All posts by Staff

Dermatology

Dealing with Chilblains

Chilblains are a common problem of the microcirculation in colder climates.

Chilblains start as an inflammatory response caused by changes in those that are vulnerable. They are seasonal and occur in the colder temperatures. They can be a particular problem in extreme sports. that take place in the cold environments. While they start out as red itchy and painful spots, if they keep recurring they become chronic and take on a dark blue coloration.

The best way to deal with chilblains is to prevent them in the first place. The feet must be kept warm with the use of appropriate socks and shoes. If the foot does become cold, it is important that it is only warmed up slowly and the circulation give time to respond to the warming temperature. It is thought that a keep issue on chilblains is the too rapid warming of the skin after it is cold.

If a chilblain does develop, then the best approach is to keep it warm, stimulate the circulation with gentle massage with creams and to protect the skin from breaking down. If the skin is broken, then wound dressings need to be used to allow it to heal up.

Biomechanics

The Term ‘Overpronation’

Overpronation is one of the most overused and misunderstood terms in running and health professional communities, especially when it comes to the use of running shoes. The whole traditional model of the design of different running shoes are based on the concept of the normal or neutral alignment of the foot. Pronation is when the foot rolls inwards at the ankle joint and the arch collapses. Supination is when the foot rolls outwards at the ankle and the arch height increases. These are normal healthy movements that are needed for normal function of the foot. It is how the foot adapts to uneven surfaces and absorbs shock. There is nothing wrong with the motions of pronation or supination.

The term overpronation is used to describe when there is too much pronation. The reason is that this is an issue is that overpronation assumed to be a risk factor for many different running injuries. For this reason, running shoes have design features in them that are supposed to help control this overpronation. These design features include medial heel posts, dual density midsoles and rigid heel counters. These shoes are supposed to be used by those who overpronate. Those who do not overpronate should use cushioned neutral shoes.

The problem with this concept is that the term is overused a lot. There is no consensus as to the cut-off point between normal pronation and overpronation. There is also very little evidence linking overpronation to running injury and if there is any, it is showing that it is only a very small risk factor. Plenty of runners overpronate severely and never have problems. Similarly, there are plenty of runners who do not overpronate that have a lot of problems. Due to this confusion, there has been a recent change in the use of the term and the understanding of overpronation in relationship to running injury and the use of running shoes.

Diabetes

The Foot In Diabetes

Type two diabetes is now so common, it is almost as though we have become complacent about this. The incidence is rising in most places despite public health interventions are trying to take care of the obesity crisis that is supporting the diabetes issue. Diabetes has a number of complications which join collectively to put the feet at considerable risk from complications. These complications vary from a slight infection up to the more severe complications like a need to amputate a limb due to a spreading infection or dead tissue. The complications associated with all forms of diabetes have an impact on a wide variety of tissues within the body.
In terms of the foot, diabetes impacts the blood supply and therefore any problems for the foot is more prone to be serious because there is inadequate good circulation to permit healing to occur. Diabetes also damages the nerves, so that if there is some injury, either major or minor like a blister, then no pain is felt, so the foot continues to be traumatised resulting in the much more serious. The body has numerous functions to battle infection, but in diabetes the reaction to an infection is much more sluggish compared with those not having diabetes. Diabetes may also affect the eye and while the eyes are quite a distance from the feet, appropriate vision is required to see any problems that may have happened to the foot so it may be dealt with. Even the kidney disease that frequently occurs in diabetes impacts wound healing once the injury has been done and the presence of disease in the renal system may affect which drugs, for example antibiotics, may be used and sometimes that range can be very restricted.
It is for all these reasons, and many more not brought up, that those with diabetes have to take special care of their feet. They have to examine them routinely to make sure that there is no injury and if there is an injury they have to get medical attention promptly. Most importantly, they need to be regularly managed by a foot doctor.

Biomechanics, Foot Problems, Sports Medicine

Cuboid Syndrome

The cuboid is a smaller cube shaped bone on the lateral side of the foot around about the center of the foot. The bone is a little bigger than a common gaming dice. The bone participates in three joints and operates as a lever for the tendon of the peroneus longus muscle to pass under. Since this is a strong muscle it can move the cuboid bone too much if it is not secure and strain those joints that the bone is a part of resulting in a ailment known as cuboid syndrome. This is probably one of the more common causes of pain on the outside of the foot, generally in athletes. The pain commonly begins quite mild and is located around where the cuboid bone is on the outside of the foot. The pain is only at first present during activity. If the exercise levels are not lessened the problem will most likely progress and then show up after exercise in addition to during. From time to time the pain can radiate down into the foot. Although this is the commonest reason for pain in this area, there are others like tendinopathy and nerve impingements.

The main management of cuboid syndrome is relief of pain. This is normally done with a reduction in exercise levels and the using of low dye strapping to immobilise and support the cuboid. Mobilisation and manipulation is frequently used to fix this condition. Over the longer term foot orthoses may be required to control the movement and support the lateral arch of the foot. This helps make the cuboid more stable so it is an efficient lever or pulley for the tendon to function around. Generally this approach works in most cases. If it doesn’t there are no surgical or more advanced treatments and a further reduction in activity amounts is usually the only option.