It is easy to relax in a cold environment because the blood readily travels to cold extremities.

Simple Steps to Summer-Ready Feet

It’s officially the start of summer! Good news for feet – it’s time to swap shoes for lighter footwear and sandals. But before you reveal your toes, give your feet some attention so look and feel their best.

Let’s start with your toenails

• Keep your nails short and well-shaped – use a good-quality file to smooth the edge after cutting them
• Use a little oil (almond oil works wonders!) on dry nails – rub into the surface and the cuticles to improve their texture
• Don’t cut cuticles though, this can lead to infection
• Did you know that nail polish can cause your nails to dry out? From time-to-time, leave off the colour and use oil to recondition them
• If you’ve had an injury or infection, then nail can sometimes thicken or become misshapen, making them difficult or painful to cut. These are best dealt with professionally and Podiatrists have the expertise help you.

Time to think about your skin

Healthy skin should be smooth and supple. Rough, thickened or callous skin, often occurs on areas of the feet which have to work particularly hard and this can be unsightly and uncomfortable. Additionally, your skin can become very dry which causes it to harden and crack, especially around the heels. In the summer, when open shoes or sandals are worn, dryness can become even worse.

Painful callouses can be pared away by a podiatrist who can advise you on how best to care for your skin. There are excellent creams and lotions available to improve your skin’s texture and comfort which, when used regularly, can make a lasting difference.

Some people suffer from skin that sweats excessively, a problem that tends to be made worse in warm weather or after activity and sports. This makes your skin more prone to chafing, blisters and fungal infections (athlete’s foot) and verrucas (plantar warts). Using a good antiperspirant can help with this (eg Dri-clor), as can dusting powders and a better choice of sports socks.

Having lots of small, itchy blisters on your skin, splits between your toes or flaky patches usually means a fungal infection, while verrucas are caused by a viral infection and both need specialist products to treat them. Podiatrists are experts in advising on and treating skin infections.

You can help protect yourself against infections by wearing flip-flops when walking in areas used by many people, by drying your feet thoroughly and by airing sports footwear well after use (fungi love soggy trainers!)

Finally, don’t forget your feet can get sunburned. If you are walking in sandals on a sunny day, remember to apply suncream regularly to the top of your feet.

Don’t forget the right footwear

As with all types of footwear, summer shoes and sandals need to be well-fitting and appropriate for the activities you are doing. Feet get bigger throughout the day, especially in hot weather, so sandals need to be adjustable to allow for this.

Pavement pounding

Flip-flops are beach shoes and are not suitable for day-long wearing on pavements. Your muscles have to work hard to keep these on your feet, so they will be tired and sore by the end of the day. Instead, choose sandals with a thicker, shaped sole, sometimes known as Fit-flops, which are held in place by a strap and give much greater support and cushioning to your foot. This is especially important if you are planning a day’s walking and sight-seeing.

Trekking footwear

Serious trekking requires a well-designed walking shoe – don’t skimp on cheap shoes or socks! You can find these in specialist retailers for outdoor activities.

Now get out there and enjoy the longer days…

Walking is an excellent activity to improve your fitness. It gives benefits to all your bodily systems, strengthens muscles and bones, improves mood and concentration and can help you to lose weight too. Aim to walk at least thirty minutes a day and keep up a brisk pace. If you are visiting the coast, walking barefoot on a sandy beach gives your foot muscles a good workout and helps to keep your feet strong and supple.

Fleet Street Podiatry Clinic

For further advice and information on treatment and how to look after your feet, see our podiatry page. Or you can book an appointment online.

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Definition/Description[edit | edit source]

Cryotherapy, also known as ice application, is the simplest and oldest way to treat injuries. Its worldwide use spread because of its effectiveness, convenience, low cost and ease of transportation. Ice is believed to control pain by instigating local anaesthesia. It also decreases oedema, nerve conduction velocities, cellular metabolism and local blood flow. The effect of the cryotherapy depends on the method, the duration, temperature of the ice and the depth of the subcutaneous fat. [1][2]

Lewis Hunting Reaction[edit | edit source]

The Lewis hunting reaction or hunting response is a process of alternating vasoconstriction and vasodilation in extremities exposed to cold. The term Lewis reaction is used too, named after Thomas Lewis, who first described the effect in 1930. Vasoconstriction occurs first to reduce heat loss, but also results in strong cooling of the extremities. Approximately five to ten minutes after the start of cold exposure, the blood vessels in the extremities will suddenly vasodilate. This is probably caused by a sudden decrease in the release of neurotransmitters from the sympathetic nerves to the muscular coat of the arteriovenous anastomoses due to local cold. This cold-induced vasodilation increases blood flow and subsequently the temperature of the fingers. A new phase of vasoconstriction follows the vasodilation, after which the process repeats itself.[3]

Vasodilation can be cold induced after initial period of vasoconstriction when cold is maintained for longer than approximately 15 min or when temperature is reduced below 10C.

Application Methods[edit | edit source]

Ice pack being used for calf strain

1. Ice Packs : It is most common method of cryotherapy. There are different types of ice used in ice packs. The most common types are ice packs made with cubed, crushed and wetted ice.[2] It was discovered that wetted ice is better to lower surface temperature during treatment and maintaining the lower temperature during recovery. It is also more effective in lowering the intramuscular temperature during treatment.[2]
2. Ice Spray : A cooling effect can also be produced by icing spray for a similar effect.[4]
3. Immersion : Simple or whirlpool immersion.
4. Ice Massage : slow strokes in circular motion for 5-10 mins.

More recently whole body cryotherapy has become popular for athletes, to help aid recover, as well as in persistent pain patients such as rheumatological conditions. More research is needed to understand the effect on the body and its relation to pain.[5]

[6]

Conditions treated[edit | edit source]

• Acute soft tissue injuries e.g. ankle sprain, muscular sprain, ligament sprain
• Myofascial trigger points
• Tendinitis
• Acute swelling
• Bursitis
• Post orthopaedic surgery e.g. TKR, ACL reconstruction, arthroscopic shoulder surgery.[7]
• Acute sports injuries
• DOMS[4]

Pros[edit | edit source]

• Pain relief[8]
• Swelling reduction[8]
• Decreased surface temperature
• Effective on a wide range of soft tissue injuries

Cons[edit | edit source]

• Little evidence regarding duration and frequency of treatment to be effective[8]
• Compression has been shown to be more effective post operatively[8]
• In rare cases bradycardia and frostbite symptoms have been observed. [4]
• Some more advanced cryotherapy devices can reduce range of movement following TKR due to immobilisation of the joint. [9]

Possible Risks/Undesirable Effects[edit | edit source]

Inhibit Muscle Function[edit | edit source]

• Cooling can temporarily Inhibit muscle function with potential for increased risk of injury/re‐injury
• Be cautious when having patients weight bear/undertake complex exercise after icing a lower extremity

Ice Burn[edit | edit source]

Elderly patients with impaired sensation and/or circulation will be more vulnerable to an ice‐burn, therefore consider using less intense icing techniques (e.g., moderately cold ice pack wrapped in an insulating layer(s) of towel/cloth)

• Younger patients with intact sensation and circulation may benefit most from direct immersion of the limb in cold water then progressively adding ice cubes
• Cold gel packs stored in a freezer have a surface temperature below 0°C (32°F) and thus an insulating layer should be used between the cold pack and the patient’s skin

Cryotherapy‐Induced Nerve Injuries[edit | edit source]

• Most common when cold is applied in combination with compression
• Check capillary refill during application of ice combined with compression therapy to ensure adequate blood flow

Generalized Cooling and Decrease in Core Temperature[edit | edit source]

• Shivering and piloerection are signs of decrease in core temperature which may compromise patient safety (especially in the elderly and those with fever)
• The application of therapeutic cryotherapy should produce only local effects

Reduced ROM[edit | edit source]

Ice may contribute to shortening of collagen fibres in connective tissue

• After gaining ROM by warming, stretching and then strengthening in the newest part of the ROM, it is likely counterproductive to cool the tissue in a shortened position
• If one wishes to cool the tissue post stretch and exercise, it is best to do so with the tissue in a lengthened position
• In patients with significantly restricted ROM due to scar tissue, it may be preferable not to use ice.

Contraindications[edit | edit source]

Be aware of conditions in which icing is contraindicated[10]

1. CRPS, haemoglobinuria, cryoglobulinemia,
2. Peripheral vascular disease
3. Impaired circulation: Raynaud’s disease
4. Urticaria
5. Hypersensitivity to cold
6. Skin anaesthesia

Resources[edit | edit source]

1. ↑ Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. The American journal of sports medicine. 2004 Jan;32(1):251-61.
2. ↑ 2.0 2.1 2.2 Dykstra JH, Hill HM, Miller MG, Cheatham CC, Michael TJ, Baker RJ. Comparisons of cubed ice, crushed ice, and wetted ice on intramuscular and surface temperature changes. Journal of athletic training. 2009 Mar;44(2):136-41.
3. ↑ Daanen HA. Finger cold-induced vasodilation: a review. European journal of applied physiology. 2003 Jun 1;89(5):411-26.
4. ↑ 4.0 4.1 4.2 Galiuto L. The use of cryotherapy in acute sports injuries. Annals of Sports Medicine and Research. 2016;3(2):1060.
5. ↑ Banfi G, Lombardi G, Colombini A, Melegati G. Whole-body cryotherapy in athletes. Sports medicine. 2010 Jun 1;40(6):509-17.
6. ↑ George Eliot Hospital. Applying an Icepack - Physiotherapy Advice Video Available from: https://www.youtube.com/watch?v=gJOMV2mZ1B0 [last accessed 28/09/2020]
7. ↑ Ni SH, Jiang WT, Guo L, Jin YH, Jiang TL, Zhao Y, Zhao J. Cryotherapy on postoperative rehabilitation of joint arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy. 2015 Nov 1;23(11):3354-61.
8. ↑ 8.0 8.1 8.2 8.3 Hubbard TJ, Denegar CR. Does cryotherapy improve outcomes with soft tissue injury?. Journal of athletic training. 2004 Jul;39(3):278.
9. ↑ Thienpont E. Does advanced cryotherapy reduce pain and narcotic consumption after knee arthroplasty?. Clinical Orthopaedics and Related Research®. 2014 Nov 1;472(11):3417-23.
10. ↑ Prohaska J, Badri T. Cryotherapy. InStatPearls [Internet] 2020 Feb 7. StatPearls Publishing.

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