By Amber Kibby MSc BSc Pod MRCP & Bob Longworth MSc DPodM MRCP

It’s festival season: don’t get floored by ‘welly leg’

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It’s festival season again, and hordes of excited music lovers of all ages are using their pocket money, hard earned cash, college holidays and accrued annual leave to descend upon a myriad of outdoors events to enjoy bands, food and time with friends.

It is also the time of year when podiatrists see foot and leg conditions that are only encountered at festivals.

Podiatrists form part of Festival Medical Services (FMS), a charity providing professional event healthcare and healthcare training, which also supports charities around the world with its proceeds. 

FMS supports some of the biggest and well-known festivals in the UK, treating around 6-8,000 patients a year. It offers a full medical and emergency service, including podiatry, dentistry and physiotherapy from its on-site hospitals. 

Amber introduced podiatry to FMS in 1997 after a huge increase in foot problems was noted at the previous year’s (wet and muddy) Glastonbury festival, and for 20 years now, a fantastic team of experienced podiatrists has been enthusiastically supporting Glastonbury and Reading festivals, as well as numerous other smaller events.

Amber coordinated the podiatry team for several years before taking up the mantle as a Trustee Director for FMS, handing the Podiatry coordinator job initially to Rachel Rowland-Jones and in 2017 to Bob.

The podiatry team is made up of lots of dedicated people with a mix of expertise, including diabetes and musculoskeletal conditions. At festivals though, emergency or reactive podiatry comes into its own as a speciality, as these conditions present a unique and particular set of challenges. 

Festival going can be like completing a sporting event. It is easy to cover 10 or more miles a day, often on uneven and muddy ground. 

Blisters are the most common foot complaint we see. The main cause of blisters is the wrong choice of footwear, when long hours of walking and standing on rough ground takes their toll. 

Our main dilemma with them though is ‘to pop or not’. 

The pain from blisters often resolves if the fluid is drained, and while this can speed up healing, it also introduces a risk of infection – particularly in the often dirty conditions of a festival. If a blister is already infected though, we have to drain it.

Strapping blisters with rigid tape under tension and then adding a redistributive padding over the top is often the most comfortable choice.

Patients are made aware of the risks and benefits of any treatment and can make an informed choice. The most important thing to remember though is not to ignore blisters. The pain they cause makes people change the way they walk which can lead to even more leg and back problems.

Ankle sprains are also something we see a lot of. Most commonly these are inversion injuries, often caused by slipping in mud. 

FMS provides X-ray facilities, overseen by a team of radiographers on site at Glastonbury and Reading festivals, so acutely swollen ankles can be accurately assessed to see if they are fractured. If so, they are plastered right there and then and the patient chooses to stay or leave the festival.

Ordinarily, when deciding whether to x-ray an ankle, a general rule is to ask if the patient can bear weigh on it (one of the ‘Ottawa’ rules). This isn’t applied at festivals though as alcohol and drug use can mask pain. We once saw a patient in the medical centre who had danced all evening on a tri-malleolar fracture (three fractures in his ankle). He had taken recreational drugs in the form of Ketamine and was unable to feel it. 

The main aim of treating ankle sprains ‘in the field’ is for protection. Strapping the ankle and the provision of crutches allows the patient to stay on site if they wish but the long-term possible ramifications – which can be pretty serious, and can even extending to life-long disability – are explained to them if they decide to do this.

We also make follow up appointments on site or off site with letters for all patients that need to be followed up.

Puncture wounds are frequently seen when festival-goers go barefoot or wear flimsy footwear. 

Festivals are strict about not allowing glass on site, but there are other dangers from tent pegs, wood splinters or abandoned drink cans, which can result in some nasty injuries that need to be cleaned and dressed to help prevent infection. Last year we had a fire-walker who was seen with an infected lesion from a puncture wound that had been caused by a hot shard of coal penetrating their heel…

‘Welly leg’ appears to be a unique yet common challenge at festivals. Lots of people wear wellies at festivals, even if it is dry. Wellies are made of rubber which can irritate the skin if your socks are shorter than the boots, and this can get infected, resulting in more severe welly leg. 

We see ‘trench foot’ too. It is really called immersion foot and is much more prevalent at wet, muddy festivals. The feet look like they have been in the bath too long, but it can worsen into deep, painful fissures under the foot that are prone to infection and subsequent cellulitis and numbness. Getting the feet dry rested and exposed to the air are essential to halt its progress. 

Post festival ‘numb foot’ is a milder version of it, due to feet getting damp in an airless environment, which often takes several months for full feeling to return. 

Other conditions we see in the microcosm of a festival are much the same as in the real world, and include ingrowing toenails, plantar fasciitis (heel pain), corns/hard skin, cellulitis, Morton’s neuroma, tendonitis and gout.

Bob and Lee at Glastonbury 2009

Top 10 Tips for festival-goers’ feet

  1. Remember you’ll be in a farmer’s field for a few days and have appropriate footwear for the conditions. Generally, this would mean good quality hiking boots or well-fitting Wellington boots with plenty of clean, dry long socks. On the dry years and good quality pair of trainers might suffice. 

  2. If you have a history of previous ankle sprains or if it is slippery under foot, wear hiking boots that protect the ankle. 

  3. Get used to wearing your footwear before attending the festival. Wearing new shoes and wellies for the first time during a festival can cause escalating problems. 

  4. If wearing wellies and shorts, make sure you have socks longer than the wellies.

  5. Air your feet overnight by taking off your footwear and change into dry socks frequently. 

  6. Avoid walking on muddy sloping banks.

  7. Limit the amount you carry – injuries frequently occur on the way into the festival when festival goers are laden with heavy rucksacks and tents.

  8. Don’t walk around the site barefoot (resist your inner hippy).

  9. Don’t ignore blisters – they can alter your gait and lead to more serious problems.

  10. Likewise, don’t ignore infections. The medical teams are there to help you. 

Festival Medical Services was inaugurated in 1979 by GP Dr Chris Howes. Annually donating between £80-100,000 to charitable projects around the world, FMS supports projects with a healthcare or educational theme. Some of the charities supported include Nepal Leprosy Trust, The Sandy Gall Afghanistan Trust supporting surgery on children suffering trauma or gunshot wounds in Afghanistan, Lalibela Trust building rural health posts and a maternity hospital in Ethiopia, Care Africa Network providing counselling training for PTSD and many other

Bob Longworth is FMS Podiatry Coordinator, Director of Podiatry Clinics (Yorkshire) Ltd, Visiting Lecturer at Staffordshire University.

Amber Kibby joined FMS in 1998 as coordinator of the then newly founded Podiatry Team and was afterwards elected Trustee Director. She was on the board of trustees for more than 10 years and was chair of the board from 2009 until stepping down early in 2015. Amber now trains and coaches professionals in leadership skills.

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