Tag Archives for " podiatrist "

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.

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!

Warts or verrucae pedis,(meaning of the foot), to give them their medical name seem to be on the increase in our practice.

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

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

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.

Undiagnosed Achilles Tendon Tear

When an Achilles tendon ruptures, the patient may tell you they heard a sound like a gunshot and they cannot walk, but with an Achilles tendon tear it is still possible to walk around without knowing your injury.

This week a lady consulted me complaining of pains at the back of both heels and into the calves, which had been there for more 6 weeks. She experienced aching, throbbing and a stretching sensation, especially in the evening. She felt less pain wearing higher heeled shoes. In addition, the pain was worse when she got up after sitting for some time.

There was a history of a right ankle fracture and some persisitent left knee pain. She  also told me that she had been diagnosed with calcaneal spurs many years ago. The lady was overweight and of short height.

During my examination, I could see and feel that both Achilles tendons were swollen and had nodules in them. Her walking stride was short and stamping. There were other significant biomechanical problems too.

Temporary treatment consisted of  in-shoe wedging. I also referred the lady for an ultrasound scan of the Achilles tendons.

Two days later the scan reported the left tendon as having “….an almost full thickness intra-tendon tear ……approximately 2.8mm thick, extending 30mm longitudinally.” On the right “……loss of fibrillar pattern, consistent with fraying.”

There were other features, but this was one lucky lady, because there could have been a rupture at any time. This time she was referred to an orthopaedic foot surgeon.

So whether you are a patient or podiatrist, when managing chronic pain at the back of the heel, consider the benefits of ultrasound scanning to assist in diagnosis and always act quickly, you might discover an Achilles tendon tear.

Ingrown Toe Nails

Post-surgery toe with removed nail shard
Image via Wikipedia

More people are complaining about their ingrown toe nails as winter comes and closed shoes are being worn more.

The most common cause of  an ingrown toe nail is poor self-treatment, but  there are numerous other factors, divided into intrinsic and extrinsic.

Common intrinsic(internal) factors are the basic shape of the nail – especially at the edges – we all have different curvatures and angles and some nails have increased curvature  on one side only.

Another factor is the structure and function of the foot (the biomechanics). If a flexible foot rolls or flattens excessively toes can rub against each other, causing pressure. Other factors can be sweaty feet and thin skin, caused by age, medication or circulation.

However, it is the extrinsic factors that really produce the problems – poor self-cutting and shoe pressure top the list. (Sometimes even health care professionals and therapists can cause ingrowns!),  tight socks and injuries can also be added to this list.

In the clinic, the appearance of  ingrown toe nails varies from a small pink swelling, to an inflamed growth or ‘proud flesh’, like a small cherry, lying over the nail plate. The pain seems to depend on the individual’s pain threshold more than the condition itself.

The offending nail can be just a small ‘shoulder’, pressing into the sulcus or a sharp spike of nail which penetrates the skin. The skin tries to heal itself when a spike penetrates it and that process leads to the formation of ‘proud flesh’ or hypergranulation tissue. Of course if the toe becomes infected then pus is also present.

Treatment for ingrown toenails varies with the cause and duration. The simplest treatment is correctly cutting out the offending portion of nail. In the more painful and complicated cases this is done under a local anaesthetic.

The permanent solution under local involves an operative procedure where the complete side of the nail including the matrix, is cut out and the matrix space is destroyed with a strong caustic. After about a month the side where the nail was looks normal – the cavity heals completely. This is a procedure that podiatrists do very well as an outpatient procedure.

Obviously avoiding  ingrown nails is the best, but nobody should suffer with them when skilled podiatric care is available.

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Bunion Surgery – A Painful Choice

Deciding to have bunion surgery can be one of the most difficult health decisions to make. ‘Bunions’ are a cause of distress to many thousands of people -mostly women -worldwide. Last year, I wrote about bunions and my opinion was and still is – “avoid bunion surgery if at possible, unless it is ruining your life and crippling you with pain”.

The ‘bunion’ referred to here is the bony deformity characterized by a big toe that deviates towards the rest of the toes, possibly accompanied by a second toe which is bent and overlies it.

When any surgical intervention is considered, be it the podiatrist enucleating a corn, removing part of a toe-nail or the orthopaedic surgeon realigning the foot in bunion surgery, all of us strive to do our best to achieve a satisfactory outcome, by exercising our skills to the utmost.

So you can imagine my concern to have two patients recently complaining bitterly about their unhappiness with the result of their bunion surgery. Add to this my surprise at the ‘twenty-something’ who wants surgery because she doesn’t like the look of her feet and her bunion (this one is the small thickening of the metatarsal bone with no deformity), prevents her from wearing the high fashion shoes she needs for work.

What can you say to a middle-aged, active woman who decided to have her bunion (deformed type) corrected, but after three months can only wear trainers with the toe cut out, has a swollen foot, pain and discomfort, difficulty driving, plus all the associated emotional stress? Or how do you respond to a similar woman who is now in constant pain and has had altered her walking style because the foot is rigid at the big toe joint?

To the best of my knowledge the procedures were technically successful and there is no deformity anymore. In addition we all react differently to a surgical “assault” and time does allow better healing. Also, there are numerous variations of operations and techniques available for bunion correction surgery.

Firstly – go back to the surgeon and discuss your options.
Secondly – see if a podiatrist can assist with biomechanical correction or alignment and footwear advice.

With my 2 patients, one has had orthotics made and the other I referred to the surgeon, who has recommended further physiotherapy, with the possibility of another operation to remove the steel plate that is in the foot.

I will still refer patients who meet my criteria outlined above for consideration for surgery, because the final decision to undergo sugery is always taken by the patient. Unfortunately, there can be no absolute guarantees since the structure of each foot is so complicated.

So what to do about ‘bunions’? Is there an underlying systemic disease such as rheumatoid arthritis?

We must consider the patient’s age. Is the patient overweight? What is the biomechanical structure and function, not only of the feet but lower limbs and body? Have all possible conservative measures such as night splints, orthotics, insoles, appropriate footwear, been exhausted?

Be guided by the severity of loss of function, pain, discomfort and limitation of daily activities. Will the patient be able to adhere to all the post-operative requirements, expected by the surgeon?

Eventually, all these factors (plus others), must be seriously thought about before undergoing bunion surgery.

New Year Resolution – Become a Podiatrist

In just under 7 hours time South Africa will welcome 2009. Will you make a resolution to become a podiatrist? Maybe one of your family or friends will?

Are you sitting with your ‘Matric’ results and not sure what to do next? South Africa has a serious shortage of podiatrists and as I wrote the other day even our new graduates are emigrating. There are fewer than 200 registered podiatrists for our population of about 48 million people.

However, with increasing access to health care and awareness of the benefits of a healthy lifestyle, there is a growing demand for foot care, especially for children and people with foot problems associated with diabetes and arthritis. Nevertheless, many sectors of the South African population still don’t know what a podiatrist is or what we do. As our population changes more people will need foot care.

A podiatrist is really a ‘doctor of the feet’. We diagnose and treat foot disorders and abnormalities. This is done in many ways. Biomechanical examination involves assessing the whole lower limb and its function and then prescribing the appropriate treatment to maintain or restore normal mobility or function.

Many systemic diseases affect the feet and may even be diagnosed from foot symptoms. As a podiatrist you may need to refer your patient to a specialist for further management. A large part of podiatry treatment involves the skilled use of sharp instruments to treat corns or callus or possibly perform detailed corrective surgical procedures on toe nails.

Some of the conditions that Podiatrists treat are fungal infections of the feet and toenails; corns and calluses; ingrown toenails; foot ulcers in diabetes; causes of foot pain in arthritis. Most podiatrists incorporate orthotics and insoles into their treatment when necessary. 

The assessment and management of childrens’ foot problems forms an important part of a podiatrists work, whilst some podaitrists are skilled in the managemment of foot problems arising from sports. Nowadays, prevention of foot problems has become very important, so foot health education is also part of podiatry practice.

Although there is no official specialist register for podiatrists, many of us have developed ‘special interests’ in sports injuries, chronic disease, children or the elderly.

The day to day work of a podiatrist is interesting and varied. Giving relief from pain or diagnosing the cause of a foot problem is both challenging and stimulating. You do need to be able to work alone but also need to be a ‘people person’ to relate to the different patients you meet every day. Most podiatrists are in private practice, but we hope there will be an increasing deployment of podiatrists in the State Health services in future. For example Limpopo Province appointed their first graduate podiatrist.

To practice in South Africa you have to register with the Health Professions Council of South Africa.(HPCSA). This means that you become part of the Team of health care professionals providing care to South Africans and that you adhere to ethical standards.(By the way, it is illegal to practice as a podiatrist in South Africa if you are not registered with the HPCSA. So always check the credentials of a podiatrist).

To become a podiatrist in South Africa requires four years of full-time study at the University of Johannesburg. You will obtain a Bachelors degree and be able to go into practice immediately. Although bursaries are limited I believe this is changing as Provincial Health Departments begin to realise the value of foot care. Your entrance is dependent on your Admission Points Score (APS) or your M-score.

There are still vacancies for 2009 enrolment. So why not contact the University of Johannesburg – they reopen on 5th January 2009 – at 011 559 6167 or www.uj.ac.za

However you welcome in the New Year, dancing  the night away, taking it easy at home with friends, walking on the beach on an exotic island or if you are unlucky, at work! Enjoy yourself and I wish you all good foot health and happiness in 2009.

TAKE CARE OF YOUR PAIR! SEE A PODIATRIST 

Holidays: Sore Feet and Sunburn

Indian Ocean Shore line - Wilderness SA
Image by Donnie Ray via Flickr

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

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