soaking

Soaking - water immersion for therapeutic effect - is a common home treatment for a number of ailments. Parents are often confused about how to soak and what to add to the soaking solution (and receive confusing or erroneous advice from friends, nurses and even physicians). Most soaking guidance seems based on tradition and opinion rather than scientific study (there's not much glamor in a double blind study of proper foot soaking). Here is my 2 cents worth, with my rationales for my advice. Remember that soaking is general first aid, an aid to but not a substitute for medical care by a trained medical practitioner. It is a home adjunct to proper initial wound cleaning and medical management.

Infections

Infections of the extremities are especially likely to result in advice about soaking, especially infections due to wounds. Soaking, especially with some gentle scrubbing, helps cleanse wounds and remove dead tissue and blood clots that can harbor bacteria. Wounds to the hands are more likely to be infected with Staphylococcus bacteria, but kids can get their hands into just about anything, so we get surprises, especially with dirty wounds and animal bites. Disinfectant soaking of hand wounds can be done with a diluted solution of surgical disinfectant (Hibiclens® or Betadine®). A cheaper solution is my personal favorite, sodium hypochlorite (common household bleach). One or two capfuls of bleach in a small basin or sink makes a very effective antibacterial soak that does not injure the tissue. You have to be careful not to the the child drip or splash this solution around on the rug or towels, and you should finish the soak with a rinse of clear water for that reason.

Infected or potentially infected wounds of the feet can be complicated by the fact that shoes and feet always harbor a germ known as Pseudomonas aeruginosa. This bacterium is usually resistant to all but a few intravenous antibiotics - serious Pseudomonas infections often require hospital treatment. Soaking in an antibacterial soap solution or bleach solution (I use two capfuls in a basin of warm water) is a good practice for wound care of the foot.

Ingrown toenails

Ingrown toenails are a special case of infections of the foot. An ingrown great toenail digs into the flesh of the nailbed, causing an infection and subsequent swelling of the tissue, which produces even more swelling and purulent drainage (i.e., pus). I have found that early treatment of the affected toe with hypochlorite soaks twice a day along with proper trimming of the toenail to reduce the tendency to curl into the nailbed often prevents more serious infection, swelling and pain, reducing the need for oral antibiotics and surgical treatment.

Sprains of the ankle or foot can be soaked in cold - never warm - water. However, that chills the entire foot, which can be unpleasant and is unnecessary. An ice pack over the site of the sprain makes more sense. Why not warmth for sprains? A sprain is a partial tearing of ligaments, which produces increased blood flow, inflammation, warmth and pain in the area of the sprain. Decreasing the temperature of the damaged area reduces blood flow and hence swelling and pain. Applying warmth aggravates swelling and pain.

MRSA

MRSA (methicillin resistant Staphylococcus aureus) is now a leading cause of problem infections of the skin and underlying soft tissue. It can cause infections ranging from superficial folliculitis to deep abscesses. Once present on the skin, MRSA can be difficult to eliminate, with recurrent infections as a result. I have recommended nightly neck-down soaks for my patients in a tub of warm water with a half-cup of household bleach for one to two weeks after we drain an abscess or treat for MRSA infection. There are often more than one family members involved, "passing it around," so the advice frequently is directed at the entire family. This technique seems to reduce the re-infection rate significantly.

Epson salts

This is a common lay recommendation from friends, relatives, and busybodies everywhere. "Epson salts" is actually magnesium sulfate, a laxative. I can't imagine any role for it in sprain or wound care.

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