FEEL FINE-FEET FIRST!
By Ravi V. Chhabra
fnbworld met up with India's leading podiatrist to get an insight into keeping the feet fit. He holds a professional qualification in the science of podiatry from America and has been practising podiatry for over 20 years. Dr. Govind Singh Bisht told us at length about various critical issues in foot care.
Fungus is a menace that can grow anywhere in the body when there is a tendency of an individual to get it or the body immunity is compromised - warm and moist conditions are ideal for fungus to grow. Fungus in feet can grow in any person when there is excessive sweating in feet or in a hurry people do not wipe well between toes after bathing or washing feet. A person with diabetes, those on immune suppressive treatment like anti-cancer treatment are more prone to get it. People may get from contaminated surface like swimming pool, wet carpets, dormitory and common bathrooms.
One should always look for extra wide, extra depth, well padded, well cushioned footwear. A narrow pointed kind of footwear in front which causes cramping of toes should be avoided. Always wear activity specific footwear, if somebody is running, he or she should wear running shoes only never do sports in formal shoes.
Rather than recommending one particular brand, I will recommend to look for basic qualities with comfort in a footwear. A footwear should have few basic elements like shock absorption, motion control, stability, light in weight and should be of according to width of fore foot, there should be some cushion in insole. There are various brands which qualify above qualities. For fashionable laies, I would request them not to go for very high heels!
There are not enough qualified podiatrists in the country. Unfortunately, there is no formal training, degree or diploma courses in podiatry in the country.
Podiatrists are qualified medical professionals or foot doctors, who are taught specifically about foot and ankle like dentists undergo training about teeth. Podiatrists undergo undergraduate training like doctors and they do residency and specialization.
It is worthwhile to know that a normal person/non-diabetic person can dip feet in warm and salty water, but a diabetic person should avoid dipping feet in warm water. When a normal person dips feet in warm water, if he/she cannot tolerate the heat, he will immediately take away his feet, but a diabetic person at times may have diminished or complete loss of sensation for pain, touch and temperature because of neuropathy and he is at a risk of getting burn injury, that’s why they should avoid dipping feet in hot water, using hot water bottle and direct exposure of heat from a heater or blower. Last winter I had 52 diabetic patients with such burn injuries which took 2 to 4 months to heal.
Injury anywhere in the body should not be neglected. Injuries in feet can be internal or external. Internal injuries can be of soft tissue or of bone like fracture, for close injury always keep in mind the RICE protocol of Rest, Ice Compression and Elevation, if suspecting a fracture of bone try to put a splint to support the injured bone, for any external injury of feet with open wound, cut, laceration and if bleeding, always use a clean piece of cloth and give pressure over the bleeding wound and continue till the bleeding stops, pressure is the best thing to stop the bleeding, wrap the wound with a clean cloth or a bandage. Keep the limb elevated and take an expert opinion. It is best to take medical advice, if not possible immediately try cleaning of the wound with tropical antiseptic lotion and dressing with tropical antibiotic ointment avoid contamination of the wound with toilet water.
Any nail which is not normal and it is dry, discolored, chipped or cracked and breaks down easily is called Brittle nail. The cause of Brittle nail can be because of environmental conditions like repeated hand washing, use of chemicals, extreme cold conditions, metabolic and nutritional conditions like, hypothyroidism, Iron Deficiency, Reynaud’s disease and fungal infection.
To clear the confusion in many minds: Podiatrists are medical professionals and doctors whereas pedicurists are like foot hygienist. In my practice 50 % are diabetic foot patients with various foot problems, among them, the majority are with a diabetic foot ulcer which is not healing even some are advised amputation of foot. As a podiatrist, diabetic wound care is my expertise and I try to work on at risk foot and try to salvage the foot. Among other common conditions of foot I get are foot pain, corns, callousities, ingrown and painful nails, fungal infection of skin of foot and nails, soft tissue injuries of foot, flat feet, high arch feet.
Healthy feet are must for a healthy body, so one should always take good care of feet. Always wash feet with lukewarm water and dry well after washing feet and after bath specially between the toes. Use extra wide and extra depth shoes. Cut nails straight across and file the corners, avoid deep cutting of the nails. If skin is dry use moisturizing cream, never apply moisturizing cream between the toes. If skin is excessive sweaty use talc powder before putting on shoes. Regular stretching and strengthening exercises of feet should be done. Always wear cotton or woolen socks; wear activity specific shoes. Smoking is the cause of narrowing of blood vessels and can cause decreased blood supply to feet. Never do bath surgery for corns and callousities.
For any non-healing or delayed healing wound in the feet take doctors advice. Always buy footwear in the evening, because 5% of people have tendency of swelling in the feet at the end of the day, a well-fitting shoes bought in the morning can be a tight fit and can cause shoe bite. Try to wear foot wear of natural material. If you have flat feet or high arch feet or painful foot conditions, fungal infection of nails and feet take doctors’ advice or visit a podiatrist immediately.
There are no supplements recommended in routine but one should always take a balance diet and do regular exercise. If there are any painful foot conditions always go to your doctor or a Podiatrist and rule out any nutritional inflammatory and metabolic conditions causing foot pain. Few most common nutritional, inflammatory and metabolic conditions causing foot pain are high uric acid, hypothyroidism, vitamin B12 deficiency, vitamin D deficiency, calcium deficiency, rheumatoid arthritis. One can use any routine moisturizing cream in feet, but not between the toes, if skin is excessive dry one can use a urea based or paraffin based cream for dry skin or show to a doctor.
One can routinely visit a pedicurist for regular foot care like cleaning of feet, nail care and foot massage and removal of dead skin. A visit to a podiatrist is like a visit to a doctor whenever one need an expert opinion about foot condition like painful foot condition like heel pain, fore foot pain, corns , callousities, plantar warts, ingrown toe nails, soft tissue injuries, flat feet, high arch feet any advice about foot wear for biomechanics and gait analysis.
If the nails are big or cuticle is hard it should be properly cleaned and trimmed in hygienic conditions, otherwise at times just by biting it may invite bacterial infection. Otherwise also biting of nails or cuticle is a bad habit - doing it in public places is not seen as appropriate social behavior, even doing it alone also may be a sign of internal insecurities or sign of mental stress or anxiety, it should be addressed by discussing it with the individual and proper counselling should be sought.
Dr. Govind Singh Bisht is MBBS, CPP (Fellowship in Podiatry, BIDMC, Boston, USA).
Principal Consultant: Podiatry (Foot care) at Max Multispecialty Hospital Panchsheel Park, New Delhi and Gurgaon.
Visiting consultant at Sita Ram Bhartia Institute of Science and Research, Senior consultant at Sri Balaji Action Institute of Medical Institute, New Delhi.
Clinical Director and Regional Clinical Advisor (Asia Pacific).
‘Fit Feet Program’ of Special Olympics International.