Oh my foot!http://www.telegraphindia.com/1160222/jsp/knowhow/story_70544.jsp

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Your Health - Dr. Gita Mathai

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Once we start to walk, (around the age of one) most of us take around 5000 steps a day, even though the recommended number to maintain health is 10,000. This means that each of our two feet, which are comparatively small compared to our body, carries half our body weight around for at least six hours a day. In addition, the feet have to propel us forward, absorb the shocks and jolts of uneven surfaces and help maintain our balance. The force eventually exerted on the feet is actually 50 per cent greater than the body weight.

The foot has 26 small bones and 33 joints - all to each other by 120 muscles, many ligaments and an intertwining web of nerves. There is therefore a great deal of potential for things to go wrong!

Once the feet start to pain, the function of the whole body is affected. But first, it is important to analyse it. Is it a onetime phenomenon due to an acute injury like hitting a door or stepping on a rock, or is it chronic and long lasting? In either case, it is important to localise the area of the pain broadly into toes, forefoot or hind foot.

Footwear can cause and aggravate foot pain if they are ill-fitting and have hard unyielding soles. Feet (specially those of school children) are often squeezed into shoes a size too small, or may flap around in shoes a size too large. Children's feet do grow rapidly and shoes are expensive but buying the correct size will prevent long lasting damage to their feet. Adults may buy shoes that are in fashion. High heels, pointed toes and shoes too narrow for the feet with hard soles can cause corns and callouses. If feet are squeezed into narrow shoes, the front toes can develop arthritis and pain.

Pain in the feet may be due to the wear and tear of age, or part of a medical problem like rheumatoid or osteoarthritis. Obesity may increase the strain on the foot. The weight gain in pregnancy can cause pain in the feet. Diabetes can make the feet numb and cause nerve damage and shooting pains. Spinal problems, weakness and paralysis, cerebral palsy or Parkinson's disease, all of which cause changes in the gait, can alter the alignment of the joints of the foot and result in pain.

If feet pain, soak them in warm salted water for about 10 minutes. Manipulate the feet with your hands to see if the pain is relieved. Practise proper walking posture. Raise and curl the toes several times. Practise picking up a soft object with the foot. Stand up and rock heel to toe.

If the pain persists, an orthopaedic surgeon needs to be consulted. There may be obvious problems in the forefoot, like hammertoes, claw toes, ingrown toe nails, bunions, corns or callouses. It may be due to a metabolic disorder like gout or diabetes. Specific remedial treatment will cure the pain.

Pain in the midfoot is often due to flat foot. This may have been present from childhood or it may appear with increasing age and obesity. Insoles or corrective footwear will help with this.

The heel often hurts because of the Achilles tendon (the large tendon attaching the calf muscle to the heel pulling on it and causing micro fractures. There may be bursitis under the heel bone, or a bony spur may form there.

Any foot pain that does not disappear in a few days with hot soaks and OTC pain relievers requires a medical evaluation.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her atyourhealthgm@yahoo.co.in

Seizure disorder

http://www.telegraphindia.com/1160208/jsp/knowhow/story_67973.jsp

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Your Health - Dr. Gita Mathai

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Epilepsy is scary to see. In a typical "grand mal" seizure there is uncontrolled flaying of hands and legs, rolled up eyes, a guttural sound, and a chance of the tongue getting bitten. The person usually falls to the ground, bowel and bladder control may be lost and there may be loss of consciousness. The seizure ends with the person waking up in a few minutes, unaware of the occurrence. Small wonder that in ancient times epilepsy was equalled with demon possession!

If you witness such an attack, don't try to hold the victim down. Seizures are usually self-limited. The best thing to do is turn the person to one side, clear the immediate area of sharp objects and remain with the person till the "fugue" or confused state wears off.

All the muscles in our body are controlled by electrical signals originating in our brain. If electrical signals become uncontrolled with rapid firing, the muscles respond with twitches or seizures. Once the "fuse" blows, the movements stop.

Typical "grand-mal" seizures involve the whole body. Partial seizures involve only one half of the brain or sometimes just a small area. There may be sudden repetitive movements in certain voluntary muscle groups. The person may wander off or see, say, hear and do things they have no recollection of later. They may suddenly find themselves in strange surroundings. They may just stare blankly and be unresponsive for a few seconds or suddenly drop to the ground. There may be twitching of a limb or a side of the mouth.

The uncontrolled movements during a seizure can result in injury. A seizure while driving or swimming can be fatal. If a seizure occurs during sleep it can cause SUDEP (sudden unexplained death in epilepsy).

Epilepsy is confirmed with tests like the EEG (Electroencephalogram), X-rays, CT, MRI and special brain scans.

About five per cent of children between the ages of six months and five years develop febrile seizures when their temperature rises to 101°F or 38.3°C. The seizures can recur with the next episode of fever, unless the temperature is aggressively brought down with paracetamol and tepid sponging.

Most children outgrow their febrile seizures but about 10 per cent do go on to develop epilepsy, especially if the seizure has lasted for more than 10 minutes or recurred within 24 hours.

Epilepsy is usually "idiopathic" which means that there is no identifiable cause. In some families many members are affected, and around 500 genes have been linked to it. It may be part of the spectrum of other conditions like autism or neurofibrosis. It can be a result of a head injury during birth or in sports or traffic accidents. It may be a sequel of infections of the brain like meningitis or encephalitis. In older adults it may be due to a stroke or a tumour. It can be due to the use of illegal drugs or alcohol. It can be precipitated by low blood sugars or electrolyte disturbances in the blood that occur with vomiting, diarrhoea or heat stroke.

Many medications are available to treat seizures. Usually a single drug is started and after the maximum permissible dose is reached, a second medication is added. It is important to take medications on time and not miss doses while fasting or travelling. Once good control is achieved, epileptics can lead normal productive lives.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

Tail endhttp://www.telegraphindia.com/1160201/jsp/knowhow/story_66774.jsp

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Your Health - Dr. Gita Mathai

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We humans have evolved biologically so much that we tend to forget that we were once animals and had a tail. That is, till we suddenly develop a pain deep down in the cleft between the buttocks, making it difficult to abruptly shift positions, from sitting to standing or getting up after lying down. This pain is called coccydynia.

That last bone in the vertebral column is called a coccyx. It actually is a vestigial tail, which has shrunk over generations. About 2.7 per cent of patients who see a doctor for "backache" actually had pain in the tailbone. It is more likely to occur in physically active youngsters and adults over the age of 40. Women, with their wide pelvis, are more prone to coccodynia.

The coccyx is prone to injury. Acute dislocations, sprains and fractures can occur. Usually there is a history of having fallen abruptly, on a staircase, the side of the swimming pool or some other hard surface. It can also occur while cycling or rowing. Chronic injury can occur if work or academics involves sitting for prolonged periods on hard surfaces like a wooden bench or a chair without cushions. In women, the coccyx can be injured during childbirth, especially if labour is prolonged. Overweight and obese men and women are more likely to develop problems with the coccyx.

Once coccydynia has been diagnosed, conservative treatment can make the pain disappear in 8-12 weeks. This involves sitting in a basin of hot water (sitz bath) for 10-15 minutes at least twice a day. A donut shaped cushion makes sitting during work easier. Inflatable rubber cushions are available which can be carried around. When seated on chairs or in the toilet, try to lean slightly forwards.

Stretches can be done for that area. The two common ones are the kneeling stretch, when you kneel on one leg keeping the other bent at a right angle. After 30 seconds switch sides. The other stretch involves lying down, bending the knees, crossing the legs at the ankle and then pulling the legs towards you with your arms.

NSAIDs (non-steroidal anti inflammatory drugs) like ibuprofen and pain modulators like amitriptyline can help reduce the discomfort. Even mild constipation can aggravate the pain because of straining. Stool softeners like ipsagol husk should be taken. Physiotherapists can manipulate the coccyx if it has been displaced. Orthopaedic surgeons can give an injection of a local anaesthetic in the coccyx. This numbs the pain, the effect lasts for many months and quite often the pain never returns. If all else fails then the coccyx can be surgically removed. Like the appendix, it is a vestigial structure. Removal has no structural consequences.

Every part of our body (even the coccyx) needs looking after.

• While cycling on a stationery bike or on the road, make sure the cycle seat is soft and comfortable. Special "cycling innerwear" is available with padding and should be used.
   
• Do not run on slippery surfaces like the edges of the swimming pool.
   
• Wear footwear that is rubber soled or has a "grip", not smooth leather.
   
• Maintain ideal body weight. This can be calculated as height in metre squared X 23.
   
• Walk and sit with the correct posture. If you feel you are slouching, stand with both shoulders touching the wall and balance a book on your head.
   
• Do not sit on hard surfaces for prolonged periods of time.
   
• Do the stretches described above.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her atyourhealthgm@yahoo.co.in