4 minute read
Winter related conditions
If you have chilblains don’t, repeat don’t warm your hands and feet in front of the fire. Are you mad?
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When I was asked to write a short article on Winter-related conditions I thought it would be easy. David Holland writes:
And it is.
Easy to write yet another humdrum article on chilblains and the importance of wearing warm socks for oldies (etc, etc, ad nauseam). I see no point in doing this however, since every newspaper and most websites will carry an article of this type over the Christmas period.
So this Winter-related conditions article is based on my observations as a podiatrist over many years of practice. I hope you find it interesting, and hope too that some of the information is helpful. Here goes…
I have nothing against Ugg Boots. They look to be comfortable, well-made, and warm. But every Winter I watch people slopping around in fake Uggs – the ones where the back has collapsed so that the heel is weightbearing on the inner side of the boot rather than the heel seat. It looks horrible, can’t be comfortable, and has to produce a pinch callous in some people. Is that a Winter condition? I think it qualifies. The problem is that the heel stiffener of the fake boot, also known as the quarter, is simply not up to the job of holding the heel and maintaining the shape of the boot. Advise your patients accordingly – fake Uggs bad, real Ugg Boots ok.
Digital corns
Surely that isn’t a Winter condition? Well yes, it can be. Thicker socks, or an extra pair of socks can either press the toes together, or curl them up making the interphalangeal joints more prominent. Same goes for ingrown nails, and callous caused by extra friction on a joint. In your regular patients look for reasons why the feet may be worse in the Winter. In new patients you can become something akin to a miracleworker if you cannot only treat the corn, but stop it returning by pointing out that the Winter hose may be just a little constrictive.
Ok, ok – chilblains
Let’s look at why folk develop chilblains, and how they can actually be pretty dangerous to one client group.
What is a chilblain, why do some people get them and others not?
A chilblain is an area of tissue which has been damaged by cold. The mechanism by which a chilblain forms is relatively simple, but you first have to revisit simple anatomy and physiology to fully understand what happens.
Our bodies are so constructed that under adverse circumstances our autonomic nervous system will ensure that the brain and vital organs remain supplied with blood, no matter what.
The main adverse circumstance in which this phenomenon can be easily observed is in extremes of cold, where circulation to the extremities – hands, feet noses and ears - closes down, sometimes completely. It can also happen in systemic infection, but far more rarely.
When you go out in the cold and your hands turn blue - that’s the circulation in your hands closing down. Tight hose and shoes can also affect the peripheral circulation, driving blood away from superficial tissues, so advise your patients accordingly. If you can warm up your extremities gently before any tissue damage occurs they will be fine. If you have poor circulation due to peripheral arterial disease you have a much greater risk of damaging the tissues. If you have any of the conditions in which the muscular arterial wall (the Tunica Media) of your arteries or arterioles goes into spasm - the most common is Raynaud’s Disease, but there are other conditions in which this happens – you have a much greater risk of damaging the tissues.
Why do the tissues become damaged? Simple – they don’t have any oxygen because the blood can’t reach those tissues to facilitate this. The result is that common Winter lesion we call a chilblain.
Advise your patients as follows:
Wear warm, non-constrictive footwear and hose – this is actually really important.
Don’t, repeat don’t, warm your hands and feet in front of
the fire. Are you mad? The tissue is already damaged and you think speed-warming in front of the fire is going to help? Chilblain ointment is useful, but not on broken chilblains.
The danger in chilblains.
I mentioned earlier that there is one client group in which chilblains can pose a real danger, in extreme cases life-threatening. These are diabetic patients. Before discussing how this works, let’s put a little meat on the bones by looking at the accepted statistics of ulceration and amputation in diabetics. (Ref 1).
It is estimated that 10% of people with diabetes will have a diabetic ulcer at some time in their lives.
Diabetic ulcers precede more than 80% of
amputations in people with diabetes.
Here’s the crunch…
Up to 70% of people with diabetic foot ulceration and amputation die within five years of having the amputation. Up to 50% of people with a diabetic foot ulcer die within five years of developing the ulcer.
Diabetes and peripheral vascular disease go hand-in-hand. So too, does diabetes and peripheral neuropathy, in which some or all of the normal protective sensation in the feet is absent.
A chilblain can be a precursor to an ulcer in a diabetic patient. Your diabetic patients should, without doubt, have regular foot checks, especially in the Winter months. I think the podiatrist is the right person to do this, although being a podiatrist myself I can legitimately be accused of being a tad biased.
