Thursday, August 31, 2017

Bakya: The dancing shoes of the Philippines

The national footwear of the Philippines is wooden clogs with a plastic strap and called ‘bakya.’ Bakya were made from local light wood e.g. santol and laniti. These were cut to the desired foot size before being shaven until smooth. The side of the bakya was thick enough to be carved with floral, geometric or landscape designs. Afterwards, the bakya were painted or varnished. Uppers of plastic or rubber were fastened using clavitos (tiny nails).

Bakya became much sought after souvenirs in late 40s and 50 and were particularly prized by the US personnel posted to the Philippines. The shoes were ubiquitous until the 70s when their popularity began to wain as cheaper rubber slippers replaced them. Bakya were demoted to shoes of low socio-economical groups and the term ‘bakya’ became synonymous with poor taste.

Several attempts have been made to relaunch the ‘bakya’ as a fashion style with appeal to the current market. To make ‘bakya’ stylish the traditional wooden base was shaped and a leather strap replaced the original plastic. Added comfort in the form of footbeds with heel gel cup and triple-layer sole features are also featured. The new bakya are available in a wide rang of styles for men, women and children.

The traditional Bakya Dance has young girls and boys teasing each other rhythmically with their bakya.

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.

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.