Saturday, July 14, 2018

Tennis bum, blisters, bunions and the couch potato

Tennis Bum is not so much a medical condition as a mental state of mind when the tennis season is on. Millions of couch potatoes sit glued to the box with little or no movement thereafter. A numb bum is usually the result caused by watching too much tennis. Fortunately I am of a certain age where the impetus to play the game, much as I love to watch it, has become an avenue of pleasure closed off. But I cannot say the same for the countless throngs of couch potatoes who inspired by what they see on the telly decide to play tennis with the inevitable outcome of getting blisters. Now as we have seen with the professionals it is amazing how sore feet can impair peak performance and blisters are no exception.

One of the most common problems people experience when the tennis season starts and that is troublesome blisters. To give them their Sunday best description blisters are a dilation of an existing space within the epidermis, (that's the outside layer of the skin), which fills, with exudation i.e. excess tissue fluid or blood. Superficial blisters or vesicles are the most common arise and measure < 0.5cm in diameter. These are caused by compression and when the skin temporarily rubs rudely against another rough surface. The simple blister is caused by shear. Friction causes damage to the skin cells and fluid gathers then separates the skin surfaces. Severity determines depth. A common cause of the simple blister is the foot rubbing against the inside of a shoe or sock. Damaged caused by dynamic friction roughens the shoe or sock surface and the constant wearing over the skin causes an inflammatory reaction. The skin fills with fluid, which initially tries to separate opposing surfaces. Pressures cannot pass through fluid and the associated burning pain ironically provides the two ways the body can protect itself from further damage. If ignored and the player plays on, the blister bursts and infection is a likely outcome. Hours and hours of play drive the skin separation deeper and sometimes a bursa (fluid filled sac) or bursitis (inflamed bursa) will arise.

(Video Courtesy: Rebecca Rushton Youtube Channel)

A favourite old time treatment for blisters was a cabbage poultice. Placed carefully in the shoe beside the site of the blister the cabbage poultice acts as a physical barrier preventing further sheers between opposing surfaces. This is the first principle of treating a blister but I cannot see Novak Djokovic wearing a cabbage poultice, can you?

A common temptation for all is to burst the blister. Not a good idea and when it is unbroken, best the skin surface is left intact. A good idea is to cover the blister and its immediate surround with stretch strapping. This encourages tissue fluid to be reabsorbed as well as a second skin to protect the sensitive area. Pain associated with a sore blister may be relieved with surgical lancing which is best done by a health care professional.

(Video Courtesy: Rebecca Rushton Youtube Channel)

Another common ailment exacerbated by friction from shoes is bunions. Many people think bunions describe a bony misalignment (or Hallux Abducto Valgus HAV). Hallux means big toe and valgus describes an anatomical position, where the big toe is tilted towards the small toe. The forefoot looks like an arrowhead. There are more than 150 operations for hallux valgus. One critic of forefoot surgery was Hans Rudolph Mayer, a Swiss medic, he believed many procedures had been designed to alter the female foot not for functional reasons but instead for cosmetic reasons to fit typical female shaped shoes. He called this the Cinderella Principle. In Cinderella (Walt Disney) the glass slipper was broken by the grotesque ugly sister. However in the original version of the fairytale, the wicked mother cuts the daughters foot in order to fit the shoe. When ladies complain of sore feet, they usually have a bunion or hallux valgus, or both.

The term bunion is a kind of bursa, known medically as an advantageous bursa and is formed to protect the big toe joint, the major lever of the foot. Painful bunions will stop your sporting prowess just ask any lady who suffers from them and they will soon confirm how they burn with exquisite pain. The bursa or fluid filled sack sits deeper in the skin at the dermal /epidermal junction. The primary function is to protect vulnerable areas such as the big toe joint or back of the heel. When the area is aggravated by repeated sheer the bursa becomes inflamed i.e a bursitis. Many professional players are plagued with sore feet throughout their career. .

An old cure for bunions was nightly rubs of patchouli and lavender oil, or chamomile or geranium ointment. This is very pleasant compared to earlier cures which involved cow dung.

So if you want to play the odd game of tennis you might like to take a few sensible precautions. First thing is to get a pair of tennis shoes that fit the feet comfortably. The range of tennis footgear is extensive and these have been designed to cope with the stresses of the game, ordinary trainers may seem similar but are not. Slipping on the old shoes for a few sets is bound to aggravate the skin. Some people advocate greasing the skin which gives lubrication and does cut down friction but this can be messy. Others prefer to use surgical spirit to toughen the skin. This may appear logical but is not recommend because it dries out the skin and makes it less able to deal with friction. The secret to prevent blisters is to wear two pairs of socks. When friction occurs it rubs the two layers of socks and not the skin. Any old war wounds like burst blisters or small new ones should be covered with a strapping such as a band aid. The tight binding of the skin offers an outer cover to the damage area. Always take time to warm up before a session by stretching and warm down after a game. This prevents stiffness and reduces the risk of injury. Aches and pains should not be ignored and persistent pain may need professional care. Follow these simple steps and keep up the practice and I may see you on the telly, next year.

More Information
Rebecca Rushton The Advanced Guide to Blister Prevention Reviewed 14/07/2018

1 comment:


Tennis elbow treatment is most often successful. The most important part of treatment is tendon rest. A long rest from aggravating activity allows the small tears in the tendon to heal. Depending on how severe your condition is, you may need to rest your tendon for weeks to months. Surgery is a last resort if other treatment isn't helpful.