‘Winter is coming again!’
Welcome to my article ‘Winter is coming!’ where I will cover a bit about options to protect feet from the cold without the usual hard sell. Please click on my self-help advice sheet. An article on Trench Foot reminds us that this condition is not one relegated to the past.
Self-help advice sheet on winter tips from Footlocker [ConsultingFootPain]
No-one likes winter but we all recognise in the Northern Hemisphere there is no avoiding our departure from the sun and warmth we all crave. Feet attached to limbs are exposed and called extremities.
The rule is simple: use the right footwear for the right job
Skin and tissue protection
One of my key roles as a podiatrist is to protect tissue. We call this tissue viability which means preventing or restoring the soft foot tissue from skin damage. While this might appear to be focused on ulcers, for the podiatrist, the burden of care is much wider as we want to stop tissue damage. So with this in mind, the aims are to protect the skin from thermal damage and naturally the secondary features of infection.
Last month I covered trench or immersion foot and highlighted the fact that this condition can still affect those who fail to acknowledge that damage can arise from the combined action of wet, cold and mud. The skin does not like exposure and can only tolerate so much damp, wet and cold. The rule is simple: use the right footwear for the right job. Skin soon turns red with the cold air and the circulation shuts down to preserve the inner heat. The skin mostly will recover unless the external conditions persist for long enough.
When do we have to be careful?
With the seasons no longer sticking to a clear geothermal plan, our changing weather patterns can catch us out. Winter starts officially from the 1st December and finishes on 20th March. It is not just the appearance of snow that we are concerned about but those wet days when a chill factor prevails.
What to look for?
Skin becomes mottled which means a changing through a variety of colours that may form blisters, or a shiny surface as the tissue swells. When these changes arise the skin becomes fragile. Red blotchy dots can appear showing patches of damage. Erosions (shallow) and ulcers (deep) form so that the layers of skin disappear with a resultant wound that weeps and might become infected. The itching is secondary to the foot warming up again. Once this happens our own predisposition to scratching causes more damage.
Who is at risk?
Anyone with poor circulation or skin disease must guard against damage by rubbing to help the itch. Those with Raynaud’s (white finger) and scleroderma, a connective tissue defect, are especially at risk but children are the ones who might not wrap up adequately and the older citizens. Bumps from bunions with thin skin are also at risk from the effects of cold and damp. Conditions associated with poor circulation relate to small blood vessel disease or central blood circulation inefficiency so medical awareness is important if this is backed by a known disease process. The difference between the child and older adult is significant. Children will recover sooner and easier although the temptation to force the skin to warm quickly under hot water is not a good idea. The adult does not recover so well as their circulation is likely to be sluggish and fast warming can lead to irreparable skin damage. Those that hug close to open fires produced a brown lattice of skin damage called ‘erythema ab igne‘, but hot water bottles can cause similar damage. Where the skin or extremities are exposed to chilling sudden deprivation of oxygen can lead allied to poor blood supply can lead to gangrene. You don’t have to walk in the Klondyke or South Pole to suffer from frostbite.
Other activities and cold exposure
I finally had to give up cycling due to an old knee injury so I no longer zoom along the lanes near my rural home. I recall all too well cold feet and safety as a cyclist, and of course wrote an article on the subject. However, there are numerous circumstances where we can find ourselves suffering from that freezing effect. Winter activities from sports to walking all require protection. Some of the hardiest people can be found wearing shorts all year round, indeed I had one patient who wore shorts for 365 days of the year. While feet might need to feel toastie, legs, trunk, and head are equally important to keep warm.
Accelerating the cold effect with speed
Quality fitted helmets with headbands covering the ears or a ski mask are helpful. Goggles or glasses to protect the eyes and layers that are windproof are required if you are attempting anything with speed – skiing as well as cycling for example. Pain can arrive soon if the extremities are exposed. Hands and feet need insulation. Most regular skiers know what to do to protect feet and there is usually plenty of expertise around, especially when going with organised groups.
But back to those feet; what are the top tips?
Most of us do not need medication to open up vessels in our legs and arms to cope with cold weather. The seasonal chilblains (perniosis) and chilling must be avoided no matter how healthy we are. Old wounds and scars are notorious for their sensitivity in the cold and even patients with internal metal work can feel intense sensations associated with cold.
A pair of waterproof insulated socks and correct outer protection from wet is important. Neoprene overshoes form good foot protection on a bike. This keeps feet dry, comfortable and warm when lower temperatures are recorded. Those Gortex ankle covers protect both footwear and legs from damp and cold. I have a home digital meteorological box so can watch out for low-temperature trends. Living near the sea I am mindful that the wind adds to the chill factor so even when temperatures appear warm, the combined effects with cold can still act unpleasantly.
So as we embrace whatever weather is thrown up this coming winter season, let’s make sure we are protected. Above all, we want to carry on with all activities but for those who are a greater risk from the cold, we must ensure our loved ones are best protected. If it is one problem that does not need medical attention that is good for everyone. Download the top tips from reliable sources. Top-Tips-for-Winter-Protection-2018-3