‘Feet and safety at home’
Welcome to the feature ‘feet and safety at home’ responding to injury.
Spring – Autumn is a great time to do DIY outside. If we want to know about the effects of home activity we could look at The Royal Society of Prevention of Accidents or RoSPA as it is better known, as this organisation publishes statistics on all kinds of accidents. However, feet tend not to be so well recorded, and as far as home is concerned, not so easy to tease out. In general, though we recognise common accidents related to; splinters and debris injuring the skin, falls, sharp implement injuries, ladders, accidents with tools and lifting heavy materials.
Click here for the audio version
Falls at home
As a category falls probably climb to the top of the ladder as far as incident frequency. Perhaps more so in the older population. This might be understandable. As muscles are used less as we age, the receptors informing our brain of movement slow down in response. This is not helped by muscle wasting or atrophy, the official given name. The nerves tell our brain how to move using feedback information from the tendons and tension. Together with reflexes, the system may work slowly compared to when we were younger and supple (article in Footlocker).
Once the muscles and joints fail it is less easy to adjust so that sways and tilts turn into that nasty off-balance effect. Add in a hearing problem such as tinnitus, congestion, infections and general deterioration of the balance apparatus in the inner ear, and the risk of falling is compounded.
While we can treat arthritic joints of course and apply physiotherapy to strengthen muscle we should do so with regular exercise. In fact, regular exercise is well proven as a method to keep us supple. People visit my local gym and many are several decades older than me.
Accidents in younger people
When it comes to younger people we (and I don’t include myself here, as I am technically old) find falls are due to lack of care. We slip on slippery surfaces. Failure to concentrate is common. Turning our attention to someone or something other than watching where we are going. Going over on the ankle is easily done.
When my stepson sent me a picture of his friend’s effort to mow the lawn, he was taken with the fact it was not just the grass that his friend was trimming. His friend managed to sever a few toes as well at the same time. Lack of concentration? Well, yes, but he was not wearing sensible shoes. In fact, he was wearing sandals. Rotary mowers are unforgiving when it meets flesh.
Of course, as a podiatrist, this was not something I was called on to fix as it was emergency medicine and ideally a plastic surgeon would be called in if one is lucky. If not, it is amputation, debridement and weeks of dressings and hope that infection does not set in.
Being the paragon of common sense I select the right footwear for the right job. In this case my old trainers for doing those odd jobs like fixing the shed roof. The galvanised tacks are covered with a heavy residue of tar as they penetrate the softer material compressing the roofing felt to the wooden under the structure.
A sharp object can easily fall to the ground as it bounces out of the felt. Left to fumble for a spare tack kept in my trouser pocket avoids having retrieved the tack. These tacks can be anything from ¼ to ¾inch in length and so if you are unlucky the tack point side up can penetrate the outer sole; and it did.
If the outer sole is thin and if the midsole (see the diagram cross-section of the shoe above) is not robust, a tack can run right through entering the foot piercing the skin like butter (video clip). This actually happened to me.
A penetrating injury, not like the cover picture hopefully should be stopped by a decent shoe. If not those sensory receptors we call nerves react, but the damage is done if the nail, tack or foreign body reached the foot. Dirt, and in my case tar, as I was hammering roofing felt in, penetrates the skin and despite limited bleeding, the depth of the penetrating injury now poses a risk of infection. I can only say my defense for quality shoes saved the day and the tack failed to penetrate beyond the midsole.
My wife is seen removing the nail in the video, but I have removed her sounds of frustration from the clip (I hope) with my own voice, but she does a good job with a penknife which in itself looks precarious.
Advice & self-help
As I reflect on this traumatic event I would always advise myself to wear strong shoes or boots with ½ inch sole when dealing with any type of DIY fixings.
Should the foot have an experience such as mine but with the ordeal of a penetrating injury, either leave the foreign object in and seek a minor injury centre immediately or dial 111 for advice or deal with this sensibly by first aid. This is not a medical life-threating emergency.
Better still; remove the tack and make the wound bleed which helps to flush the wound and lower the risk of infection. You can use salt water, ideally boiling the water first and letting it cool down before immersing your foot to irrigate the wound. To make salt water add a hand full of domestic salt to the water and stir well with a clean spoon. Add more salt if the bowl is larger or use around a hand full to every 5 litres (or 10 pints approx [1.8 pt = 1l])
Using an antiseptic solution is helpful and you can keep sterile sachets of chlorhexidine in your first aid box for that time when you need to flush quickly. Each sachet is 25 mls and you ideally should use 3-4 over a bowl. Washing the wound out with a sterile syringe is better but the item may not be something many keep routinely at home. Both items however can be purchased from a pharmacy.
Syringes are useful for a wide range of purposes but if used for flushing they must be taken from a sterile wrapper. After all, we must not follow the folly of drug addicts!
When to use dressings
A light dressing can adhere to the foot with gauze and tape unless it bleeds heavily. This advice is not indicated for managing penetrating injuries with objects that go into the foot deeply so as to rip through blood vessels, and joints. If you do happen to tread on something that does this, then a little common sense must prevail as to who to seek help from. Heavier dressings are required for wounds that bleed through or have discharge. These need more attention and professional help from pharmacists to clinical staff. A small amount of antiseptic cream (in date) or spray can be applied to the skin or dressing for those light puncture wounds. This will keep the area clean and disinfected. Monitor the wound for 2 days and if there is no pain or discharge you may no longer need a dressing. Of course, this is for healthy fit people young or old.
Medically challenged patients would be best registering the injury with their doctor or clinic nurse.
Signs of infection
The signs of infection are represented by expanding redness and increasing pain. Red streaky lines going up the foot. A swollen foot (compare the injured side to the normal foot) is now a medical concern and will require antibiotics. The timeline for escalating infection is around 36-48 hours so you will know quickly if all is not well.
If you leave the redness to progress you will then enter into sepsis with feeling ill, hot and sweaty. Septicaemia kills and so what started as a simple injury is now an emergency requiring A&E admission with intravenous management.
In some rare cases a sharp object can penetrate causing internal foot bleeding. Even the ½in. nail can do this in the right circumstances. If the foot swells within ½to 1 hour then internal vessel damage must be suspected. A blood pool forms a haematoma and if left unmanaged will becomes infected and the cycle continues.
We must minimise the risk of serious injuries by being aware of dangers all around us. If they happen the best is to be aware of the potential dangers from even the smallest of accidents. A little be of first aid could save your life or at least your leg.
Thanks for reading ‘safety at home’ written by David Tollafield.
First published 5th September 2019. Please also listen to the audio version.