Chilblains – a winter blight that can affect us at any age…a blog by UK podiatrist Martine Abrahams

The other day I was asked by one of my patients about chilblains – not something one hears much about these days, so I decided to jot down some info on this bone fide medical condition

chilblains-smallChilblains, otherwise known as ‘pernio’, are small, itchy, painful lumps that can develop on the skin.  Found on eithers hands or feet, they are caused by local poor circulation when the skin is exposed to cold.

Not a prolonged condition, these irritating lumps settle after about 7 – 14 days but if you are susceptible to this abnormal response to the cold, you should try your best to keep your extremities warm in winter.

Who suffers the most from chilblains? – Chilblains can strike at any age and both men and women suffer in equal number.  It’s thought that around 1 in 10 people in the UK suffer from chilblains, not only hands and feet they can also occur on the nose and earlobes – anywhere that becomes cold quite quickly, for example, horse riders might have problems with their lower legs and thighs….

chilblain-handsCauses of chilblains  – The reasons why some people are susceptible and others not is unclear, but we do know that the small blood vessel lying under the skin constrict when cold, which in turn reduces the amount of blood supply getting to the area.  As the skin warms there is some leakage of fluid from the blood vessels into the local tissues.  Inflammation and swelling result, leading to the symptom of chilblains.

Prevention is better than cure with this uncomfortable complaint:

  • One of the key ways to help avoid the chilblain taking hold is to avoid warming your self up too quickly after exposure to cold – avoid hot water bottles, sitting next to direct heat etc
  • Keep head, ears, hands, feet warm when outside in cold weather (heated glove and sock inserts can be a real help)
  • Keep the body as warm as possible – loose layers are best to trap body heat
  • Keep body and extremities as dry as possible
  • Some medication can constrict the blood vessels which leads to chilblain susceptibility – beta-blockers are one example

chilblains-foot-2Chilblains are uncomfortable but do not tend to leave lasting damage. If they become a real issue your doctor might consider a drug to help dilate the small blood vessels, but this is rarely indicated.

So, condolences if you are a chilblain sufferer!  Also, apologies for the lack of really constructive solutions for this sometimes debilitating problem.  The good news is that you only have another 4 or so months to avoid the cold – spring will be here before you know it!

One New York fashion editor swaps heels for flats – your feet will thank you says Martine Abrahams, UK leading podiatrist

American Elle’s fashion editor, Lauren Sherman declares that she’s fed up of the constant pain and discomfort caused by the heels that have gained almost ‘uniform’ status for fashion industry set.

As  demonstrated in this amazing 3D xray, heels push the foot forward, causing the toes to bend in an unnatural way.  Pressure also builds up on the soft pad under the toes, referring pain back to other structures of the foot, i.e. ankle and metatarsals.

I have explored the blight of bunions in previous blogs, these common deformities are another uncomfortable result of wearing heels.

With my podiatrist hat on, I applaud the actions of Ms Sherman and hope that others will follow where she leads.  Is now the right time to warn her of the foot arch damage potentially caused by flat shoes? Maybe another time…!

As Victoria Beckham’s bunions hit headlines in UK, leading podiatrist Martine Abrahams shines a light on this painful and ugly condition

vb-bunion-oct-13As Victoria Beckham’s bunions make headlines in the UK (once more!), I thought I would explain the condition, solutions and recovery for those of you in a similar predicament.

Bunions are certainly not life threatening, but can cause a great deal of grief, pain and discomfort for sufferers.   They can be hereditary, and can often be caused by external pressure from ill-fitting shoes or regular wearing of vertiginous heels – á la Posh Spice!

A bunion is a bony lump that forms at the base of the big toe, where it attaches to the foot.  Often, the big toe deviates towards the other toes. When this occurs, the base of the big toe pushes outwards on the first metatarsal bone – which is the bone directly behind the big toe – forming a bunion.

As a bunion occurs at a joint where the toe bends during normal walking, the entire body weight rests on the bunion at each step, causing a great deal of pain. They are also vulnerable to excess pressure and friction from shoes and can lead to the additional problem of calluses and painful corns.

Diagnosis:

Bunions are usually easily recognised thanks to their classic shape, but often an X-ray will be performed to check the extent of the deformity.  A blood test might also be arranged to rule out various forms of arthritis.  A formal diagnosis enables the best course of treatment – insoles, orthopaedic shoes, medication, surgery or other treatment…

Many bunion sufferers live with their toe deformity, wearing increasingly comfortable shoes and avoiding footwear that cause severe pain.  It’s probably a good idea to consult with a podiatrist who will then refer you on to a Podiatric Surgeon if surgery is a viable option.

Treatment options:

bunion_and_xrayYou podiatrist may suggest over-the-counter pain relief, as well as medication to relieve the swelling and inflammation.  A heat pad or warm footbath may also help relieve the immediate pain and discomfort – ice packs can also help.

If your bunion isn’t persistently painful and you take action early on, changing to well made, well-fitting shoes may be all the treatment you need.  Your podiatrist may advise an orthotic device that can improve and realign the bones of your foot (i.e. bunion pads, splints, shoe inserts, bespoke insoles and uppers…)

Surgery may be recommended for some bunions, but only when symptoms are severe enough to warrant such intervention.

Surgery for a bunion, called a bunionectomy, is done in hospital usually under general anaesthesia.  The surgeon can often realign the bone behind the big toe by cutting the ligaments at the joint. For a severe bunion, you may need to have the bone cut in a technique called an osteotomy. Wires or screws may be inserted to keep the bones in line, and excess bone may be shaved off or removed. Potential complications of surgery include recurrence of the bunion, inadequate correction, overcorrection (the toe now points inwards), continued pain, and limited movement of the big toe.

Recovery:

It is suggested in the attached press clipping, that bilateral bunion correction cannot be performed – this is not the case, often sufferers choose to have both feet operated on at the same time as this obviously reduces overall ‘downtime’.  However, bunion recovery can be painful and difficult, with the patient having to rest with their feet up for several weeks whilst the bone heals.

And, bad news for Victoria Beckham, heels and shoes with tight toe space must be avoided for several months after surgery – up to a year in some cases!

Bunions are unsightly and cause a great deal of discomfort on a daily basis.  Seek advice and help from your local podiatrist, as there are many ways we can help make life easier for you – and your feet!

vb-heat-oct-13-1

Foot abuse, we’re all guilty of it BUT do you know how vital feet are to the whole body’s wellbeing? Leading UK podiatrist, the London Nail Clinic’s Martine Abrahams explains

Foot abuse, we’re all guilty of it BUT do you know how vital feet are to the whole body’s wellbeing?  Leading UK podiatrist, the London Nail Clinic’s Martine Abrahams explains

foot-absueWhat’s the big deal with feet, you might ask? Well, the body is a finely tuned organism with each component joined to the next, all keeping in close communication via the nervous system.

The most vital part of this delivery structure is the connective tissue, which acts as a type of rigging, keeping messages flowing from one part of the body to another.  These tissue groups are known as ‘meridian’ or ‘fascial’ lines. (Wikipedia.  Connective tissue: biological tissue that supports, connects, or separates different types of tissues and organs of the body.)

Interestingly, all groups of meridian lines start or end at the bottom of the foot.  Any imbalance of any of the body’s muscle groups can put the whole line out of sorts e.g., if the hamstring is tight, then symptoms might be felt in the calf, back of knees, back, neck – and, you might not realise it, but also the feet!

Any tension release along a compromised meridian line can help relieve symptoms in other parts – the domino effect. As the bottom of the foot contains a high concentration of nerve endings, it is the most straightforward area to tackle, and you don’t really need a specialist therapist to help.

ball-rolloingGently rolling a golf ball under your feet can go a long way in relieving all sorts of body wide aches and pains.

Make sure you use your own body as a guide – a pain scale from 1 – 10 can be useful, (where a score of 1 is no pain and a score of 10 is the worst pain you could describe).  Do not roll the ball to a pain level of 8 or above as this can have a negative effect on the body.

Let’s put an end to foot abuse, our feet deserve better! 

As the sportsman’s injury, plantar fasciitis makes sports headlines in the USA, UK podiatrist, Martine Abrahams sheds some light on this common, often debilitating condition

High profile athletes might create headlines, but this painful condition can affect us all.

The plantar tendon and its function:

Albert Pujols, player for Los Angeles Angels of Anaheim, the latest elite athlete left sitting on the bench, thanks to plantar fasciitis

The plantar tendon runs the length of the bottom of your foot, spanning the area from the base of the toes to the front of your heel. The two ends of the tendon attach at the base of the toes and at the front of the heel bone by means of fascia, a strong fibrous membrane. The plantar tendon keeps the arch of the foot from flattening completely when the foot bears weight, providing cushioning and shock absorption during walking, running or standing. This tendon also allows you to point your toes.

Albert Pujols, player for Los Angeles Angels of Anaheim, the latest elite athlete left sitting on the bench, thanks to plantar fasciitis.

What is Plantar Fasciitits?
When the plantar plantar fascititis 1fascia tissue is stressed, small tears can occur, which in turn, causes extreme pain during movement or even weight bearing – or any movement that creates a pull on the tendon.
Stressors can be varied in nature and include: regular exercise/sport, heel striking during striding, tight calves, inflexible Achilles tendon and wearing high heels.

 

 

Other common causes of plantar fasciitis include:

  • Wearing inflexible or worn out shoes
  • Very low or high arches
  • Being overweight
  • Spending long hours on your feet
  • Tight calf muscles or tight/stiff ankle muscles
  • Walking barefoot in soft sand for long distances
  • Those with natural flat feet (hyper-pronation) seem to suffer this condition more than others

Symptoms of Plantar Fasciitis:
Pain can be extreme and is often felt on the underside of the heel and more intense at the start of the day: “You almost want to pee in your bed rather than go to the bathroom,” Pujols told USA TODAY Sports. “It’s really painful in the morning.”

Treatment:
This condition can be difficult to treat and, perhaps most annoying for those who enjoy exercise, is that the main solution is rest, combined with physiotherapy, anti-inflammatory medications, corticosteroid injections and/or night splints to stretch the injured fascia.
As a short-term pain relief measure, you can roll the bottom of the foot back and forth over a tennis ball or cold bottle of water, to gently stretch out the tendon and disperse the fluid that pools there.

Stretching exercises can also help:

Orthotics can be worn to help support the foot arch:

Ultimately, prevention is probably better than cure where plantar fasciitis is concerned. Wear good shoes with adequate arch support; stretch the area well before and after exercise and regular foot massages will all help.

Festival-goers BEWARE – fungal spores lurk in dark, damp conditions, waiting to take hold in those vulnerable nail beds!

glast sunshineGlastonbury Festival 2013 is upon us and I hope all you intrepid campers have fun in the sun, but, JUST in case the British summer does what it does best, please remember to take good care of your feet. Clearly foot care will not be your number one priority, but maybe it should move up the list – at least a little!

Why? Fungal spores love dark, damp and dirty conditions and the fields of the Glastonbury Festival provide the perfect breeding ground – especially when the heavens open!

During the summer months I see an increasing number of holidaymakers who made the brave decision to camp in the UK, only to come home with fungal nail infections and Athlete’s Foot.
Fungal spores enter via any small break in the skin integrity and soon take hold. Once established, the infections can be difficult to eradicate.

Here are some practical tips to help avoid nail fungal infections during the long weekend:

  • Trim your nail short before you go
  • Dry feet thoroughly after bathing – try to keep your towel clean and dry (!)
  • Wear 100% cotton or wool socks – helps absorb the sweat and moisture
  • Wear shoes that have wide space for your toes to ‘breathe’
  • In wet and moist areas, avoid walking in barefoot
  • If possible, wear shower shoes, sandals or flip flops when going to public areas
  • Before going to bed, try to thoroughly dry your feet
  • NEVER share shoes and sandals with others
  • Avoid injury to nails, nail beds, and nail plates

If you do suspect a fungal nail infection has taken hold, then book in to see your local podiatrist. Over-the-counter solutions are not particularly effective and you may well need a more sophisticated treatment such as state-of-the-art Lunula Laser.

Symptoms of nail fungus:

  • Thickened nails
  • Crumbly or brittle nails
  • Nail distorted in shape or separated
  • Nail with no lustre or shine
  • White, yellow or brown coloured nail

glast wet 1How does it work? Unlike conventional solutions, the Lunula Low Level Laser is the first treatment to tackle the root cause of nail fungus – not just the symptoms. Known as the ‘COLD’ laser – this new device does not rely on heat to treat, instead utilises two light wavelengths, 635nm and 405nm, to tackle differing cell membranes.

Have a fabulous time – if nothing else, keep your feet happy by avoiding walking barefoot around the venue, and let’s hope you will all be basking in sunshine. (I’ll save my sunscreen lecture for next year!)