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Saturday, February 21, 2009

Preparing Your Feet for TEOTWAWKI, by The Surgeon

This essay will cover several common foot problems which can be prevented with proper care. These problems can lead to impaired walking, running, and decreased mobility, which may adversely affect survival in a serious post disaster situation. The foundation for this information is basic knowledge gleaned from the 1930s edition Scout Handbook, which relied heavily on Lord Baden Powell’s experience in the British Army.The author is a Board-Certified Surgeon.

The feet have a hard job to do. They support the weight of the body standing, walking, running, and jumping. Any time there is excess body weight, the added load on the feet can result in problems. These include plantar fasciitis and ankle sprains. There is a much higher incidence of Type II Diabetes in the obese, and this leads to a host of foot problems, many of which can be life-threatening.
Ingrown toenails are a common preventable problem. There is a congenital predisposition based on the geometry of the nail, and this is made into a problem by the bad habit of keeping the nails too short and ripping the nail off instead of trimming or filing it straight across. This leads to a spicule of nail which points into the soft and delicate tissue of the nail fold, where it causes irritation, inflammation, and finally chronic infection and pain.

The preventive treatment is to keep the nail as thin as possible by filing the surface, which makes it flexible instead of rigid, and to avoid any ripping of the nail. The nail should be gently filed or trimmed straight across, with only enough rounding of the sides to prevent digging into the skin. A small tuft of cotton can be wedged between the nail and the nail bed if needed to prevent digging in until the nail grows long enough. [JWR Adds: I concur that a relatively "square" cut is best, as has been encouraged by military organizations since before the 1850s. However, readers are forewarned that changing the profile of toenails radically can cause in-growth, so make any changes gradually!]

Sometimes cutting a “V” notch in the center of the leading edge can relieve the pressure on the sides until it grows out.

There are proprietary systems which involve gluing a rigid polymer or metallic strip across the nail to pull up on the sides. In theory this should work. It is difficult to get any adhesive to work on nails, but they are worth a try.

If things have gotten too far out of hand, and a spicule of nail is growing into the nail fold, then a thin portion of nail will need to be removed by a surgeon or podiatrist.
This can be done as an office procedure with local anesthesia. The procedure itself is not very hard but I have found that getting good anesthesia requires some skill and patience and I would not recommend it as a “do-it-yourself” project. The nail matrix needs to be destroyed either by cautery or by a caustic agent to prevent re-growth on the affected side. Recovering from this to achieve normal walking takes several weeks.

Parents and partners need to look out for each other and their children since this can become a serious problem. Education about proper foot care starts early along with toothbrushing.
Immersion foot or trench foot is caused by chronic exposure to water and extreme environmental condition, either hot and humid or cold. The best prevention is avoidance of immersion, and if this should occur, dry socks need to be put on after drying and powdering the feet. It is helpful to have spare boots. The time to break these in and waterproof them is now.

Ankle sprains can be extremely debilitating. Wearing well-fitted ankle high boots, laced securely, best prevents this. There is a great product available wherever animal health supplies are sold called Vet rap made by 3M. It is flexible elastic wrap that is self-adherent. It provides excellent support for those who have previously injured their ankles, and it makes an all-purpose first aid dressing material, which can help hold a pressure dressing in place, or keep a splint immobile. If you would like to pay more, the human version is called Coban. I would recommend the 4” size.

Diabetics need to take special care of their feet. In a survival situation it is extremely unlikely that you will be able to get the specialized care needed to treat a diabetic foot infection, so prevention is key. Because of the peripheral neuropathy which many diabetics develop, the feet may lose sensation. It is very important to frequently inspect the feet for any injury, nails rubbing on the skin, pressure sores, etc. This is best done with a partner so all parts of the foot can be seen. Nails need to be cared for meticulously. Cotton tufts can be placed between the toes. Shoes must be “shaken out” frequently to make sure that no pebbles or debris get inside. Well-fitting high boots are less likely to get debris inside than sneakers or low-cut footwear.

Smoking can lead to severe peripheral vascular disease with loss of arterial supply to the toes and feet. In a normal situation it can lead to gangrene and amputation. Combined with diabetes it can result in more severe atherosclerotic changes in the blood vessels. It can also make the smoker more susceptible to frostbite.

Who can help you meet these challenges? Most experienced outdoorsmen and soldiers have learned the hard away about these issues. Next to making sure the troops get enough water to drink, foot care comes a close second. It might be a good idea to link up with a healthcare provider to make sure you don’t have any remediable issues such as ingrown nails that require attention.
Diabetic control and smoking cessation can be approached with your primary care doctor. There are specially trained nurses who frequent senior centers and nursing homes, providing basic foot care. Those with a nursing background might check out this type of training. For good quality shoes with plenty of toe room, and custom made inserts for pressure relief, you’ll need to see an orthotist.
Having healthy feet is critical to maintaining a tactical readiness for future possible disaster. Some chronic foot problems develop over years, so now is the time to make appropriate changes in one’s habits.


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