Monday 23 April 2018

Ask the GP: Problem feet and the importance of fat

Balanced meal
Balanced meal

Nina Byrnes

I have real problems with my feet. I seem to permanently have some kind of scaling and itching of the skin between my toes. I've tried using foot powders and creams but they don't seem to be working. What can I do?

Dr Nina replies: It sounds like you have a case of tinea pedis or athlete's foot. This is a fungal infection that causes itching, burning or stinging of the skin and often scaling or cracking of the skin. Infection can also then spread to the toenails causing crumbling and splitting of these too.

The fungus that causes athlete's foot is commonly found on floors and clothing, however it does not infect everyone. Fungi require a warm moist environment to multiply. Those who walk around barefoot are rarely infected.

In athlete's foot the skin may become red, scaling or peeling and there may be itching, burning or stinging. In more severe cases there may be oozing or crusting and cracking, leading to open red areas.

If left untreated infection may spread to the sides or surface of the feet. Rarely infection can spread to the hands in those who touch their feet and don't wash them after.

Fungus may live happily on clean dry skin without multiplying. When a warm moist environment exists, fungi multiply rapidly. Wearing tight hot shoes and socks, or wet environments such as those found at a pool or spa provide the perfect environment for fungi to thrive.

Athlete's foot is highly contagious and can spread through direct skin to skin contact or indirectly through infected sheets, towels or surfaces.

Most cases of athlete's foot can be treated by over-the-counter medicine found in your local pharmacy. For mild infection, creams and powders may help. In more severe infections anti-fungal tablets may be prescribed. Anti-fungal tablets may interact with other medication such as warfarin or the contraceptive pill and should not be taken in pregnancy.

When applying creams and powders ensure your skin is dry and clean. Apply the cream to the affected area and some of the normal skin surrounding it as some infection may not be evident. It may take several weeks of treatment for the infection to resolve.

You should keep applying the treatment for several days after the skin appears clear in order to ensure all fungi are treated.

Foot care remains an important part of treatment. Wash your feet twice daily and dry them well. Go barefoot or wear sandals or flip flops as much as possible. Keeping feet cool and dry makes it difficult for fungi to flourish.

Wear socks or shoes made from natural "breathable" material such as cotton, canvas or leather. Take shoes off as soon as possible after sports or exercise. Try not to wear the same shoes everyday. Allow your shoes to dry between use and consider putting anti-fungal powder in your shoes to kill any fungi there.

Lastly, always wear flip flops or sandals when attending public pools or spas.

If fungal infections reoccur despite appropriate foot care and treatment, it is worth having blood tests done. Fungal infections are more common in those with diabetes or suppressed immune systems.

Question: I have been trying to lose weight and live better so I have cut most fats out of my diet. My doctor now tells me this isn't a good idea, that I should be eating some fats. I'm confused, can you explain?

Dr Nina replies: Your doctor is right. A healthy diet should get up to 30pc of its calories from fat. There are different types of fat. Monounsaturated fatty acids (MUFAs) are found mainly in vegetable oils, nuts, seeds, olive’s and avocados.

These are liquid at room temperature. Polyunsaturated fats (PUFAs) are found in vegetable oils, fish and shellfish. These may be liquid or soft at room temperature. Saturated fatty acids are usually solid at room temperature. These are found mainly in foods of animal origin like dairy and meat products.

Trans fatty acids are liquid vegetable oils that have been chemically treated to become solid at room temperature. These are also referred to as partially hydrogenated oils. They are often found in processed foods.

MUFAs and PUFAs are considered healthy fats while saturated fatty acids and trans fatty acids are not healthy.

Vitamins A,D,E and K are found in fatty foods so a non-fat diet may be deficient in these.

MUFAs also have anti-oxidant activity and may help prevent and treat heart disease, diabetes and different cancers.

They may have anti-inflammatory activity and have a positive effect on clotting, cholesterol and blood pressure. Omega 3 fatty acids are PUFAs essential to brain health and have anti-inflammatory activity.

Consumption of saturated and trans fatty acids may increase the risk of diabetes, cardiovascular disease and various cancers.

Choose salad dressing made with MUFAs. Use healthy oils instead of butter when baking. Avoid fried food in restaurants.

Lastly, read food labels and become nutrition aware.

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