Handout from the December 1997 meeting

Santa Barbara Foot Clinic A Podiatry Group, Inc.
14 E. Arrellaga St. Santa Barbara, CA 93101-2502
Telephone: (805) 965-1515

Dr. Gregory Aposperis, Board Certified In Podiatric Primary Care and Surgery

" FOOT PROBLEMS IN RHEUMATIC DISEASE "

Problems are similar to all chronic diseases but with special considerations due to medications

In comparison to your general medical problems, foot problems may seem rather mundane to you and even your physician but can result in pain and inconvenience; or serious complications requiring hospitalization and amputation Never be "ashamed" to have your feet examined. That's what we are here for; and we have seen it all

Foot problems include:

• Bunions and hammertoes, with and without degenerative joint disease
• Heel pain caused by spurs, plantar fasciitis, Ankylosing.Spondylitis, Gout, low back disease, sciatica, etc.
• Nerve pain caused by neuromas, Tarsal Tunnel Syndrome, neuropathies, low back disease.
• Ingrown, thick, deformed, fungused, pitted and clubbed nails
• Corns, calluses and warts.
• Foot and ankle sprains, painful arches, stress fractures

SPECIAL CONSIDERATIONS FOR PATIENTS WITH COLLAGEN DISEASE

1. Many medications used for your disease impede healing, clotting and/or your body's immune response.
2. Long term or chronic use of steroids can cause atrophy of the plantar foot fat pad, general skin atrophy and friability, slow healing, osteoporosis, mask infection, and slow the body's immune response Therefore, all injuries should be considered potentially serious:
   1. Stress fractures of bones in the feet are common; yes, you can walk on a broken foot bone.
   2. Minor cuts should be cleansed and treated with topical antibiotic If they appear to worsen alter three days, they should be examined Hydrogen Peroxide is considered to decrease wound heating; use wound cleansers instead-- Phisohex, etc.
   3. Blisters, if not painful, should be left to heal without draining.
   4. Contaminated wounds, especially puncture wounds, should be examined by a doctor immediately and possibly treated with tetanus booster.
   5. Traumatized or ingrown toenails should be examined immediately as they tend to become readily infected (from both bacteria and/or fungus) and they often will appear or feel better before they get worse, usually Saturday and Sunday nights before a Monday holiday

SAFE SELF-TREATMENT ALTERNATIVES

1. After an injury, use Ice to prevent swelling and bleeding Do not apply directly on the skin and avoid altogether if you have Raynaud's or Erythermalgia.
2. If you suspect infection, soak your foot in LUKEWARM water (the same temperature you would bathe a baby) and Epsom salts--one tablespoon per quart. Table salt is not the same.
3. Use moisturizing cream on your feet daily, especially before bedtime. Avoid scented creams as they contain alcohol which is drying!
4. Use plain talcum powder the morning, if your feet perspire. Avoid chronic use of Athlete's Foot Powders.
5. Foot odor can be caused by increased perspiration in the presence of bacteria or fungus. It is also caused by some allergies--localized to shoes or socks, or generalized which causes the body to detoxify itself through perspiration.
6. Beware of pedicures If you have them done, be certain the person sterilizes her instruments, changes solutions, thoroughly cleans her soak basin and uses a hot bead sterilizer for the instruments.

Helpful Hints For Healthy Feet

1. Bathe your feet daily in warm water and dry thoroughly. If it is difficult to dry between your toes, use Q-Tips for drying.
2. Wear clean socks and change them daily; discard them when they are worn.
3. Wear shoes that fit snugly but not lightly. Keep them in good repair. Purchase shoes late in the day when your feet are swollen, to assure for a better fit. Wear the shoes only around the house for 2-3 days to be certain the fit is good--if you wear them out of the store, they may not be returnable.
4. Trim your toenails straight across but following the contour of the toe. Do not round off the corners or dig under the nails to clean them.
5. Do not trim your own corns or calluses or use commercial remedies as they contain acids.
6. Wear slippers around the house or sandals at the beach or gym; bare feet invite injury
7. Avoid extremes in temperature Never use hot water bottles or heating pads Protect your feet from sunburn.
8. Avoid anything tight around your legs or ankles which may restrict blood how.
9. Avoid smoking, which impedes blood flow.

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