The Hong Kong Foot

Dear reader,

Today’s topic is requested by a reader from Singapore. Hopefully today’s topic will spice up your curiosity about the Hong Kong Foot. Why does specifically called the “Hong Kong Foot”? Well, you will find out soon!

The origin of the Hong Kong Foot

There were many sayings regarding of the origin of the Hong Kong Foot and one of the famous stories dates back during the Qing Dynasty. After the British won the first Opium War, they successfully occupied and stationed themselves in Hong Kong. Unlike Britain, the weather in Hong Kong was warm and humid, and the footwear worn by the British soldiers were not providing enough ventilation for their feet. Such condition creates an ideal environment for fungus to grow and releases an unpleasant odour. Many of them caught the disease during their service in Hong Kong and such medical condition was never been seen or treated in the West. Since the epidemic started in Hong Kong, therefore they named it the Hong Kong Foot.

Nowadays the term Hong Kong Foot is widely used in Asia especially in China, Hong Kong, Taiwan, Malaysia and Singapore. A Hong Kong Foot is also known as an Athlete’s foot in the Western world.

For us podiatrist, we call it tinea pedis (doesn’t it sound professional?) Anyway, they are the same thing =)

What is Tinea Pedis/ Athlete’s foot/ Hong Kong Foot?

If you ever come across someone mentioning either one of the above, they are all the same condition. Throughout the rest of the blog, I will be using TP (Tinea Pedis). Basically, TP is caused by harmless skin fungi (plural of fungus), also known as dermatophytes, that already exist on the human skin but only in a small number.

When did my ‘harmless’ fungi became an embarrassing NIGHTMARE?

Based on two conditions listed below:

1. Resources - Our keratinised skin tissue is the food supply for the dermatophytes
2. Environment - Dark, warm, moist (sweaty!) and limited ventilation area especially the foot is an ideal location for the dermatophytes to breed and multiply.

Without either one of the above, these skin fungi do NOT stand a chance!!

How do I know if mine is TP?

TP often affects the skin between the little toes first (4th & 5th). If you separated the toes, you will notice accumulation of moisture and sogginess, and also a kind of unpleasant odour. It will slowly spread to the entire sole of the foot with the followings:

Itching

Blisters

Cracked skin

Redness/ tiny red spots

Scaling/ skin flaking/ peeling of skin

Who gets it?

Nowadays you don’t need to go to Hong Kong to have a Hong Kong Foot, nor be an athlete to get an Athlete’s foot. One can easily gets contracted by walking barefoot around the swimming pools, wearing an enclosed footwear for long period of time, sharing footwear or towels with someone who has got TP.

MANAGEMENT

When you have had enough of the harmless yet annoying TP, there are two things you can do. You can either D.I.Y or consult a Podiatrist =)

What you can do

At the beginning we discussed about the two conditions that allow the dermatophytes to grow happily on our skin. Which are again the RESOURCES and ENVIRONMENT available FREE for them. Everyone loves FREE stuff and so do the Fungus! So I am going to share with you some TIPS that will help to improve, if not cure the fungal infection on your feet.

There are two important criterias to be met: FOOTWEAR & FOOTCARE

Footwear

There is no point treating your feet without sorting out the source of infection (footwear). So first and foremost is to investigate the footwear that you wear regularly or on a daily basis. A good way to do that is to check for: Dampness & Odour. If YES, please follow the 5 Simple Steps below.

The 5 Simple Steps:

1. Remove the insoles of your shoes & let it air dry
2. Undo/ loosen the laces & open up the tongues to allow air ventilation
3. Place them in areas that has got sunlight (UV-ray kills germs)
4. Allow at least 24-48 hours before wearing them again
5. Alternate your shoes daily

Lastly, change your socks every single day, period!

Footcare

There are many ways that you can make the environment of your feet less sustainable for the dermatophytes. There are a lot of antifungal products out on the market that can are effective in treating Athlete’s foot and they come in sprays, gels, powder and emollients (cream) depends on your need.

The 4 Simple Steps:

1. Clean your feet with cold water (bearable coldness)
2. Tap dry the entire foot and in between the toes with a separate towel
3. Apply the antifungal product based its given instruction
4. Put on a pair of clean cotton socks

Thumbs up if you are doing so :) If not, please start getting into the habit now as its never too late.

What we can do

TP is not that difficult to get rid of if you follow the advice and tips given above. Many patients are able to get rid of TP via self-treatment within two weeks provided that they comply accordingly. If everything you have done still does not solve the problem, please visit your local podiatrist. Sometimes self diagnosis may not be always accurate, but with the opinion of a foot expert (podiatrist) you can be assured the best treatment for your condition.

Alright folks, before I conclude today’s topic, please remember to maintain a good foot hygiene as this will prevent yourself from getting fungal infection. Also remember that tinea pedis, Athlete’s foot and Hong Kong foot are the SAME thing! They are all fungal infections.

Once again thank you for reading and have pleasant week.

See you next week

Louis :)

Corns + Callus = 2Common (Part 2)

Dear reader, 

Welcome back to Corns + Callus = 2Common (Part 2). In this episode, we are going to focus more on corns. Some might think that a callus and a corn are the same thing. I would agree with you but not 100%. First of all they are caused by friction and pressure build up on the surface of the skin. They are also keratinised tissue of the skin. There are TWO ways to distinguish a corn and a callus.

1. Presentation 2. Feeling

Before we go any further, let’s just focus on the corns right now.

A corn? Something edible?

Well it sounds like it, written like it; but this is not the corn we are talking about. I believe some of you readers might like the edible corn but this is no one’s favourite!

So what is a corn?

It is a circular cone-shaped thickened skin, so basically it looks like a cone when it has been ‘dug’ out. And it leaves a hole on your foot depending on how big the size of the corn was.

Why does it develop?

Similar to calluses, corns develop due to long term of friction and pressure between the skin and its surrounding.

Where is it most commonly found?

Corns are most likely to be found on prominent areas of the foot like the joint. This is because the joint has little fatty pads or tissue surrounding it. Having said that, corns are still likely to be found on odd places e.g. in between the toes, the side of the foot, the arch of the foot or even underneath the CALLUSES!!!

How does it feel?

Okay readers, let’s imagine you sellotape a tiny stone on the sole of your foot regardless of the area you stick it on. Try to walk on it. ‘Ouch Ouch!!!’ That’s how bad a corn hurts =(

Management

What you would do

Based on my experience, many people tried to remove corn by digging it out using fingernails or using the nail clipper. It can be very unhygienic to remove them using non-sterile tools. Unlike calluses, corns are normally embedded deeper in the skin which can easily cause bleeding if not carefully managed. This can easily creates a portal of entry for infections.

Some of you might even go to a local pharmacy to shop for over-the-counter treatment product. So far the most commonly seen product would be the corn plaster. Basically, it is a plaster is impregnated with salicylic acid which helps to break down the keratinised tissue (hard skin) of a corn. Not everyone is suitable to use it, why? Because it’s salicylic ‘acid’. That’s right! Please refer to the list below to see whether you are suitable or not =)

      

You are encouraged not to use a corn plaster if:

• you are allergic or sensitive to any of the ingredients in the medicine/ product
• you are someone under 16 years of age
• you have circulation problems
• you have broken or inflamed skin around the corn that needs to be treated
• you have DIABETES

What we would recommend you to do Remember corns and callus do not form within one day, it takes time together with external pressure and friction for it to form. Again a good advice would be similar to how you reduce the thickness of your callus. 4 Simple Steps:

1. File the callus or corns of your feet with a skin file or a pumice stone
2. Wash them with soap & tap them dry with a towel
3. Apply foot cream/emollient
4. Put on your socks and go to bed

What we would do

By following the 4 Simple Steps will slow down the process of extra thicken skin and corn formation. Once you have done your part, you can leave the rest to us. In order to get rid of the corn and callus formation is to get rid of the pressure and friction that is causing it. Well this is what we as a podiatrist do best.

Enucleation using Scalpel blade

All podiatrists are well-trained in handling scalpel blade and all the blade being used are sterile ones (Wiki: free from bacteria or other living microorganisms; totally clean). Corns will be dug out from the skin as precise as possible. Once a corn has been removed, patient will be able to feel the difference when an external pressure is being applied on the ex-corn area.

Padding and insole

Initially a temporary padding will be given to patient to try out. The aim of a padding is to provide a better distribution of pressure across the whole foot. The temporary padding will be reviewed to ensure maximal comfort has been achieved before a more bespoke insoles being custom made.

Diagram above: This is how the padding would look like depending on the position of the corn.

Diagram above: This is how we analyse your foot pressure and based on the information gained we can manufacture the orthotics that is specifically for your feet.

*The Diabetes Corner*

A corn can be problematic if left untreated or unnoticed by patient or carer. 

‘Unnoticed?!! How could that be possible?? It is already so painful to walk on!!!’

Yes unnoticed! In fact certain patients with diabetes are not able to feel an existing corn. Diabetes can cause neuropathy (lack of sensation) due to high level of glucose in the blood which damages the small blood vessels that supply the nerves. If left untreated or unnoticed, a corn can cause a healthy skin to break down from the underneath and develop into an ulcer. Normally, a good indication of break down underneath the skin will be presented in a reddish-brown colour. If an ulcer develops, the wound will be harder to heal and it is even harder to heal when it is infected. Eventually, this will lead to more responsibility for you and the health care professionals.

If you know someone with diabetes or elderlies who are less-abled, please please please ensure that their feet are checked on a regular basis for any signs of corns or calluses. This would mean a lot for the person you care for.

It all started with a corn…

Diabetes + Neuropathy + a CORN = Ulcer + treatment fail = AMPUTATION!!!

If you CARE, you can PREVENT it!

Thank you for reading and don’t forget to spread the love

Have a pleasant evening!

Louis =)

Corns + Callus = 2Common (Part 1)

Hello and welcome to today’s blog! Since our main theme is about Common Foot Problem, corns and callus are definitely my most favourite conditions to talk about.

Corns and callus can exist together or separately depending on many factors. Let’s talk about them in a simple and organised way. First, we gonna discuss about CALLUS then move on CORNS.

What is callus?

Callus (a.k.a callosity) is basically an area of thickened and roughened skin that act as a protective barrier to the underlying soft tissue.

Why does it develop?

The human body is a clever mechanism, it will protect itself whenever and however it can. Therefore, callus develops when a particular area of the skin is exposed to a continuous friction or a high pressure or both for a long period of time.

Where is it most commonly found?

Calluses are most commonly found on our feet (skin rubs against the bone, shoe or ground) but they can be found on the palms of our hands too especially in weightlifters (skin rubs against heavy metal bars).

Who gets it?

Basically anyone can have callus build up. However, some people have a higher tendency to form callus due to their natural skin type. For instance, elderly people are more prone to developing calluses on their feet because they have less fatty tissues in their skin. Younger people that work on their feet a lot for example Taekwondo fighters tend to have calluses build up.

When to seek treatment?

Always remember that callus serves a purpose, which is to protect the underlying skin from further friction or pressure that caused it. Normally callus is not painful but if a callus became very uncomfortable to walk on, please feel free to try the 4 simple steps below:

1. File the callus on your feet with a skin file or a pumice stone
2. Wash them with soap & tap them dry with a towel
3. Apply heel balm or foot cream/emollient
4. Put on your socks and go to bed

Please be aware not to remove too much or all calluses from the feet as this may cause more discomfort to walk for the newly-exposed skin surface. Callus will slowly grow back to aid to the protection of the feet for as long as the pressure or friction is present. It is always helpful to consult a Podiatrist or Chiropodist if the calluses on your feet are troubling you day-to-day activities =)

Management

There are many various treatment that can be provided by a podiatrist. It all depends on what causes the callus to form and which area the feet are affected. Not just that a podiatrist will also examine your gait (a.k.a walking patterns) to identify the problem.

Footwear

There are many fancy footwear out there on the market, from commercial to designer, from glossy to pricy! Footwear nowadays emphasized more on fashion rather than protection. If you bought a footwear that is not suitable for your feet, it may cause more harm than good to your feet.

First of all, footwear will affect your gait or walking pattern. Just compare high heels and pumps, you definitely notice the difference! Not just that, it will also affect the distribution of pressure on your feet. The heels of your feet are structured to withstand ⅔ of your body weight and ⅓ on your forefoot (the ball of your feet). By wearing high heels changes it the other way round. So now the forefoot is carrying ⅔ of your body weight and ⅓ on your rearfoot. Sadly our feet aren’t designed to do that. What happen next?

Callus! That’s right!

Wearing the right footwear is very important but again it is a choice for most individuals.

Orthotics

There are many different kinds of insoles out in the market. I call them the universal standard insole. First of all they are not custom-made, we have to accept that the human feet come in different shapes and sizes;  so they might suit you but not the others. Unless you have got someone on the spot that has got good knowledge about orthotics and insoles (I don’t mean shoe fitter). Don’t get me wrong, of course they are people that benefited from the standard insoles they bought from the store. If you find the off-the-shelf orthotics not helping, it is advisable to visit your local podiatrist or chiropodist or orthotist.

Non-invasive scalpel blade debridement

The name sounds so CooooOOLLL right? It is actually a debridement method using scalpel blade. Don’t worry, don’t faint if you see a podiatrist tries debriding your hard skin without injecting local anesthetic (L.A.). A podiatrist or a chiropodist is well trained and entitled to use a scalpel blade. The reason to use scalpel blade debridement is when the callus got too thick for filing.

*The Diabetes Corner*

For those who has got diabetes, the skin is normally quite dry. Callus may breakdown or crack apart due to the its thickness and dryness. We normally call it a callus fissure or heel fissure if it is on the heel.

If no action is taken, the fissure will crack deeper and cause an open portal for infections. This will lead to an ulcer formation or even an infected ulcer. I strongly advise people with diabetes to check their everyday before going to bed and first thing in the morning. Please go visit your local podiatry clinic if you have any doubt or uncertainty.

Well, a fire always starts from small. Same goes to heel fissure, if no action is taken it might lead to an ulcer, and an ulcer can take up to months or even years to heal. Amputation might be the last option. No joke!

If you CARE, you CAN prevent it!

That’s all for today folks! Hope you enjoy reading and don’t forget to share it to your love ones! Every little kindness counts!

Goodnight and stay tune for Part 2

Louis