May is World Foot Awareness Month – Diabetes & Crocs

Foot Health Awareness is vital for people with diabetes.

PEOPLE WITH DIABETES ARE 25 TIMES MORE LIKELY TO LOSE A LEG THAN PEOPLE WITHOUT THE CONDITION

Today I want to issue a timely reminder to people with diabetes who want to wear ‘Crocs’.

Last Friday, I saw a patient who “lived in her ‘Crocs’.” That was until she got splinters which penetrated the soles and stuck into her big toe, as she was walking across the university campus. The splinters were removed by her GP and today she told me there was a small remaining piece that also had to be removed. Fortunately, although she has neuropathy, the wounds are healing well.

Last Christmas, a family member (with no diabetes) also had a piece of metal go through the sole of  his ‘Crocs’, whilst walking across the garden.

Previously, I have not taken a strong stand on this, but these two events have prompted me to express my opinion in the form of a WARNING.

If you have diabetes, think very carefully about wearing ‘Crocs’. If you have poor circulation or reduced nerve sensation; do not wear them outside the home.

EVERY 30 SECONDS A LOWER LIMB IS LOST TO DIABETES SOMEWHERE IN THE WORLD

Closed Kinetic Chain Exercise for Joint Rehabilitation – Jump for Joy!

Closed Kinetic Chain Exercise for Joint Rehabilitation was the title of a Rehabilitation Workshop that I was invited to yesterday. It took place at the University of the Witwatersrand Sports Science Institute and introduced  me to Reboundology and a quite extraordinary piece of kit called Kangoo Jumps.

Kangoo Jumps are a Swiss designed boot that almost defies description – the nearest that I can come to is – a Ski boot with an oversized doughnut lying on its side as a sole!

They have the ability to reduce the impact force to the ground by up to 80%. This patented Impact Protection System utilises the principles and practice of closed chain kinetics.

Basically, the difference between open and closed chain kinetics is that in open chain there is still some movement in part of the limb, this allows additional twists or rotations to affect other body parts. In the closed chain, the part is stabilised (eg foot or hand) against a hard surface. It’s actually more complicated, but this is what I understand at present. 

Rebound exercise is different due to the following factors: During rebound exercise; We are opposing gravity and acceleration: Acceleration in the vertical plane develops a greater G-force: All these forces come together at the bottom of the bounce: Cells have to work harder to maintain their position in space: This explains why trampolinists have extra unexplained strength.

Kangoo Jumps utilise these principles by allowing you to jump up and down, whilst concentrating your body weight through your centre of gravity.

I was able to test the theory in practice when we were put through an exercise session. I had a great time bouncing around the gym, being guided in various exercises. The first thing I became aware of was that my posture improved immediately, I stood up straighter and my core lower abdominal muscles were getting a workout! My heart rate went up quite quickly too. In addition, yesterday and more importantly, today, I don’t have any muscle soreness or stiffness.

Where you will be asking is the Science? There have been many studies worldwide, but there is ongoing research underway at the University of the Witwatersrand. Have a look on the website www.kangoojumps.co.za

Reboundology has also been the subject of considerable research by N.A.S.A

The application of this technology is for rehabilitation as well as strengthening. (You would be surprised who is using them!) For example they will improve balance, co-ordination and agility; improve foot alignment; increase overall muscular tone. They stimulate cellular bone rebuilding ability. The potential application in managing arthritis is an exciting thought.

Closed chain kinetics using Kangoo Jumpssseems to me to be offering a new clinical modality and challenge to our current way of thinking. You can be any age from 6 to 90! I can’t wait to start rebounding!

May is World Foot Health Awareness Month: Baby Walkers

Today’s Foot Health Awareness Tip:  Avoid Baby Walkers.

Children will decide to walk independently when their bodies are able to. Baby walkers place extra stress on joints before nature intended. In addition they cause the foot and lower limb  to move in an unnatural walking pattern.

Research has shown the use of baby walkers is associated with a delay in normal walking and activites such as standing and crawling.

Their use is best avoided – they are banned in Canada.

Source: Children’s Feet. Gordon Watt. Lecturer in Podopaediatrics, Glasgow Caledonian University and Consultant Podiatrist, Royal Hospital for Sick Children, Glasgow. Society of Chiropodists and Podiatrists, UK.

May is World Foot Health Awareness Month

The International Fedaration of Podiatrists, headquartered in Paris, France, has declared May to be World Foot Health Awareness Month. I join them in calling the attention of the public and health care providers to the importance of good foot and ankle care. It’s time for all South Africans to stop and take a look at their feet!

The importance of good foot health and the role played by the podiatrist cannot be overstated, since, most South Africans will develop some foot or ankle problem during their lifetime. World Foot Health Awareness Month is a marvellous opportunity to stop and consider the value and importance of our feet.

Winter is nearly here and we will be spending more time in closed shoes. Do last year’s boots really still fit? Are they going to cause pressure calluses?

Don’t wait for your foot problem to become severe. Remember that the average person takes about 8,000 to 10,000 steps per day and while you’re walking, your feet are taking a pounding; often enduring more than your body weight with each step.

As part of World Foot Health Awareness Month 2009, there is a special focus on Diabetes and the Diabetes Health Care Team. In support of this initiative, the South African Diabetic Foot Working Group (DFWG), will be presenting free patient-oriented symposia nationwide.
PRETORIA:
30th May. Contact: Andrika Symington: 012 548 9499
CAPE TOWN:
9th May.Contact: Anne Berzen 072 342 9558
BLOEMFONTEIN:
13th June. Contact: Dr Willem de Kock 082 379 6231
DURBAN:
to be confirmed. Contact: Dr Paruk 031 241000-ask for speed dial
JOHANNESBURG:
to be confirmed. Watch this space!

These symposia will offer a unique opportunity for people with diabetes and their families to ask questions of the members of the health team directly involved in foot care.

MAY 2009 is WORLD FOOT HEALTH AWARENESS MONTH

Foot Fit for Voting?

Are you ‘foot fit’ for voting? On Wednesday of this week South Africans go to the polls to elect a new government. Foot fitness could be important since the process can involve many hours of extra standing or walking.

Here are a few tips to help you through the day!

Try to get a lift to the polling station – this reduces the walking you have to do.
Take a folding chair or sit on the ground if your feet start to ache.
Wear comfortable shoes with thicker soles – trainers or lace ups are best, because they can be loosened if your feet and ankles start to swell.
Don’t stand in one position for too long – move from foot to foot, wriggle your ankles up and down to keep the circulation going.
Bend gently from the knees up and down a few times.

If you have diabetes and reduced sensation take extra care that you don’t rub a blister from your shoes.

Start talking to the people around you – it helps to pass the time!
(Try to avoid talking politics!).

Have something to eat before you go to vote. (Voting on an empty stomach is as risky as shopping on an empty stomach!).

Sometime it’s a good idea to go later to the polling station, since everyone wants to get there early!

Above all do vote. Remember that it is a Public Holiday, so rush home and put your feet up.

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

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!

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.

SA Men “Push and Bhobhoza” their feet

Men usually escape the painful feet we associate with poorly-fitting shoes. Surely it’s women who are wearing high heels and sharply pointed toes. They were doing it when I was at varsity. However I was amused by an article by Thando Pato entitled ” Men in sharp shoes miss the point” in the Sunday Times Lifestyle section on May 18th.

I checked with my associate Tshidi and sure enough “P&Bs” as they are known, are a real fashion item. Especially amongst black men. Ms Phato expresses her concerns about the growing number of South African men in all situations wearing shoes “so long and pointy that they look like spears.” (The word ‘bhoboza’ means to pierce in Zulu).

She also expresses a concern that I often use as a humour line in foot health talks – that shoes for women are designed by “cruel European men who claim to love women”. The message from Thando Pato is a great – not only are these shoes sold in garish colours, apparently white is cool – but she is also “traumatised” by the damage inflicted on the wearer’s feet.

She uses a great expression to describe corns, bunions, calluses and a host of other foot deformities that we traditionally associate with women; “Hammer Time”. I think this should become part of podiatry terminology. Her description of the pain experienced by one guy she sees is really funny. Thando Pato you must have been a podiatrist in a former life!

If you want to study the effect of high heels on how you walk, get along to the Victory Theatre in Johannesburg and take in The Rocky Horror Show. We went last night and it was a great show. Obviously I went for the anatomical study!

By the way the references for Angiosomes are: Taylor 1991. Plastic & Reconstructive Surgery.102.599. There is a fully illustrated article in Plastic & Reconstructive Surgery. 2006.117. 261-293.

I know these are not 100% accurate but that’s what I wrote down at the congress, so put on your best Google and see what you get!