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.
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.
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.