Chilblains

  • By Judith Sullivan
  • 05 Apr, 2017
08 Jan, 2017
Author/blogger Reggie Simpson  with thanks to the Society of Chiropodists and Podiatrists and NHS Choices

What are they and how do you treat them?

Season’s Greetings from my birthplace of Ohio (yes, one of the defining US swing states for Donald Trump! ).

I managed to miss out on the heavy snow and sub-freezing temperatures (-24C at their lowest). Temperatures then rose briefly to 15C and then returned to the average norm (-1C to 6C). With the Lake Erie effect, the wind chill makes it even colder. Potential chilblain weather .

What are they?

For those who like to study the etymology of words, ‘chilblain’ comes from the Old English ‘cele’ – chill/cold + blain/‘blegen’ – a sore. The modern medical definition of chilblain is pernio or perniosis, and is a localised form of vasculitis.

Chilblains are small, itchy, red (and sometimes purple) swellings on the skin, which can become increasingly painful. They usually develop several hours after exposure to the cold. They typically cause a burning and itching sensation and when they dry out they can cause cracks in the skin.   It is important not to scratch the skin as it can break easily and become infected.

Chilblains most often occur in the toes, fingers, the face (particularly the nose) and the earlobes. They can also occur in areas exposed to pressure, such as bunions.

Chilblains should not be confused with frostbite.  Frostbite is an injury to the body that is caused by freezing and exposure of the body to cold temperatures for a prolonged period of time. Frostbite can permanently damage the body, and in severe cases can lead to amputation. Those who have reduced blood circulation and those who don’t dress properly for the extremely cold temperatures face increased risk of frostbite.

Although chilblains are most associated with cold weather, damp conditions can also bring about chilblains. The condition can also be worsened by poor circulation, often diabetics and the elderly people have poor circulation and prone to peripheral vascular disease, low body weight, poor nutrition or health, lack of exercise, hormonal changes, genetics and family history.  Also those who have connective tissue disease such as lupus erythematosus, anemia, Raynaud phenomenon, systemic sclerosis may be more prone to chilblains. Those who smoke are more at risk of chilblains as nicotine constricts blood vessels.

How do chilblains develop?

Chilblains develop when tiny blood vessels under the skin constrict because of any or all of the aforementioned conditions, reducing the flow of blood until the area warms up and causes some leakage into surrounding tissues. You may remember how exposure to cold weather makes your skin tingle as it warms up, but this does not necessarily mean you have chilblains.

How do you prevent them?

The best advice is prevention, and chilblains can be prevented by keeping your legs, feet, and body warm, especially if you have poor circulation and your mobility is limited. Wear warm clothes, socks and gloves to keep to hands and feet warm which are not too tight, keep your whole body warm and if needed carry around a form of portable heater such as the G-Tech Hand Warmer – (a portable warming pouch offering instant heat anytime, anywhere). Warm up slowly when cold and do not use too hot direct heat. Exercise and move about don’t sit for too long so that the blood flow keeps pumping; especially before and during outdoor activities. Avoid medicines that might constrict blood vessels: this may be problematic with some blood pressure medication, please discuss alternatives with your GP, also known to constrict the blood vessels are caffeine, decongestants, diet aids and smoking.

How do you treat chilblains?

Chilblains often get better on their own without treatment after a week or two.  However, there are various home remedies such as soothing lotions you can use such as witch hazel and calamine or speak to your pharmacist.  If your chilblains continue to be a problem or have ulcerated, get advice from your podiatrist, who may refer you on to your GP for medical treatment. Equally, your GP may refer you to your podiatrist for specialist chilblain and related foot care. If your chilblains are severe and keep returning, your GP may recommend taking a daily dose of a medication called Nifedipine. This works to relax the blood vessels and improve circulation.

Other treatments may include:

Topical corticosteroid cream applied accurately for a few days to relieve itch and swelling.

Antiseptic dressings, antibiotic ointment or oral antibiotics for secondary infection if required.

You can read more about how to keep warm in very cold weather and looking after your health in the winter in the following links:

http://www.nhs.uk/Livewell/winterhealth/Pages/Verycoldweather.aspx

http://www.nhs.uk/Livewell/winterhealth/Pages/Winterhealthhome.aspx

Don’t suffer in silence! Visit Betafeet Podiatry today, conveniently located in Hemel Hempstead and Tring.





By Judith Sullivan 18 Jul, 2017
Andre was an associate podiatrist at Betafeet for five months.  His contributions to the practice were considerable.  Sadly we lost him to a higher professional and personal calling.

After a stellar educational background and career, Andre joined babylon Healthcare Services, UK based, with a view to helping them set up and deliver the first digital healthcare pilot services to the NHS.   Digital healthcare is a cluster of new and emerging applications and technologies that exploit digital, mobile and cloud platforms for treating and supporting patients. Digital Healthcare is being applied to a  wide range of social and health problems, ranging from monitoring patients in intensive care, general wards, in convalescence or at home – to helping doctors make better and more accurate diagnoses, improving drugs prescription and referral decisions for clinical treatment.

Rwanda then beckoned.

Since joining babylon Rwanda in April 2016, Andre has been instrumental in successfully setting up and launching Africa's fastest growing digital healthcare service.  According to Lindsey McConaghy, babylon's PR manager, 'Rwanda has a population of around 12 million but doctor numbers are in the hundreds. There’s an imbalance between supply and demand'.  

Digital Healthcare is not without its sceptics nor controversies - at what point do you let an app do the diagnosis?  Will GPs embrace technology in this way?

Here is Andre's report about his experiences in Rwanda:  

Rwanda is a small ambitious country known as the land of 1000 hills with a population around 12 million and a rapidly growing economy. It has rolling hills for as far as you can see, a rain forest, gorillas and volcanoes, making for quite the site to any visitor. However, it is also known for the 1994 genocide in which over 1 million people were killed in 100 days across the country.

This tragic event has led to some very big health issues, which the country still faces, but thanks to a range of donor funding and strong political leadership, the country is on its way to quickly becoming a middle-income country.

As countries shift from low incomes to middle income economies, health issues become complex, where the country can face a mix of communicable disease (ie. malaria, HIV, TB) and the introduction of non-communicable disease (ie. diabetes, high BP, cholesterol) with changes in lifestyles.

Now you are probably wondering what this has to do with podiatry?

Well, as clinicians we play a role in the overall wellbeing of every patient that walks through our door for treatment and we become advocates for a number public health issues. While our specialist area is focused on the foot and ankle, an understanding of the bodily systems is imperative for understanding the impacts on the lower limb. This allows us to transition from clinical practice to other work streams such as health policy, public health programmes, service management and research.

As a podiatrist with a public health background, the increase of diabetes and chronic conditions in developing nations has become of personal interest. In many of these countries, diabetes is poorly understood and without proper prevention and care, can lead to a large economic burdens on the healthcare system. In 2012, the UK alone spent a whopping £639 million on foot ulcers and £662 on lower limb amputations, so the prevention and monitoring of these conditions is of paramount importance in the developing world.

The quality of life for individuals with diabetes is also drastically affected if not controlled, impacting mobility, footwear and overall lifestyle. Additionally, chronic ulceration and limb amputation, creates an increases risk (approximately 80%) of mortality within the first 5 years post amputation.

How did all this lead me to Africa, I hear you say?

In April of 2016, I (sadly) departed from the Betafeet clinic to implement an mhealth project in Rwanda in partnership with the Ministry of Health. This project, allows patients across the country to speak with a doctor and receive a prescription via SMS through their mobile phone, reducing the travel time, wait time and expense of receiving care from one of the local physical hospitals. The system is also working on monitoring both communicable and non-communicable disease using artificial intelligence, engaging patients to take ownership of their health.

This could be a major milestone for a country with stretched resources. To put things into perspective, over 80% of the population lives in remote areas of the country and works in the ‘in-formal’ sector as subsistence farmers with an average income of 2-3 dollars per day, which is not very much. To receive care, a patient may travel over an hour to reach their nearest hospital where a doctor is present and then wait anywhere from a few hours to a few days to receive the care they need. However almost 80% of the population already has a mobile phone.

Appropriate access to clinical care is a large part of the prevention and management of many conditions and undertaking this project has been a great experience. As a clinician, I have had the opportunity to utilise my knowledge to develop operational pathways and input into the technology development to shape the way patients receive their care. 

'Footnote'

It is with this experience I now look to move on to my next adventure focusing on Aboriginals and the utilisation of technology in the prevention of major non communicable disease such as diabetes.

Final comment from Reggie Simpson and Betafeet Podiatry

 We wish Andre the very best in his future and thank him for this interesting blog account.  We look forward to his next blog focused on his work with the Aboriginal population.  

By Judith Sullivan 12 Jun, 2017
By Reggie Simpson
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