Cream for Chilblains

Chilblain season has just finished for us here in Melbourne and I will have to admit that this year I have seen more than a few really serious cases – a few more than usual. One in particular was so bad and nothing neither I or her GP could do could make any headway to helpher. For the first time ever, I was serious when I said that they should move and live in a warmer climate. I have joked with patients in the past about this, but this time I was really serious.

I do find chilblains somewhat frustrating to treat as there is not a lot that can be done to help them and most treatments just tend to give some symptomatic relief while you wait for them to heal up and hope another one does not occur before that first one heals up. I have tried lots of things, various chilblain creams tend to only have limited effectiveness, but do help somewhat with a bit of symptomatic relief. They have been used historically with many claims made for chilblain creams.

The other intriguing phenomenon about chilblains is the number of people who say the used to have them and for some reason they just stopped. You can never elicit from anyone something that might have changed for them in the year that they stopped. They just stopped for no identifiable reason. That one is a mystery on me.

They certainly are more common in females, suggesting a role for hormones, but I am not aware of anything involving that to explain the pattern of them resolving and not occurring again for no reason.

All we can do is resort to creams etc and give very strong advice on preventing them… and very occasional suggesting they move to a warmer climate.

There is some good information on Podiatry Arena about chilblains.

The Cracked Heels

The Cracked Heels

Awesome picture from the stock photo service that I use, so I have to write something about cracked heels!

Cracked heels hurt, never look very good and can be a portal for entry for an infection, so they need to be taken seriously. I like the tomato analogy to explain them. The skin around the periphery of the heel splits just like the skin of a tomato skin splits when it is squashed.

We see lots of patients with them. I wish more would take them seriously as they are so easy to self manage. Use a foot file or pumice stone regularly and apply a cream regularly. That its. Do that it will not be a problem.

Lunge Test

Like a lot of other things (eg supination resistance, windlass function, and “overpronation”), the Lunge Test is something I talk about and write about a lot. The main reason being is that it is a clinical text that is supported by a lot of evidence regarding its reliability and validity, especially it link to injury. Not a lot of the clinical tests that are traditionally done tick as many boxes.

The lunge test is well documented online, but is a clinical weight-beairng test of the range of motion of the ankle joint. A couple of studies have now linked a limitation in it to injuries in footballers.

My preference is to actually do the test in shoes on top of any foot orthotics that they have to see if they can reach the required 35 or so degrees that is considered normal.