A Question of Health

What are these holes in my soles? And should I be taking blood-pressure drugs?
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My feet are the pits

My feet are the pits

Q. My feet have become very smelly recently. The skin on the heels is rough and itchy, with lots of tiny little holes. It almost looks as though something is eating into the skin. I have tried creams and powder for athlete's foot, but things are not improving.

A. Smelly feet are a side effect of wearing trainers and other shoes that don't allow feet to breathe. The warm moist environment inside trainers is an ideal breeding-ground for bacteria and fungi. Athlete's foot is a fungal infection, but it usually causes problems between the toes, rather than on the heels. I think you have a condition called pitted keratolysis, caused by an infection with several bacteria, including one called Kytococcus sedentarius. The bacteria thrive inside sweaty socks and trainers. They produce a chemical that eats away at the surface of the skin, causing tiny "pits". The smell is sometimes likened to rotting fish. The best treatment is to use an antibacterial cream such as fusidic acid (also known as Fucidin) or clindamycin lotion (also known as Dalacin T and usually prescribed for acne). If these fail, you can take the antibiotic erythromycin for a few weeks. Avoid sweaty trainers and wear cotton or wool socks. Avoid synthetic fabrics, as these encourage sweating. You might also want to use an antiperspirant containing aluminium chloride on your feet.

Losing the scent

Q. I seem to be losing my sense of smell. Other people in the house are able to smell things that I can't. For example, we have a bread machine that bakes bread overnight. When we wake in the morning my wife notices the smell of baking bread immediately. I don't smell it until I'm standing right next to the bread machine. Is there any sinister reason why this is happening, or is it one of the things that happens with age? I'm in my early fifties.

A. There is a long list of possible causes of loss of the sense of smell. Most of these are obscure things, like injuries to the skull that cause damage the olfactory nerves - the nerves that connect the nose to the brain. People who have allergic nasal problems, such as allergic rhinitis, sometimes lose their sense of smell when their allergies are bad, but the sense of smell can return when the allergy is under control. People who have nasal polyps sometimes have difficulty smelling things. Of course, even a common cold can cause a temporary loss of smell. More worrying, perhaps, is the fact that loss of the sense of smell has been linked to both Parkinson's disease and Alzheimer's disease. Recent research has identified a possible reason why smell may be impaired in these diseases. Unfortunately, none of the available treatments for either Parkinson's or Alzheimer's seems to help bring back the sense of smell.

Under pressure

Q. A routine blood-pressure check with the practice nurse recently picked up high blood pressure. I have been asked to have my blood pressure checked three more times over the next three months, before any decision is made about treatment. This seems rather dangerous to me. Is it wise to carry on with untreated high blood pressure for three months? I would be happier to start treatment, and then stop if my blood pressure improves.

A. A single reading of high blood pressure is not a sufficient reason to start treatment, unless the blood pressure is exceptionally high. Blood pressure naturally varies through the course of the day and night. Even people with completely normal blood pressure can occasionally have a high reading. It is considered to be good practice to check the blood pressure a few times before starting treatment. Often a single high blood-pressure reading seems to return to normal without any treatment. If you start medication to lower your blood pressure, you are likely to be taking pills for many years, and possibly for the rest of your life. So it is wise to be absolutely certain that your blood pressure is genuinely raised before sentencing yourself to a lifetime of treatment. If there is any doubt about whether or not your blood pressure is up, you may be asked to wear a 24-hour monitor. This is a device a bit like a Walkman that automatically measures the blood pressure throughout the one-day period.

Have your say: readers write

Four years ago a mother asked my advice about tongue-tie. "Our three-month old baby is tongue-tied," she wrote. "The tiny piece of skin connecting the front of his tongue to the bottom of his mouth is incredibly short and he can't stick his tongue out. Will he need an operation?"

I was reassuring: "Operations to relieve tongue-tie are now rarely done and the problem seems to solve itself as babies get older. It should not cause any problems with feeding or learning to speak."

I was contacted by Mervyn Griffiths, a children's surgeon in Southampton, who disagreed. "It is every child's inalienable right to stick out their tongue at grown-ups and to lick ice-creams. A tongue tie prevents both. Also, there is a definite group of children who cannot latch on to a breast because their tongue is tied."

Mr Griffiths and his colleagues Carolyn Westcott and Monica Todd have recently presented the results of a trial to see if a minor operation to release the tongue tie helps babies who are having feeding difficulties. The results are impressive: of 57 babies who were unable to breast feed, 54 were able to feed normally within 48 hours of the operation to snip the tongue tie. The operation is quick, easy and seems to cause very little distress.

Send your questions and suggestions to A Question of Health, 'The Independent', 191 Marsh Wall, London E14 9RS; e-mail health@independent.co.uk; or fax 020-7005 2182. Dr Kavalier regrets that he is unable to respond personally to questions

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