Summer Loving:  get your feet shipshape!    

  • By Judith Sullivan
  • 09 Jun, 2017

Take a good, hard look at your feet.  Are they ready for the summer?    

By Reggie Simpson published in large part in the summer edition of Tring Living

The warm, sunny weather in March has already had some people out in shorts and sandals.

Whether exposed in open footwear or encased in closed shoes), you need to minimise potential abuse to your feet. Contrary to winter, feet are more susceptible to problems in the summer.

Common foot complaints

 Here are some traditional foot issues and our take on how to manage them, ‘home or away’:

The problem: Fungal infections

Athlete’s foot is one of the most common fungal infections. It causes flaky, red skin with white cracks that can be agonizingly itchy. Fungal infections in the nails can also cause problems and shouldn’t be ignored as, if left untreated, they can spread to other nails.

Home solution

·      Anti fungal treatments

·      Soak your feet in Tea Tree oil

·      Use antibacterial wash such as Hibiscrub®.

·      Consult pharmacist for other over the counter treatments

Professional help

You only need to visit your GP or a podiatrist if your Athlete’s foot persists or is causing you wider discomfort or other foot problems.

The problem: Ingrown toenails

This is a painful condition when the toenail has grown into the skin on the side of the nail bed. It can become infected.

Professional help

It is best to seek professional help from a podiatrist who can remove the spike of the nail and cover it with an antiseptic dressing. In extreme cases, antibiotics and nail surgery may be required.

The problem: Corns and calluses

Corns are small but painful areas of thickened skin that are caused by repeated pressure on the area, such as from socks and tights or badly fitting shoes.   Foot position and/or how you walk can also contribute. Heredity may also play a part.

Calluses usually occur on the sole or heel of the foot.  Corns and calluses are symptoms of an underlying problem. You should only self-treat (using Compeed© for example for corns) if you know the cause and you've spoken to a specialist about the best way to manage them. Shaving away your calluses on your own may only cause bleeding and discomfort and could lead to infection.

Professional help

A podiatrist can help to treat corns or badly callused areas using a sharp blade to remove the thickened area of skin. This should help reduce pain and discomfort.  Further advice on self-care and prescribing special insoles can also be given.

The problem: Bunions

Bunions are a misalignment of the joint at the base of the big toe. It’s usually genetic, and you can live with it most of the time. Problems are caused when it becomes inflamed and painful, usually at the part where it meets the shoe.

Flat shoes can actually make the problem worse as they don’t provide any support, as can high heels or pointy shoes.

Professional help

If bunions have become painful then they may require surgery to correct the misalignment.

Verrrucae (warts)

Verrucae are caused by the Human Papilloma Virus (HPV). The virus invades the outermost layer of skin and causes visible lesions. Our immune system is far more active in the deeper layers our skin, which explains why verrucae are so resilient. The virus is contagious and can be spread.

Home solution

You can try over-the counter solutions such as Bazooka© or salicylic acid-based treatments, but verrucae tend to persist without professional help.

Professional help

Betafeet Podiatry offers the following verrucae treatments:

·      Salycidic acid (prescription strength)

·      Cyrotherapy (freezing)

·      Falknor’s Needling (requires surgery consent)

·      Swift Microwave Therapy (new): https://www.betafeetpodiatry.co.uk/swift-microwave-therapy-for-verrucae

Final thoughts

This list is by no means exhaustive, but there are some other feet health issues to also consider:

Diabetes

Diabetics need to be especially careful about their feet; a lack of sensation when, for example, treading on potential hazards, as simple as stepping on a thorn, could lead to life changing complications due to poor healing ability.   Aside from daily foot checks, diabetics should not walk around barefoot. Wearing socks and appropriate footwear helps to 

decrease the risk of developing blisters and sores, which could lead to wider infection.

Gout

This is by no means an old man’s illness or old wives’ tale. Gout can be hugely painful and debilitating at any age. Gout is a form of arthritis and can be controlled by medication or following a diet. 

Climate plays a big role for gout sufferers especially when it’s hot and humid, which can lead to dehydration and triggering a gout attack.   So think on your feet when venturing out in the summer.

***

Of course, the best treatment for any or all of foot ailments is to avoid them in the first place. Here are some tips:

·      Keep your feet, especially the area between your toes, clean and dry.

·      Air and change your shoes and socks often to help keep your feet dry.

·      Avoid synthetic socks (nylons) where possible.

·      Exfoliate your feet regularly.

·      Make sure you wear sandals in public showers or wet areas.

·      Stay away from talc on the feet.

·      Moisturise your feet daily.

·      See a podiatrist when you can no longer self-manage.

June is ‘Feet for Life Month’ and you can find out more information on foot health with free leaflets and tips at the College of Podiatry website: www.feetforlife.org .

 

 


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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