Monday, June 12, 2017

Let's talk Curly Toes




It may be a bit of a shock to learn it is more common to have buckled toes than it is to have straight ones. Straight toes in children are quite rare. Only in a very few cases is there any real concerns, and usually in such cases the child will have already report other painful symptoms and or an unstable gait or lack of normal growth development.



Toe deformities are of two types, congenital and acquired. Congenital deformities are inherited which is governed by genetics. Two common congenital deformities affecting the smaller toes are webbed feet (syndactylism); and extra toes or polydactylism. Currently the in the Guinness Book of Records 2016, the largest number of toes on one foot, is seven. Neither syndactylism or polydactylism present real problems nor it is usual to remove the extra toes early in life.



During the Middle Ages when removing a toe was life threatening broad shoes (Bear's Paw) became vogue. Many believe it was because the King of Spain had polydactilism fashions changed to accommodate. In the Connan Doyle's, The Hound of the Baskervilles, the solution Homes seeks involves congenital polydactilism.



Acquired deformities describe a process which usually involves post-traumatic repair. So a major cause of toe deformities is either one off trauma such in stubbing the toes; or miro-trauma where the damage is built up over many years. In acute episodes, pain is usually present whereas in the latter, deformity happens over such a long period of time, pain is not a factor. There are two types of acquired toe deformities i.e. fixed deformities which involve osteoarthrosis: and buckled toes which are non-arthritic. The names given to these conditions are very descriptive.



When the toe is bent and fixed at the first knuckle, this condition is called "a hammer toe". If the toe is buckled and fixed at the second knuckle, then you have a mallet toe. Some people have both. Painful fixed toes may need to be surgically treated.



To make sense of the non-fixed deformities of toes we need to accept the foot changes shape when we walk. The muscles and tendons not only control this function but they also set the timing for movement. When the action of muscles are upset these may cause the toes to buckle. If the muscles outside the foot (extrinsic) are not working in unison, the toes are pulled away from ground contact, these are known as retracted toes.



If it is the muscles within the foot (intrinsic) that are at fault then the toes claw. For most of us these deformities have no serious impairment to normal activities and provided shoes have adequate room then we can live in total harmony with our curly toes. In others, such as people suffering from rheumatoid disease or diabetes mellitus, the condition is part of related pathologies.



Non-fixed toe deformities respond well to conservative treatment with customised splits which does not involve surgical treatment. Consult your podiatrist for more information.

Footnote
Many concerned parents worry needlessly and seek medical/podiatric advice because the toes of their offspring, curl. However, I am very pleased to report parents’ concern is usually ill founded and they generally have nothing to worry about. They are of course, quite right to seek expert opinion and usually this is met with sympathetic reassurances.

Reviewed 12/06/2017

Tuesday, June 6, 2017

Let's talk verrucae (plantar warts)




Verruca and plantar wart are the same thing with the former English and the latter the Latin name. A human papilloma virus invades the cells of the growing epidermis and causes a local hypertrophy (benign thickness) of the skin. A wart may present as a circumscribed lesion with a cauliflower appearance and black or brown pepper pot like spots within. There is infinite variation in the shape and size of warts but often they appear as a single raised growth or irregular shaped mass. Warts occur anywhere and in people of any age, but are most common in the young.



What is seen is deceptive as the bulk of infected tissue lies beneath the skin surface and invariably involves local blood vessels and nerve tissue. Plantar warts can be extremely painful with pain often reported with the first few steps in the morning. Painful areas on the foot can be difficult to diagnose, warts are frequently mistaken for corns or a foreign body, such as a splinter of glass, a hair, or a bristle. It is very important to identify a pigmented mole (melanoma) at the earliest and if in any doubt, see your doctor or foot physician for confirmation.



Warts may disappear spontaneously with or without treatment. Veruccae can be self-treated (see your pharmacist), but persistent and painful lesions need prescribed care from your doctor or podiatrist. Treatments include chemical, cold or electrical cautery agents and these are sometimes administered under local anaesthesia.



Although warts can be comparatively minor transient lesions they are contagious so it is prudent to take precautions. Viral infections are picked up by physical contact and can live outside the body especially in wet conditions e.g. changing room floors.



Saturday, June 3, 2017

Let's talk blisters




Increased skin hydration, as in sweating during exercise, reduces the ability of the outer layer of epithelial skin to cope with dynamic friction. Unable to act as a sheer protector when local temperatures increase, pooling of fluid results and when a cavity forms within a split in the stratum spinosum. The simple blister contains clear transudate and provided the blister site has no secondarily infection significant inflammatory infiltrate is not always observed. The most vulnerable parts of the foot are the back and bottom of the heel although the toes can also be effected.



Simple epidermal blisters do not pose serious health risks although they are irritating and guaranteed to ruin a good workout or a long walk. Blood blister arise when dynamic friction causes the skin to bleed into the blister. This is often accompanied with burning pains.



Simple blisters are best left alone because careless treatment can manifest into more serious infections. Tempting as it may be, "popping" a blister by pricking it with an unsterilized needle is not recommend and tearing off the top skin is definitely not the way to go. In most cases small, unbroken blisters should be strapped tightly with an adhesive bandage to give a sturdy ‘second skin’ and reduce the effect of sheer whilst encouraging fluid reabsorption.



In the case of painful unbroken blisters, home treatment may involve disinfecting a dressing pin by either boiling it or cleaning it with an alcohol wipe before puncturing the blister in two separate places to encourage draining. This takes the pain away and should be followed by an antiseptic footbath such tablespoon of common salt dissolved in warm hand-hot water (46 0C) for 10 minutes.



Simple ways to prevent blisters is to maintain good foot hygiene at all times. Wear comfortable sports shoes appropriate to activity and regularly inspect and replace them when excess wear is apparent. Socks should be acrylic/cotton mix as these retain less moisture and dry quickly. Socks with low friction against the foot helps reduce plantar shear and many athletes wear their socks inside out to prevent seams rubbing on the toes. Some people wear two pairs of socks (one thick, one thin). This allows the sheer to occur between the layers of socks rather than between the shoe and the skin. Socks with reinforced heels and toes (double knit or visco-elastic padding) also can help. Wherever possible try not to get the socks wet.



Things to avoid include coating the feet with petroleum jelly or another such lubricant in the belief these helps decrease surface friction, However, thick lubricants also prevent sweat evaporation and increase skin hydration making the vulnerable areas more prone to blister. Coating the feet with astringents such as surgical spirit dehydrates the skin which may result in cracking (fissures) and or blisters. By preparing yourself for the event this usually means blisters are dealt with well before competition. To prevent other sports injuries always warm up and warm down prevent other sporting injuries.



Tuesday, May 30, 2017

Let's talk corns and callus




The skin is made up of layers: the epidermis is the outer surface layer and the dermis a dense fibrous tissue which lies beneath. Deeper subcutaneous tissues composed mainly of fat cells provide protection against heat and cold, pressure and other forms of injury. Skin thickness varies over different parts of the body with the thickest in the soles of the feet.



The outer epidermal cells are composed of keratin and are replaced every 28 days when they naturally shed. The process is known as keratinization (or cornification) and is modified by environmental factors such as pressure and friction. The cells of skin on the soles and palms contain far more keratin than the skin on other parts of the body.



When the outer layers of skin are subjected to general mechanical stress this causes the skin to thicken protectively. The localized thickenings of the skin, i.e. callus or hyperkeratosis, formed is painless. When the skin surfaces are subjected to more intense intermittent pressure and friction this causes painful callus.



Prolonged complex ‘cork screw tension’ across skin surfaces especially over bony prominences results in more painful corn formation. Outwardly, the corn appears to be growing from a core or root. Pain is due to the thickened mass transmitting pressure to sensitive nerve endings within the surrounding subdermal tissues. Only certain skin types have a built-in predisposition to produce hyperkeratotic plaques, hence not everyone has problem hyperkeratosis and the reason for this remains unknown.



Pain relief comes from removal of excess skin usually with a sharp scalpel. However, this is almost impossible to do safely for yourself and needs an expert (podiatrist) to do this on your behalf. Anyone with failing eyesight, or those coping with reduced blood supply to the feet, or suffer systemic disorders like diabetes mellitus should never attempt self-treatment. In the case of chronic corns treatment options are palliative and not corrective, routine skin reduction will however, relieve symptoms. In any case, successful outcome is dependent upon removal of all external shearing stress.



Corn paints and medicated plaster should be avoided as these products may contain acids which can prove hazardous to those with poor circulation or impaired immune response. Non-medicated padding may bring temporary relief.

Monday, May 29, 2017

A brief history of dance crazes and related injuries




The frenzy caused by the popular celebrity dance competitions across the globe has resulted in an alarming increase in reported dance related injuries from couch potatoes wanting to be the next Ginger Rogers and Fred Astair. Medical experts are warning people suddenly taking to the dance floor after years of inactivity risk a range of agonising injuries because the tricky routines of tango or foxtrot expose poor levels of fitness. The number of people taking ballroom classes has doubled since the shows began and now more people are being treated for snapped tendons, sore feet, twisted ankles and back pain.



Previously knee injuries were more common due to the craze for step aerobics, now the incidence of ankle and foot injuries has increased due to ballroom dancing. Different dances carry different risks with the jive or a quickstep putting tremendous pressure on the balls of the feet. Slower dances such as the foxtrot and rhumba put stress on the muscular of the leg causing strain and shin splints. Poor technique as much as lack of fitness is likely to result in injury for amateurs, the experts warn.



People are advised to build up their fitness, and warm up and stretch thoroughly before attempting ambitious moves. The most common injuries reported are ankle strain, knee injury, lower back pain, foot strain, hamstring and quadriceps injury, as well as shoulder strain.



Whenever a dance craze takes hold there always follows a spate of related injuries and the current situation is not new by any manner of means. The tarantella is an Italian folk dance whose origins date to the Middle Ages. The choreographed steps are associated with choremania, (a psychological disorder), specifically tarantism, which involved frenetic, spontaneous dancing caused by the bite Latrodectus tarantula spider. The venom caused headaches, fainting, shortness of breath, giddiness, convulsive movements (shaking, trembling, and twitching), as well as possible hallucinations. Tarantism caused people to dance all day until they literally expired. Tarantism is considered to be similar to the choremania outbreak in Germany of Johannistanz (St. John's Dance, also known as Veitanz (St. Vitus Dance or Sydenham's chorea).



St Vitus is the patron saint of epileptics, actors and dancers. When tarantism was at its height and because it affected so many of the community attempts were made to make it appear normal behaviour including musicians playing mandolins, tamborines, or other instruments as the taranti danced. This is thought to be the origin of the folk dance and the tempo in music notation. So many people reported having a religious experience during their long dancing episodes that dedicated religious pilgrims adopted ritualised dancing to achieve trance and ecstatic states. The headaches, shortness of breath, muscle soreness, and exhaustion related to extended physical exertion.



Similar symptoms were reported in the 1930s and 40s, when the Western World became preoccupied with body image and youth culture. Marathons of all types took place and dance marathons in particular were extremely popular with many people literally dancing until they dropped. Swing dances were even more athletic then the previous craze of the Charleston and dancers were getting younger and more capable of physical moves.



Throughout the decade shoe styles altered to give support to feet as foot strain became the most reported injury. Ankle hugging straps became vogue and shoes were decorated with bows and fastened by buttons to detract the eye from their supporting role. Arch supports became essential accessories as the cult of body sculpting, exercise and fad diets prevailed. Naked feet seen in public, which had been once taboo were now flaunted as glamorous fashion sandals became vogue.



Thirty years later, in the sixties, medical concerns were raised again at the wisdom of twisting in stilettos. The heeled shoe had become the dread of all dance hall owners since 1952, when they were introduced and caused extensive damage to expensive floor surfaces.



The introduction of discos a decade later and swell in popularity of disco dancing once again brought a spate of foot and ankle related injuries. The condition Disco Foot (a complete collapse of foot structure due to fatique) was reported at A&E across the western world. The popularity of Saturday Night Fever ensured more people were tripping the light fantastic and the same phenomenon came a decade later with the Chemical generation and Raver’s Foot.



The ascendency of the humble arch support dates from the 30s marathon craze. Now called foot orthosis (or orthotics) they continue to be popular. A reported takeover for an Australian company that produces an over the counter range of foot orthoses exchanged hands for a reported £14.6 million ($32.9 million Aus)a decade ago.



Friday, April 7, 2017

Dancing Plague: Choreomania




Between the 13th to 16th century large populations of Europe were afflicted with frenzied dancing. People would gather together and dance until they dropped with exhaustion or sometimes death. The Dancing Plague or choreomania was a significant challenge to public health as it pervaded through the populations of Germany, Holland and Italy for three centuries.



First described medically by Theophrastus Bombastus von Hohenheim better known as Paracelsus (1493-1541). The cause of the dancing plague (or dancing mania) remains unknown. Paracelsus, Philippus Aureolus, was a Swiss physician, chemist, alchemist and metallurgist, he gained wide popularity, although his contemporaries often opposed him. Paracelsus classified variants of the disorder according to whether the underlying cause was lust, an abnormal mental state, or some unidentified physical factor. Davidson (1867) later defined the condition of choreomania as a psycho-physical disease in which the will, intellectual faculties, and moral feelings are more or less perverted, with an irresistible impulse to motion, and an insane love of music, often sporadic, but with a tendency in certain circumstances to become epidemic. The essential features of the disease were it could occur sporadically or in epidemics. It was a psychological disease distinguishable from modern chorea, and from organic nervous diseases.



Choreomania was always characterised by an uncontrollable impulse to dance, and a morbid love of music. Physical contact with an affected person was not a prerequisite for contracting the disease (the sight or sound of someone already afflicted could be sufficient). In its epidemic form, an attack was generally preceded by premonitory nervous symptoms and the disease was commonly manifest by physical symptoms including death. Many claims were made as to the actual cause including demonic possession, epilepsy, tarantula bites, ergot poisoning as well as social adversity. It is unlikely to have been caused by any one single event but instead due to multiple factors combined with predisposition such as cultural background, and triggered by adverse circumstances. (Donaldson, Cavanagh and Rankin, 1997).



Corrupt clergy claimed baptism prevented the disease and hence, by reverse logic, claims were made the dancing plague was caused by demonic possession. Because the involuntary movements during an epileptic seizure appeared similar to dance like movement many contemporaries confused the condition but it is unlikely the dancing plague had any connection with epilepsy.



In Italy from the fifteenth to the seventeenth centuries as deforestation took place a large population of tarantulas appeared in the Apulian region. Many claimed spider bites were the cause of choreomania but due to the nature of the disease this is also thought unlikely.



The most plausible cause was poisoning due to eating rye contaminated with a fungus, claviceps purpura. This resulted in ergot poisoning which gave symptoms such as nausea, abdominal cramps, itching, muscle pain, spasms, and visual and hearing disturbances, all of which may precede epileptic convulsions. Larger quantities of rye were consumed during periods of hardship when people could not afford meat. The Christian church was determined to stamp out old and pagan religions and would brand previous forms of worship as the behaviour of the ill and disturbed. Another reason for the Dancing Plague was a spontaneous release from the bleakness of the Middle Ages. The Church realised the danger of dancing and a council meeting in Paris (1212) declared that "dancing was a worse crime then ploughing the soil on Sunday" (Hennig, 1995).



By the sixteenth century court dancing was well established and the tune Green Sleeves was popular at this time. Green Sleeves is considered by many to be the oldest dance tune to have survived in modern times.



During the 14th to the 16th century in Europe there was an important ritual called the Dance of Death. The parade was led by a figure representing death and became established after the Black Death in 1373. It is thought the dance of death reflected rituals performed by primitive peoples, who had also danced to acknowledge the passing of the seasons of the year and of a human life on Earth. Other dances in the Middle Ages did the same.



In the spring dances, village people performed fertility dances including Morris Dancing and during certain saints' day women danced in churches. Battle dances including the sword dances were performed throughout Europe.



Apart from ceremonial shoes which were found in tribal dancing from North America to Australia there appears to be no special shoe requirement for European dancing until after the 11th Century in Europe where more and more social dancing became the prerogative of aristocracy.

Thursday, April 6, 2017

A brief history of the Sock Hop (or Record Hop)




In the mid 40s, Record Hops became popular in North America. These were usually informal dance events for teenagers, held by the American Junior Red Cross to raise funds for the War effort. The school gym or cafeteria at high schools and other educational institutions was the preferred venue. However, to protect the varnished floor surfaces, the dancers were required to remove their hard-soled shoes, and bop in their stocking feet. The absence of young men at War meant a dearth of live entertainers and the young dancers usually jived to vinyl records presented by a disc jockey.



Unlike today, teenagers were neglected socially and expected to be seen but not heard. All that began to change at the beginning of the 20th century when psychologists identified adolescence as a concrete life stage. Teenagers began to be treated as a group psychologically distinct from children and adults. During the war years, it was important to keep ‘spirits up,’ and the mind of teenagers occupied. The focus on supervised school dances with the swirl of skirts, crinkle of lettermen's jackets and the soft scuffle of socked feet across a wooden gym floor to the sound of their favourite pop stars was very effective.



Teenage girls wore white socks which were either ankle length or collected at the ankle. These were called bobby sox and soon the term was used to describe teenage girls who went to the sox (sock) hop.



The fashion started with young Frank ‘The Voice’ Sinatra fans, who publically swooned at the prospect of his live performances. Swooning was a public display of infatuation and involved girls groaning and dramatically flailing their arms before placing their hands on their foreheads or cheeks and ultimately falling to the ground, overwhelmed. The Sinatra fans were collectively called "bobby-soxers" in reference to the white, folded-over ankle socks they wore. The term soon was adopted to describe all female adolescents.



By the 50s and introduction of television, teenagers could now see their favourite musicians performing live and the wild new incarnation of fandom was forged. Sock hops became associated with Rock ‘n Roll where live groups replaced vinyl records. The new, bobby-soxers wore ankle socks with saddle shoes, penny loafers or ballet-style slippers. A Shetland sweater with cuffed blue jeans or a poodle skirt, along with a trendy identification bracelet bearing a girl's name or initials, completed the outfit. Boy’s footwear of choice were chucks.



Sock hops evolved into ‘Discos,’ by the early 60s, as older teenagers with disposable income, flocked to more intimate night club settings.



There was a brief revival of sock hops in the UK during the 80s, when rockabilly became vogue.