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Diabetes, your feet and the podiatrist in Covid-19

Do you know your foot health risk status? Have you had your feet thoroughly examined by a podiatrist?  Experts Worldwide in their guidelines for the management of diabetes recommend an annual foot examination at the very least. This foot examination establishes the risk for complications or your Foot Health Risk Status. If you are aware of this, so many foot problems associated with Diabetes could be prevented.

These foot complications can be as simple as a painful corn or as complicated as an amputation. Of course if you have reduced sensation – peripheral neuropathy – there won’t be much pain and probably non at all.

As a podiatrist I would like to be celebrating an improvement in the foot health of South Africans, but unfortunately many people with diabetes have never seen a podiatrist, mistakenly believing that since they have no visible foot problems everything is fine.

Diabetes causes changes to the circulation and nerves to the legs and feet which often develop slowly and almost without notice.  I have heard people say that they have the less serious diabetes “the second type.” Comments like this make me realise that the Foot Health message is still not reaching our patients clearly.

Managing diabetes is a team effort and the podiatrist is a member of the team. If you neglect your feet and have no idea if they are showing the effects of diabetes, you are probably going to develop, corns, callus, blisters, ulcers and worse. Do you know the quality of your circulation? Are you sure you can feel everything with your nerves?

Why not commit to better foot health today by making an appointment with a podiatrist for a diabetic foot assessment?

Where did Andrew go? Help for lost ‘soles’ – introducing Louise Stirk

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.

Kameeldoring tree:A rare Bush injury?

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 – November 14 2010 – Foot Screening

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.

Trips, Slips & Falls – Occupational Hazards

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.

Walk the Talk – 2010

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:

  • improve circulation and reduce the risk of heart attack and blood clots
  • reduce weight
  • strengthen your bones
  • burn off fat everywhere
  • look leaner and wear smaller clothes
  • relieve stress and anxiety and become more relaxed
  • improve your posture
  • just feel better

Start walking. No excuses! We’ve had a month sitting watching football.

Now fight the winter chills, improve your health and WALK.

Football needs Podiatry

Football and podiatry. What a combination! The FIFA World Cup has arrived in South Africa. 64 games, each game with at 22 pairs of players feet, plus the 3 pairs of the officials, on the field at any one time! (Unless someone gets sent off).

Add the team officials and finally the fans – 98,000 of them for the first game. Feet for Africa. Call for the podiatrist.

The podiatrists associated with the World Cup are ready for foot problems that might afflict players, officials and fans.

I was surprised to learn from one of the World Cup podiatrists that very few countries have a podiatrist associated with their teams. I think this is a great opportunity to get them to understand that many foot injuries can be prevented and treated better by podiatrists than anybody else.

During the next month, I hope everybody enjoys this great event and when ‘footbal feet’ get sore, they will find some special South African podiatrists ready.

Toxic leather shoes? Don’t panic!

“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.

Holiday Foot Problems?

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 on foot

Sunburn on the foot

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.

Interesting cause of Heel Pain

Heel pain can be a really crippling  problem at all ages and especially for adult males. I have recently had an email from a 60 year old man complaining of heel pain. 

He described “sharp shooting pains in the left heel area. Usually when it comes under tension – even slightly, say from bending at the waist – or on impact – even the slightest.”

He went on to explain the pain as “odd, insignificant, but very sharp when it occurs.” He had only become aware of the pain in the past few days and said that the only change of habits was that he had started doing quite a lot of swimming. He didn’t indicate that he had had any injury.

My first thoughts were a series of questions:

 – “Do you have any lower back pain?

 – “How strong are your abdominal muscles?”

– “Does it come on spontaneously when sitting in the car or at the computer?”

– “Do you have any residual joint damage from sports injuries or osteo-arthritis?”

Shooting pains like this are usually associated with nerve entrapment,  pinching, or tight muscles like the hamstrings. At this age, osteoarthritis of the spine is a common cause. However, in this case, I suggested that the pain could be associated with the new range of movement since he started swimming.

Treatment for heel pain, begins with trying to find the cause, including the possible underlying cause at this age of being overweight, with a protruding belly! Not so in this case. Bearing in mind that this was an email communication and the symptoms were clearly described, I suggested the following:

  • Start by gently stretching your lower back when lying on your back on the floor
  • In this position, with knees bent and feet flat, roll gently side to side, all the time pressing your lower stomach into the ground
  • In the same position, curl your knees up to your chest
  • Another fun exercise is to kneel on all fours; extend your left arm out in front and your right leg out behind you; hold this for 10 seconds and change sides!
  • A Physiotherapy consult is advisable at the same time

A few days later, the gentleman diagnosed the problem as tension-related. He actually tried a rather risky move – “I can provoke sustained pain by crouching and then arching my back to put the whole back, rear leg muscles under tension.”

 Luckily he was able to get up from this position, not call the Fire Brigade to lift him up and take him to hospital!

There is no apparent foot problem of pronation or flat feet, so it does sound like a nerve – related problem.

Then out of the blue, another man of similar age visited the practice with similar symptoms. By me moving the foot into certain positions that stretched his lower back, I was able to reproduce the burning, shooting and tingling pains he complained of.

Doing some research on heel pain reveals many causes; nerve entrapment is one of the more difficult to diagnose.

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