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.

Warts and All!

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.

Plantar Wart

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

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 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.

Fungal Infection – Your Christmas Present?

Athletes Foot is the name used to describe a fungal infection of the skin of the foot. Characterised by an itchy, blistering rash on the skin in the arch of the foot - which rapidly spreads to between the small toes and even the heels, it can ruin your Christmas.

Tinea Pedis is the medical name for this condition. It is worse in the hot summer months when feet are either trapped in their usual dark, sweaty environment, or exposed to areas where someone with the infection has walked.

Usually communal showers at the gym, in hotels, airplane carpets - the fungal spores are everywhere - just waiting for the perfect dark, moist environment to enable them to grow.

A fungal infection can also be spread by your favourite leather sandals, as the spores can live in the leather for ages!

Try to prevent Athletes Foot by following a few simple steps.

• AFTER WASHING ALWAYS DRY YOUR FEET THOROUGHLY, ESPECIALLY BETWEEN THE TOES
• WEAR CLEAN SOCKS EVERY DAY
• AVOID SYNTHETIC OCCLUSIVE FOOTWEAR IF POSSIBLE
• WEAR SLIP-SLOPS IN ANY COMMUNAL SHOWERING AREA
• USE AN ANTI-FUNGAL OR ANTISEPTIC FOOT SPRAY
• EXAMINE YOU FEET FOR SIGNS OF A RASH, SMALL BLISTERS IN THE ARCH OR WHITE ITCHY SKIN BETWEEN YOUR TOES
• BAREFOOT AND FRESH AIR IS GOOD, UNLESS THERE IS A MEDICAL REASON NOT TO BE

If you have a fungal infection treatment with oral medication can be costly, so start simple:

• GOOD FOOT HYGIENE
• SPIRITUS PEDIBUS FOOT SPRAY OR PROPRIETARY ANTIFUNGAL SPRAYS
• TOPICAL ANTIFUNGAL CREAMS
• HOWEVER, A COURSE OF ANTIFUNGAL TABLETS MAY BE NEEDED

Unfortunately, the fungal organisms that cause Athletes Foot tend to be very difficult to kill off. So even when your foot looks clear continue with the treatment for at least two more weeks.

One final word of warning. Not all rashes, or areas of itchy, moist skin are fungal infections. In the arch you might have a dermatitis. Between the toes it might be because your toes are stiff and bent. Or you might just need a good wash!!!

​

High Heels in the Spotlight Again

The visual delights of high heels were the subject of a post on this website on 24 March 2008 – go back and have a look. Recently however, the “high heels issue” was the subject of a motion at the UK Trades Union Congress (TUC), in September this year.

High heels

The Society of Chiropodists and Podiatrists (SCP) tabled a motion calling on employers who promote the wearing of high heels………..to examine the hazards involved. They suggested further that employers should not be able to insist on the wearing of high heels by female workers as part of a dress code.

It received massive media coverage, even pushing  Prime Minister Gordon Brown off the the early pages of some newspapers.

The dangers of long term (even short term) wearing of high heels are of back, hip and knee pains caused by the change in natural lower limb alignment. The forces placed on the metatarsals (balls of the feet) are estimated to increase sevenfold as the heel height increases. In addition there is an increased risk of  falling or tripping.

Needless to say there was intense debate of the issue. With one newspaper calling  it ‘raucous.”

If you compare your gait (way you walk)  barefoot or in low heeled shoes, with your gait in high heels, you can easily see that in heels your knees don’t extend, the heel can’t hit the ground first followed by the rest of the foot going over it – ‘heel over toe walking’ – so the muscles act differently and the joints get stressed. High heels shorten stride and cause a jarring to the joints.

There is evidence of the use of lower heels on airplanes, when female cabin crew use lower heels for their in-flight duties when they often spend long periods on their feet.

However, when we look back at the post of 24 March 2008, we get to see that high heels are all about image! The hunter and the hunted. The allure of a long leg attached to a 9cm stilleto heel and the associated ‘rock & roll’ of the hips, arms, shoulders and anything else, is why high heels are worn by women and men will watch whilst women endure!

So until your bunions get really painful, your feet look like the front of a bricklayers trowel, the varicose veins resemble a set of train tracks, your corns are hard and yellow and your joints ache all the time due to arthritis. Ladies strut your stuff and visit your podiatrist regularly.

On the other hand, according to the SCP, this is a serious health and safety issue  in the UK, with ‘two million days lost each year to ilness resulting from lower limb disorders.’

Ultimately, it comes down to the right to choose. Or should that be Jimmy Choo’s!

Prevent a fall-visit your podiatrist

Many older people suffer a fall with consequent injury such as a fractured  shoulder, wrist, hip, ankle or foot. In the UK there is an active falls prevention initiative, promoted by the National Health Service.  Not so in South Africa, although we are aware of the problem.

Have you ever thought how the state of your feet could contribute to a fall? Podiatrists should be  involved in preventing falls and your visit to one could help to prevent one.

Hazel Tomkins, a British podiatrist, writing in Podiatry Now has detailed how your feet can cause a fall.

So, if you want to stand on your own two feet here’s what to look out for.

Any corn, callus, ulceration, painful nail condition alters the way your foot hits the ground. This usually makes walking uncomfortable and unsteady. With age, the cushioning fatty pad on the soles  of the feet thins out – giving less protection to the bones and joints underneath.

Changes to the basic shape of the feet alters the ability to walk evenly. Often the cause of these changes is reduced muscle strength. On the other hand, any change in posture – quite common as we age – is associated with weakening of our muscles, so there is the potential for loss of balance or unsteadiness.

Watch out for changes to the length of your legs after hip or knee replacement surgery. The pain has gone but you really do need to do all the physiotherapy to restore muscle strength and balance.

At the same time there are many changes to hearing and eyesight which affect the ability to balance and see clearly what is going on around us.

If you have any nerve changes associated with diabetes (neuropathy), you are disadvantaged, because you have a reduced ability to respond to the sensory stimuli around you. On the other hand, arthritis can cause deformity as well as stiffness, making movement difficult, slower or unsteady.

Research into barefoot walking showed a 19% worse performance when barefoot compared with even a least unstable shoe. Going barefoot or stocking feet dramatically increases the falls risk.

Simple you might think, I’ll wear slippers or shoes. Well this is an area of some dispute. There is good scientific evidence that if you change to a lower or flat heel after a lifetime of wearing high heels, you have a greater risk of falling! At the same time there is research which suggests that the most important feature of footwear in preventing falls is the grip of the sole on the ground. Added to that is the need for good fit and thicker soles.

So what to do?

Keep mobile – exercise regularly – start walking, even if you use a walking aid. Maybe you need to start using one? Make sure that you can see and hear as well as possible.

A visit to a podiatrist for a biomechanical assessment is an important way to identify any underlying structural and functional problems. Treatment of any painful foot condition, such as corns and calluses, is essential and  information on the best shoes for you, will be provided.

Avoid higher heels, barefoot walking and slippers. Consider wearing trainers with a rippled sole. A word of warning though, some trainers have really ‘grippy’ soles and that can cause a fall!

Try to remove all loose carpet runners and potential hazards that you could trip over. Make sure the lighting in your home is adequate (most falls occur at home!).

It takes team work to prevent falls, so get any advice that you can, or share it with those who you know are at most risk of a fall.