Holidays: Sore Feet and Sunburn

Sore feet or sunburn could ruin your holiday. Whether you are going to the coast, mountains or bush, you need to pay special attention to protecting your feet this summer.

As the holiday season gets going, many of us will be exposing our feet to the African sun for longer periods than usual. Remember that if your feet are usually covered by shoes and socks, they will need as much protection as your face and shoulders. (Or your bald head). Despite the fact that we spend a lot of time barefoot or in sandals in South Africa, during holidays the time is often extended.

The most vulnerable part of your feet is the skin on top of your arches. However you can also get sunburn on the soles of your feet if you like to indulge in serious ‘sun-worship.’ Obviously any part of your feet that is exposed is at risk. Initially you might not feel too much discomfort from sunburn, but when you put closed shoes on there will be pain.

Usually, sunburn is confined to a patch of inflamed, sensitive skin, which responds to protective after-sun preparations. The end result is skin dryness and peeling after a week or so and little harm is done. In severe cases however, the inflamed area starts to blister and itch. This is when scratching or opening the blisters can lead to infection.

Always apply sunscreen on top of your feet before you go to the beach, shopping or walking. You might need to re-apply after swimming, depending on what you use, or suits you. If you are spending a long time lying face down with bare feet protect the soles. After showering, treat your feet as you would the rest of your body with your choice of after-sun preparation.

Another common holiday foot problem is burning the soles of the feet. Here again it is usually because the soles of our feet are not as tough as we think and so we forget that the beach sand burns. The same thing applies to the patio tiles or paving.

Don’t do crazy things like walking barefoot over the car park. We all know that it’s thought to be very ‘macho’, to run around barefoot on holiday, but there is nothing ‘macho’ about peeling, blistered soles.

Unfortunately wherever you are, at the beach or around the dam your bare feet are not protected from broken glass, cool drink cans, palm thorns, bits of charcoal from the braai, even rubbing from your new sandals! Watch out for those beach thongs rubbing between your big toe and second toe too.

Always wash sea sand off your feet before you walk any distance, because it can chafe and irritate skin between your toes.

You might even get painful feet from all the extra walking that you do. This can be a big problem if you are walking along a beach where the sand is rough, or if you spend time jumping around in the sea on rough sand. It can also happen if you are enjoying the sights of a chilly Northern Hemisphere winter, as you spend more time walking around.

Finally, as you lie on that soft, sandy beach preparing to enjoy the warm Indian Ocean, remember it’s not just the sharks that can get you, look out for sea anenomes, puffer fish and coral!

So just think ahead. Protect your feet and those of your family, but above all, relax and enjoy putting 2008 behind you. Don’t let sore feet or sunburn spoil your holiday, but if it does, go and see a podiatrist.

TAKE CARE OF YOUR PAIR

Sesamoid Fracture – an interesting case – treatment

The case of the sesamoid fracture that I referred to the other day, has had an interesting development. You will have read that we ended up using an Aircast below knee walker. Unfortunately this was only successful for about one day. By the end of the day the pain was increasing.

I advised my patient to get advice from an orthopaedic surgeon who I know. The advice was really simple! Wear thick-soled soft trainers and take pain-killers until it is better. (Obviously only take the pain-killers as often as really necessary). This will allow normal movement – remember this condition is not treated by immobilisation in a cast – but not over use.

So what’s the lesson here? Simple treatments are often the most effective. Never ignore foot pain in the ball of your foot. Have it accurately diagnosed – it might be a sesamoid fracture.

Bunions – Should they go or stay?

Bunions create as much comment and discussion as they do pain for their ‘owners’. Let’s assume that your bunions are bony lumps. First ask yourself are they getting bigger and more painful? Being disappointed with the look of your feet is not reason enough for surgery. Possibly you have some underlying arthritis and the joint is painful at every movement and it is seriously affecting your quality of life. Rheuma-surgery,as it is known is becoming more appropriate nowadays. Another cause for concern is if the big toe is deviating away towards the smaller toes so much that your foot is beginning to look like a tennis racquet.

Whatever the nature of your problem, if you do decide to undergo surgery I believe there are some basic truths to come to terms with. Perhaps the most basic is the most obvious – make sure your surgeon is a specialist foot surgeon – not one who includes foot surgery with the rest of his/her practice.

Then you have to fully understand and accept the conditions surrounding the surgery. This usually includes at least six weeks of careful rest, individualised treatment and immobilisation, plus the general life disruption. It’s my opinion that most “disappointing” surgical outcomes are the result of patients being unable or unwilling to fully comply with the post-operative care requirements.

So what to do about your bunions? Try every conservative measure that you can to preserve your feet. if your life has become interrupted and painful because of your bunions then DISCUSS with your surgeon all about the procedure and after care before you go ahead. Or maybe don’t!

Footwear For Babies – Barefoot is Best

Babies do not need footwear. Anything that you put on a baby’s feet will constrict and damage it. Don’t be persuaded to buy ‘pram shoes’ they should be hanging from the rearview mirror of your car!

As children develop they are all action and this is part of the normal growth pattern so it is essential that they are allowed freedom of movement at every opportunity.

There can also be damage from clothing that we put our babies in. Romper suits (called a Babygro when my children were small) are often too small or tight and restrict the very important kickiing activity the all growing babies need. In South Africa there is a trend to cover babies when in the pram or stroller. DON”T. Any covering that reduces the normal developmental reflex movements will cause harm. Those beautiful knitted bootees from Aunty Tshidi – watch them – they must allow the wriggling, growing toes to keep doing just that.

If you look at ‘pram shoes’ you will see very little of their shape matches the baby foot, especially at the toes wher usually they are too narrow. It could be the equivalent of you or I wearing a shoe one size too small. Even the fastening around the ankle, although it may look OK has the potential to press into baby’s foot.

During the first 6 months total freedom should be the aim. This allows the unhindered development of the neuromuscular responses. Just take a moment to look at the feet of the newborn and infants before they start walking. What you will see is a range of curling, wriggling, turning in and out, twitching and so forth which need to bee allowed without being enclosed in footwear of any sort.

Barefoot is best. Loose covering obviously to keep warm. Yes keep the sun off, but don’t constrict the feet. Throw away the ‘pram shoes’n the only footwear you need for babies is bare skin.

Sweaty Feet

Sweaty feet affect everybody at some time of their lives. The complaint can be seasonal -worse in the warmer months – but can be present at any time of year. The medical term is hyperhidrosis (excessive sweat production) and if there is an accompanying bad odour, it is called bromidrosis.

There are many causes. The most common is poor foot hygiene associated with footwear with a high synthetic material content. Socks, stockings or tights made of nylon also cause the feet to sweat excessively. In teenage years glandular changes are a frequent cause amongst males and is made worse by poor hygiene and footwear. Occasionally, there is a systemic problem which shows in increased sweating of the hands and other body parts. Whenever we exercise, we develop sweaty feet, which is is quite normal, but it does lead to the smelly foot and shoe syndrome.

An excessively sweaty foot is susceptable to the development of fungal infections and because it is important to differentiate between sweating and fungal infections, I’ll write in detail about fungal infections in the future.

Treating sweaty feet needs patience and perserverence. Daily washing with soap and water is essential. Then dry feet thoroughly. Try to avoid wearing shoes with synthetic uppers and soles. Make sure your socks contain high percentages of cotton or wool. Read the labels to see what the socks are made of. Try using an anti-perspirant under the arches of your feet. There are some products advertised specifically for this application. Podiatrists usually recommend ‘Spiritus Pedibus’ also called Foot Spirit. It contains 3% Salicylic Acid in Ethyl Alcohol. Occasionally a weak solution of Formalin can be prescribed. Obviously any opportunity to have your feet bare in fresh air will help. So wear sandals whenever possible. However, beware of plastic and synthetics, go for leather if you can. If the condition is really severe, a change of socks may be necessary during the day.

There is a surgical procedure called a sympathetomy – which must be performed by a specialist surgeon – for very severe sweating of the hands and feet.

Smelly feet are usually caused by the bacteria which live on our feet normally, not being washed off thoroughly. They can of course be caused by the materials themselves, especially some rubbers. Washing and drying is a good start followed by any of the above treatments. Naturally if you favourite trainers make your feet smell, but your normal shoes don’t, you have a hard choice to make!

Powder is often used for sweaty feet, but be careful since it tends to solidify between the toes.

Sweaty feet are a common complaint and they can be embarassing. However, treatment is often very simple, starting with an intensive foot hygiene routine.

Can High Heels Heal?

‘Walking on sunshine.’ ‘Sexual heeling.’ ‘Toeing the line.’ All headlines for articles recently printed in the South African press taken from The Telegraph, The Sunday Times and The Times respectively, all from London. Toeing the line is all about the Chinese tradition of foot binding and I’ll pick up on that later this week.

The other articles are all about the benefits and effects of wearing high heels! Both suggest that wearing high heels is sexy and in ‘sexual heeling’ the research of a University of Verona urologist, Dr Maria Cerruto, is reported where she tackled “bizarre” theories about the effects of wearing high heeled shoes. The idea of sexual heeling refers to the Dr Cerruto’s assertion that pelvic floor activity is affected.

Traditionally we have blamed high heels for a variety of ailments, such as bunions, stress fractures, knee pain, lower back pain and increased risk of arthritis. South African research by Drs. Zipfel and Berger of The University of the Witwatersrand in Johannesburg showed scientific proof that wearing shoes had bad effects on the wearers when compared to unshod people. (I know this was on old bones but they have the proof). Dr. Cerruto’s evidence is due to be published in the journal European Urology. Since I am concerned with your foot health, I’ll leave that train of thought for you to follow.

However, in the article there is a comment from a UK fitness instructor who runs classes in London for women with high heels called Sweat and Stilletos. These sessions are designed to help women wear stilletos more comfortably. Whilst she agrees with the effects of muscle toning in the buttock region, she says that there must be compensation somewhere else and therefore her classes help with postural alignment.

Now as podiatrists we spend a lot of time dealing with and correcting the effects of postural malalignment. A personal trainer to some celebrities was quoted as saying that” the knees and metatarsals are put under strain, the hips are out of position. It can lead to long-term health risks.”

For me the evidence is there that the movement of the body’s centre of gravity forward causes increased loading and pressure. There is an increase in callus formation and the calf muscles shorten over time. This will lead to deformities of the toes. I agree however that exercises specifically to strengthen the intrinsic muscles of the foot will resist these deformations.

In “Walking on sunshine” they report on a New York sports therapist who holds classes for women to strengthen their foot muscles to cope with wearing high heels. Yamuna Zake also gives some good advice on foot care. She has been working with dancers for 25 years and those of you who struggled to get your (or your child’s) feet into the basic ballet positions without them falling flat will appreciate this. The essence of ballet is to be able to get your foot extended down from the ankle as far as possible and have almost 90 degrees of flexibility at the big toe joint.

So what’s the bottom line? Let me quote from the articles. ‘It’s a way to appeal to the male species. I have men who say heels have saved their marriage.’ Yamuna Zake says, ‘my husband is a freak about high heels. He thinks they’re very sexy.’ During my recent tutorials with Wits University medical students I was demonstrating the possible effect of rheumatoid arthritis on the way a person walks. I asked on of the girls to walk across the room in her high heels and then again barefoot to show the difference in patterns of healthy person. Guess what she said before walking barefoot? ‘Oh please I’ll walk like a boy!’

I wonder if walking in high heels will become an Olympic sport?

Read the articles:

Walking on sunshine. Melissa Whitworth. The Telegraph, London. In The Sunday Times (Johannesburg)Lifestyle section. [not sure when, towards the end of 2007].

Sexual heeling. Roger Dobson & Steven Swinford. The Sunday Times, London. In The Sunday Times (Johannesburg) Lifestyle. February 24 2008. Page 17.

Eschewing shoes may save your soles. Gill Gifford. The Star, Johannesburg. Friday October 26 2007.Page 6.

You And Your Feet

I’ve just come across an article I wrote a while ago for the South African Journal of Natural Medicine and thought it might be useful as a reminder as we embark on another year.

We need to take care of our lives, our relationships and our bodies as we renew our efforts in the New Year – and that includes our feet. 

Take a look now at You and Your Feet

Are Bunions The Bane of Your Life?

Bunions are among the most common and frequently most painful of conditions affecting the foot.

Remembering that your feet carry ALL of your weight ALL of the time that you are standing or walking then it is not surprising that the complex structure of your feet sometimes suffers re-alignment as they strive to accommodate our lives and activities.  Sometimes we do not help matters by forcing our feet into unsuitable or badly fitting shoes.

Go to the Foot Health Articles section for some useful advice on bunions.