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thorns and blisters

Thorns and blisters: unexpected summer holiday hazards

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Warm weather tempts us to wear sandals or even go barefoot. This increases the risk of exposing part of your foot to injury, such as thorns and blisters. How you deal with the injury if you have diabetes could be the difference between ending up with a successful outcome and having to seek emergency care because the situation has complicated.

Many people are all too quick to self-diagnose and self-prescribe treatment, especially with thorns and blisters. The media and the internet constantly bombard us with information and a variety of products in convincing campaigns. Packaging instructions often leave much to be desired – since warnings for people with diabetes or peripheral vascular disease are often in tiny-sized type, unable to be read by people with less than perfect vision.

Annual diabetic foot assessment

Before summer arrives, if you haven’t already done so this year, make an appointment to visit your podiatrist to have your annual diabetic foot assessment done.

The thorough assessment should cover musculoskeletal examination of your joint function, flexibility, range of motion, and loss of shape/bony protuberances. It should also assess your skin texture, hydration/lack of hydration, presence of infection in skin or nails, presence of callus or corns indicating high-pressure areas.

The podiatrist will also carry out a comprehensive vascular examination of your feet to establish whether you have good blood flow. The assessment also includes a full neurological sensory exam to pick up any warning signs of loss of sensation (neuropathy). These measurements are tiny yet vital to knowing what risk your feet may be at. Feet are classified into risk categories after an assessment.

Risk categories

LOW-RISK classification is given to those people living with diabetes who have no risk factors. For example, there is no loss of sensation, no sign of peripheral vascular disease, no history of foot ulceration (breaks in the skin that are difficult to heal), no foot deformity, no foot infections, no high-pressure areas, and normal vision.

People with diabetes in the low-risk classification have low chances of developing foot complications and foot ulcers. They may not need regular podiatry treatment since their feet are in good condition. They must, however, have an annual full screening to compare year to year.

MODERATE-RISK people with diabetes are those with one risk factor (neuropathy,
or peripheral arterial disease, or foot deformity) and no previous history of foot ulcer/amputation. Risk factors are:

  • Loss of feeling/altered feeling in their feet.
  • Reduced circulation in the feet.
  • Hard thick skin, corns or callus on the feet.
  • Vision has been affected.
  • Shape of foot is altered/there are bony protuberances present.
  • Signs of redness on the feet after taking off shoes.
  • Person who cannot look after their feet themselves.
  • Infections present on the skin or in the toenails.

HIGH-RISK people with diabetes have two or more risk factors (neuropathy, peripheral arterial disease, or foot deformity) and/or a previous history of foot ulcer/ amputation. High risk factors to develop foot ulceration are:

  • Loss of feeling/altered feeling in the feet.
  • Reduced circulation in the feet (verified by Doppler or ABPI test).
  • Hard thick skin, corns or callus.
  • Vision impairment.
  • Shape of foot is altered/there are bony protuberances.
  • Signs of redness on feet after taking off shoes.
  • You are unable to take care of your own feet.
  • Infections on the skin or in the toenails.
  • Previous ulceration.
  • Previous amputation.
  • On renal dialysis treatment.

Actions to take

If your feet are moderate or high-risk, you should:

  • Wear protective versions of footwear and skip the strappy sandals that can expose you to harm.
  • Use a SPF30 sunblock on exposed areas of ankle or feet to prevent sunburn.
  • Wear flip flops to protect the soles of your feet from hidden germs and fungi in public showers or swimming pool areas.
  • All injuries to the foot in a moderate- or high-risk foot should be reported to your podiatrist or doctor.
  • Products and actions that are perfectly fine on non-diabetic feet (that have good working pain sensation and good blood supply) can be dangerous if used on moderate-risk or high-risk diabetic feet with nerve damage (neuropathy), or a combination of nerve damage and poor blood circulation (neuroischaemia). It may not be that the product itself is ‘bad’ but the fact that it may cause a problem if used in the wrong way. It may also mask a problem in a foot with less than perfect sensation, or prevent you from getting professional care.

Always carry an emergency kit

Whether you’re going to the beach, or if you’re going to be away on holiday at a location that is far from medical assistance, be sure to pack a basic emergency kit. This should consist of a pair of scissors; a fine tweezer; a sewing needle and a flick lighter to sterilise it; a small bottle of a liquid disinfectant soap, such as Bioscrub or Savlon; a small bottle of surgical spirits or surgical alcohol; cotton wool; a pack of gauze; a tube of disinfectant cream, such as Betadine or Germolene; plasters; a miniature magnifying glass; and two crepe bandages plus two safety pins. Always carry a spare bottle of water. All these items are available from a pharmacy.

How to get a thorn out of your foot

Please note: this should only be done if you are far from medical assistance.

  1. Do not put your weight on the affected foot as it may drive the thorn/splinter/prickle deeper.
  2. Before you start trying to get the thorn out, it is a good idea to wash your hands and the area of the injured area with soapy water. Then pat dry with a square of gauze.
  3. Use the tweezer to grab the end of the thorn and pull out slowly and gently. Pull in the same line of entry that the thorn went in otherwise you risk breaking it if you pull against it.
  4. If this doesn’t work, sterilise the pointy end of the sewing needle for a few seconds with the end of the flame from the lighter. Wait a second or two for the needle to cool down, then gently push against the end of the thorn and work it back out enough to use the tweezer to pull it out.
  5. If this doesn’t work, soak a wad of cotton wool with the disinfectant and water and hold it up against the part of the foot with the thorn in it for at least 3 minutes so that it can soak and soften the skin. Then try again to loosen the skin around the end of it so that it can be pulled out.
  6. If this doesn’t work, apply antiseptic cream and a plaster to cover it so it doesn’t catch on anything until such a time as you can get to medical help.
  7. Thorns and prickles can be difficult to get out, and are more likely to become infected.

DO NOT: squeeze a thorn. This makes it more likely to split apart and break, increasing risk of infection.

NB! If you have moderate- or high-risk feet, do not attempt to remove the thorn without a trained medical person. Loss of protective sensation will mean that you won’t feel pain while probing for the thorn and you may inadvertently cause more harm.

When to seek medical help urgently

You should definitely seek medical help if the thorn/splinter is under your toenail and you can’t get it out, and if the area is red, oozing, swelling or warm to the touch as this may indicate an infection and medical extraction and care is needed.

Glass

Slivers of glass can usually be taken out fairly easily. Staining the skin with Betadine liquid can highlight a hidden piece of glass since the glass will show up clear against the stained skin background.

How to treat a blister

Blisters develop because of friction or rubbing, warmth and moisture, such as sweat. You should plan on changing socks during the day if you know that your feet will sweat. Always ensure you have the correct fit of shoes or sandals. Remember, feet normally swell by as much as 7% within 4 hours of getting up in the morning.

Small blister

If a blister is smaller than a 10c coin, wash the overlying skin gently with disinfectant, gently pat dry and apply a plaster to cover and protect it. The blister should re-absorb once the cause of friction has been removed and you are wearing sufficient protective padding.

Large blister

If the blister is larger than a 10c coin, it is more prone to split open and become infected so you should release the pressure in a controlled, sterile way. See below:

  1. Pour surgical spirits over the blister to disinfect the overlying skin.
  2. Disinfect the pointy tip of a sewing needle by passing it under the end of a flame for a few seconds.
  3. Then gently puncture the edge of the blister. Never puncture the centre of the blister.
  4. Mop up the blister liquid with cotton wool and disinfectant.
  5. Using a fresh piece of gauze moistened with disinfectant, gently press down on the top of the blister to release all the blister liquid.
  6. Pat dry with more gauze and cover with an adhesive plaster.
  7. Avoid submersing the blister site in water for the next 4 days but change the dressing daily and keep the rest of the foot clean. The roof of the blister will act as a protective layer while the new skin repairs itself underneath.

Keep the area dry, padded and protected until complete healing takes place.

MEET OUR EXPERT

Anette Thompson
Anette Thompson (M Tech Podiatry (UJ) B Tech Podiatry (SA)) is the clinical director at Anette Thompson & Associates, Incorporated, a multi podiatrist practice in KwaZulu-Natal. Tel: 031 201 9907. They run a member service for Diabetes SA members at their Musgrave consulting rooms as a service to the community.
holiday fitness exercises

Holiday fitness exercises

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Tone up and torch some fat this festive season by doing these holiday fitness exercises. You can do them while at home or even if you are away on holiday. Perform four sets with a minute rest after each round of five fitness exercises.

Forward Lunge

holiday fitness exercises
  • Keep your upper body straight, with your shoulders back and relaxed, and chin up (pick a point to stare at in front of you so you don’t keep looking down).
  • Always engage your core.
  • Step forward with one leg, lowering your hips until both knees are bent at about a 90-degree angle. Make sure your front knee is directly above your ankle, not pushed out too far, and make sure your other knee doesn’t touch the floor.
  • Perform 10 repetitions alternating on each leg.

Jump Squats

holiday fitness exercises
  • Stand with your feet shoulder-width apart.
  • Start by doing a regular squat, then engage your core and jump up explosively.
  • When you land, lower your body back into the squat position to complete one rep. Land as quietly as possible, which requires control.
  • Perform 12 repetitions.

Tricep Dips

holiday fitness exercises
  • Position your hands shoulder-width apart on a secured bench or stable chair.
  • Slide your butt off the front of the bench with your legs extended out in front of you.
  • Straighten your arms, keeping a little bend in your elbows to keep tension on your triceps and off your elbow joints.
  • Slowly bend your elbows to lower your body toward the floor until your elbows are at about a 90-degree angle. Be sure to keep your back close to the bench.
  • Once you reach the bottom of the movement, press down into the bench to straighten your elbows, returning to the starting position.
  • Keep your shoulders down as you lower and raise your body. You can bend your legs to modify this exercise.
  • Perform 12 repetitions.

Mountain Climbers

holiday fitness exercises
  • Start in a plank position with arms and legs long. Beginning in a solid plank is the key to proper form and good results in the Mountain Climber. At its heart, the Mountain Climber is a form of plank.
  • Keep your abs pulled in and your body straight. Squeeze your glutes and pull your shoulders away from your ears.
  • Pull your right knee into your chest. As the knee draws to the chest, pull your abs in even tighter to be sure your body doesn’t sag or come out of its plank position.
  • Quickly switch and pull the left knee in. At the same time you push your right leg back, pull your left knee in to the chest using the same form.
  • Continue to switch knees. Pull the knees in right, left, right, left. Always switching simultaneously so that you are using a ‘running’ motion.
  • As you begin to move more quickly be in constant awareness of your body position and be sure to keep a straight line in your spine and don’t let your head droop. Core body stability is crucial.
  • Perform 15 repetitions on each leg alternating.

Wall Sit

holiday fitness exercises
  • Stand with your back pressing against a wall.
  • Slide downward into a squat position by moving your feet forward until your knees make a 90-degree angle and your hamstrings are parallel to the floor.
  • Hold this move as long as you can. For beginners, aim for a 30 second hold.

MEET OUR EXPERT

holiday fitness exercises
Richard Wood is a personal trainer. Visit his Facebook page Richard Wood Personal Training.
holiday season weight gain

Avoid holiday season weight gain

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In a recent study, it was found that half the annual weight gain in South Africans occurred over the holiday season. Paula Pienaar informs us how not to become a part of this statistic.

The next three months’ weight gain

End-of-year functions, the holiday season and ‘back-to-school/work’ jingles are key events on the horizon over the next three months, and sadly unwanted weight gain.

During this time, we find ourselves taking a break from our usual daily routine, which on the one hand is great because it allows us to engage more with our loved ones and let our hair down, but on the other hand, also coaxes us into less healthier habits. Diet and physical activity are often the first lifestyle habits to be neglected.

You need not give up quality time with your loves ones to hit the gym, but it is essential to maintain a healthy physical activity pattern during the holiday season to avoid weight gain.

Seasonal food purchases and weight gain

In a recent study,1 investigating the relationship between seasonal food purchases and weight gain, it was found that half the annual weight gain in South Africans occurred over the holiday season.

Interestingly, the research showed that the least nutritionally desirable foods were purchased in November and December, and the most fruit and vegetables in January – possibly due to optimistic New Year’s resolutions. These findings support the need for an increased focus on lifestyle interventions to address health habits during holidays.

In a country where obesity is at its highest level, it is pertinent that we maintain a healthy, conscious lifestyle throughout the year, and especially during these upcoming months.

Weight gain associations

Weight gain is associated with raised blood pressure, cholesterol and blood glucose. When unmanaged, these conditions may culminate to Type 2 diabetes, which may often co-exist with hypertension (high blood pressure) and dyslipidaemia (high cholesterol).

For the first time, researchers have shown a strong link between diabetes and obesity in all regions of Africa. This first of its kind obesity and diabetes trend analysis, conducted between 1980 and 2014, showed that the prevalence of diabetes continued to increase rapidly and that it was triggered by the high incidence of obesity2.

Take responsibility of your health

To prevent the progression of this diabesity epidemic, it is up to us to take responsibility of our own health. When combined with dietary changes, physical activity has the potential to delay the progression of full-blown diabetes,3 by playing a key role in managing the intermediary risk factors, such as obesity, high blood pressure and a poor lipid profile.

Let’s optimise the beautiful summer days and take care of our heart and blood vessels by being mindful of our food choices, and maintaining a healthy active holiday season.

Benefits of regular physical activity

The table below provides information on the physiological benefits of regular physical activity. The exercise prescription is based on international guidelines aimed at using physical activity as a potent treatment of health conditions. These guidelines complement prescribed medication in those with diagnosed chronic disease.

  Physiological benefits Exercise prescription:

Type, duration and frequency of activity

 Pre-cautions
Diabetes4,5 Promotes adaptations in the muscle, fat tissue, and liver associated with enhanced glucose uptake. A: 30 minutes, at least 3 days/week with no more than 2 consecutive days without exercising. Preferably at the same time in relation to meals and insulin injections in patients treated with insulin.

RT: 1–4 sets of 8–15 repetitions, 2 days/week on non-consecutive days. Aim for 5–10 exercises per session.

 Taking care of your feet:

  • Always inspect your feet for any changes before and after exercise.
  • Avoid exercise that causes stress to the feet. Exercise which poses minimal weight or stress on the feet is ideal, such as riding an exercise bike, or brisk walking in good footwear.
  • Wear comfortable and well-fitting shoes.
Hypertension6,7 Helps to ‘relax’ the blood vessels, facilitating blood flow and may lower high blood pressure by and average of 11mm Hg (systolic) and 5mmHg (diastolic). A: 30-60 minutes continuous or accumulated in bouts ≥10 minutes each. Most, preferably all, days of the week.

RT: 1 set of 8-12 per muscle group (using light weights) 2-3 times a week.

Please note the precaution for RT with high blood pressure.

 You should not do the following, as they can raise your blood pressure to dangerous levels for a short period of time:

  • Lift heavy weights without supervision of a qualified biokineticist or personal trainer.
  • Vigorous short bursts of exercise like boxing or squash.
Dyslipidemia (high cholesterol and triglycerides)8,9 Increases the enzymes responsible for raising HDL ‘good’ cholesterol. A: 40-60 minute sessions at least 5 days a week.

RT: 1 set of 8-12 repetitions, 2-3 days a week. Best when including 8-10 different exercises.

 Certain medications used for the treatment of dyslipidaemia may have a negative impact on exercise, such as:

  • Muscle weakness or pain.
  • Muscle cramps.
  • Fatigue (feeling tired).

You may need to increase rest periods or reduce intensities to accommodate these adverse side effects.

A: Aerobic (cardiovascular) exercise; RT: Resistance (strength) training

MEET OUR EXPERT

Paula R. Pienaar
Paula R. Pienaar (BSc (Med)(Hons) Exercise Science (Biokinetics)), MSc (Med) Exercise Science) is the scientific advisor to EOH Workplace Health and Wellness, and a PhD candidate at the University of Cape Town. Her scientific research relates to sleep health and managing daytime fatigue to improve workplace productivity and lower the risk of chronic disease. Her thesis will identify the link between sleep and cardiometabolic diseases (Type 2 diabetes and cardiovascular disease) in South African employees. She aims to design a tailored sleep and fatigue management workplace health intervention to improve employee health risk profiles and enhance work productivity. Contact her at paula.pienaar@eoh.co.za

References:

  1. Sturm, R., Patel, D., Alexander, E., & Paramanund, J. (2016). Seasonal cycles in food purchases and changes in BMI among South Africans participating in a health promotion programme. Public Health Nutrition, 19(15), 2838-2843. doi:10.1017/S1368980016000902
  2. Kengne, Andre Pascal, et al. “Trends in obesity and diabetes across Africa from 1980 to 2014: an analysis of pooled population-based studies.” International Journal of Epidemiology (2017).
  3. The Society for Endocrinology, Metabolism and Diabetes of South Africa Type 2 Diabetes Guidelines Expert Committee. “Physical activity and type 2 diabetes” in 2017 SEMDSA Guideline for the Management of Type 2 Diabetes Guideline Committee. JEMDSA 2017; 21(1) (Supplement 1): S1-S196.
  4. Mendes R, Sousa N, Almeida A, et al Exercise prescription for patients with type 2 diabetes—a synthesis of international recommendations: narrative review Br J Sports Med 2016;50:1379-1381
  5. Colberg, Sheri R., et al. “Physical activity/exercise and diabetes: a position statement of the American Diabetes Association.” Diabetes Care 39.11 (2016): 2065-2079.
  6. Börjesson M, Onerup A, Lundqvist S, et al Physical activity and exercise lower blood pressure in individuals with hypertension: narrative review of 27 RCTs Br J Sports Med 2016;50:356-361.
  7. Pescatello, Linda S., et al. “Exercise for hypertension: a prescription update integrating existing recommendations with emerging research.” Current hypertension reports 17.11 (2015): 87.
  8. Jacobson, Terry A., et al. “National Lipid Association recommendations for patient-centered management of dyslipidemia: part 2.” Journal of clinical lipidology 9.6 (2015): S1-S122.
  9. Pescatello LS, Arena R, Riebe D, Thompson PD. (eds.) ACSM’s guidelines for exercise testing and prescription. 9th ed. Baltimore, MD: Wolters Kluwer-Lippincott Williams & Wilkins; 2014: 165