s feet here..
Do Crocs “bite” your feet?
The Crocs saga seems to be getting bigger every day. There are reports on various websites including www.fin24.co.za the Independent Online, www.mycrocs.co.za in Die Burger to name just a few, joining in the debate for and against this popular footwear.
Crocs are being blamed (along with other types of sandals) for injuries to people travelling on escalators in shopping centres. In Singapore a youngster lost a toe in an escalator accident.in November 2006, a Crocs spokesperson blamed poor escalator safety. Apparently there is also a Crocs Accidents blog on the Internet!
The Independent Online article has comments from a spokesperson from the Society of Chiropodists and Podiatrists in the UK, who agrees that Crocs "have shortcomings" and goes on to say that if a person only wears Crocs "they’re disastrous"," that they don’t give the feet enough support" and that "they are better suited to holiday wear." Read for yourself; http://news.independent.co.uk/health/article2950842.ece
Despite all the current negative publicity, Crocs remain enormously popular and 20 million pairs have been sold in the past 12 months, so there are plenty of very happy wearers worldwide.
My advice is to wear the real thing. Avoid knock-offs which are cheap and wear very quickly especially if you have a walking style that causes local increases in pressure.(Look for where you have callus under your feet). If you have diabetes with no complications then you might be OK, but avoid them if you have loss of sensation or poor blood flow to the feet – this advice applies to any footwear for people with diabetes anyway.
Finally. look out for Croc Mammoths – a fur-lined shoe designed for the Northern Hemisphere winter.
Crocs damage hospital equipment!
No monster crocodiles rising from the water, but those extraordinary – love them or hate them – funny-shaped garish coloured foot adornments. The UK tabloid newspaper The Sun reported on September 5th that in A Swedish hospital there have been incidents where a patient’s vital respirator and two other key pieces of equipment were knocked out by static electricity caused by Crocs. This resulted in a ban on the footwear.
In Sheffield, UK the health authority also barred Crocs to avoid problems in the operating theatres. Now it seems that a ban might be applied by other players in the UK National Health System (NHS). Apparently thousands of nurses and other NHS staff wear Crocs, with nurses being quoted as saying Crocs have relieved months of suffering with painful feet. In addition it appears that there is a possible problem with Health & Safety regulations with comments about infection control and the risks of needles being dropped through the holes in the uppers.
Read th article at http://thesun.co.uk/printFriendly/0,,2-2007410358,00.html
Do podiatrists like Crocs?
Some do, some don’t.
“They should not be worn by people with diabetes” says a colleague in Cape Town.
On the other hand, a British podiatrist, writing in Podiatry Now, thinks they have great therapeutic potential and presents a case history as evidence. He suggests that they be researched by the podiatry profession.
Some UK websites are full of therapeutic ‘evidence’ and testimonials.
WATCH THIS SPACE!
Sports Podiatry and Football Injuries-an end in sight?
What would podiatrists who treat foot injuries say about a football boot that will encourage players to consider injury protection as much as performance when choosing footwear? I found the following information in the July 2007 issue of the Brighton Graduate, the magazine of the University of Brighton Graduates Association.
The prototype boot, called the RF5, has spawned a new buzzword – ‘safe performance’. Designer Jonathan Farr at the University of Brighton says the aim of creating such a boot was "to provide protection of the foot and lower limbs alongside the feeling, efficiency and range of motion required to achieve maximum performance." According to Jonathan, "footwear in sports serves three major functions.
- provide adequate and effective adhesion between the feet and the playing surface
- protect the feet
- permit normal movement."
He believes that these functions have yet to be perfected in sports footwear as the interaction of the legs, feet, footwear and ground is still to be fully understood.
The design of the RF5was influenced by research into the causes of injury (etiology), measurements of body size and proportions (anthropometrics), and structure and function (biomechanics). In addition user-centred aspects, emotional elements and boot design were included.
The RF5 boasts some impressive features. An outsole that dissipates pressure and reduces unwanted foot movement; a stud pattern that spreads pressure and reduces foot fixation; a heel cup that helps prevent ankle and knee injury and contoured insoles to give arch support, help postural position and joint alignment.
The only illustrations are clearly computer aided design, so it remains to be seen whether the prototype and concept can be developed cost-effectively into production and then scientifically researched to prove that these design features really do prevent injury. Certainly it appears that some of the features have a therapeutic potential.
Unfortunately, RF5 may ultimately only be suitable for players on World Cup 2010 on your XBox! I hope not.