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Should you go outdoors barefoot? - (8/11/2020)

By Dr. Ron Gasbarro

The pharmacist was enjoying his day off, sitting in his lounge chair, watching the lawn sprinkler go spitz-spitz-spitz-spitz. The cool water was just reaching his bare toes when he decided to move the sprinkler head to another part of the yard. He jumped up. Right before he landed, he noticed a wet, gloppy pile of dog poop that someone (aka his son) forgot to remove. He slid about 5 feet, knocked over the sprinkler over and jammed his left heel into a rusty shard of metal hidden in the grass.  

“Ouch! Damn! Ouch! Damn!” and any other words he could think of spat from his mouth. The pain leaped up one foot while the other leg was festooned with a 4-foot sloppy skid mark of stinking canine crap. He limped into the house and gingerly placed his injured foot on the laundry room's washing machine. He plucked the corroded spur from his foot. Some blood trickled out. Then, he slid out of his smelly shorts and stepped into the shower. 

First things first: The poop or the foot? As a healthcare professional, the pharmacist knew that the foot needed to be cleaned from any debris that could cause infection. The force of the water and gravity took care of Barney the Dog's fecal function as it spiraled down the drain. The fact that the piece of metal was rusted concerned the pharmacist. Rust, also called ferric oxide, is a crumbling material that destroys metal items as a result of oxidation, especially in salty or wet conditions. Rusty metal can be dangerous. It is a perfect environment for the spores of Clostridium tetani—the bacteria that causes tetanus—to grow. Soil, dust, rust, animal feces, and manure harbor these bacteria. They enter the body through an opened wound. Once inside the body, the remnants of each bacterium – called endospores – travel through the bloodstream to the nervous system. Here, the endospores release a toxin that causes a constellation of symptoms referred to as tetanus symptoms: muscle spasms, nervous system cramps, and neck stiffness. Because of the neck involvement, tetanus is often referred to as lockjaw, because it explicitly causes the jaw to stiffen. When not appropriately treated, tetanus may lead to death.

According to the Centers for Disease Control and Prevention (CDC), a vaccine has made tetanus a preventable and sporadic disease in the United States. All adults need to be vaccinated against tetanus because there is no cure, and 10% to 20% of victims will die. The World Health Organization (WHO) recommends that the first doses be administered throughout childhood and adolescence. After the third dose, everyone is immune to the disease. However, this immunity can wear off, and booster shots are required throughout life. Ideally, a booster shot should be given every 10 years to maintain protection. Also, get a booster within 48 hours of an injury if one's immunization is out of date. The pharmacist did have a booster shot two years ago when he stepped on a garden trowel while trying to outrun some hornets. A lesson partially learned. 

If you are up-to-date on shots, clean the wound thoroughly. Once it stops bleeding, apply an antibiotic cream or ointment. Then, bandage it. If it does not easily stop bleeding, go to an emergency room, as you may need a stitch or two. A wise man once said, “One’s soul cannot be really naked unless one is also barefoot.” While this is true, remember that one’s soles are the only part of the body where the skin kisses the earth. As delicious as being barefoot can be, protect your feet when you can.

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Rx-Press.  


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