Photo credit: Reddit
Just like its sometimes fun to ride an old board that hasn’t seen the light of day for a few years, here at SM headquarters we’ll occasionally dust off an old issue of the Journal and revisit an article that particularly strikes our fancy. ‘Course cutting-edge medicine changes a bit over time, so we may take ‘er back to the shaping room for a few tweaks or a new set of fins before presentation to the general public. Presented here is a classic by “Doc” Renneker from the 1991 Q&A “Ask the Surf Docs” column in Surfer Magazine.
SEA ULCERS
Dear Surf Docs,
I recently cut my foot really badly while surfing. The cut wasn’t big, but it was kind of deep. At first I paid little attention to it and kept surfing almost every day, but soon the cut began to get deeper and wider.
Thinking I could outsmart it, I bandaged it every time I went surfing and wore a bootie on that foot. The cut didn’t really grow any deeper, but it didn’t take any steps towards healing either.
So now, almost four months later, I’ve been forced to sit it out and let my cut heal. As you can well imagine, I’m going through hell right now, as I have the mentality of a grommet and surfing is all I think about. Anyway, could you please tell me if there is any way I can speed up the healing process.
Jake,
El Cajon, California
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Dear Jake,
You’ve got a ‘sea ulcer’, which is a common problem among surfers, sailors, and other seafarers. Sea ulcers typically develop in just the way you describe: first there is a seemingly minor scrape or cut; then, instead of healing shut like most wounds, it deepens and becomes encircled by a thick, rubbery kind of callous. And there it stays for weeks, months, even years, never looking particularly infected, but just never healing.
Sea ulcers are most common on the feet, ankles, and backs of the hands, which is a big clue as to why they develop. Ever notice how much a cut in the mouth will bleed, and then how fast it heals, compared to how little a cut on the ankle bleeds, and then how slowly it heals? Blood supply is the answer, and the foot region -even in completely healthy people- doesn’t have very good circulation. For people with diabetes or circulation problems, poor wound healing is extremely common. One of the first signs of being a diabetic is that cuts on the feet never seem to heal. If you have a family history of diabetes, or this problem of poor healing recurs, you should be tested for diabetes.
Photo credit: “Surf Survival” book
As you have figured out, daily surf sessions contribute to the formation of these ulcers. It was wise to try to protect it from being rubbed or bumped, by wearing a bandage and booty, but the real enemy is leaving the wound wet for extended periods of time. When a wound becomes wet, it loses its protective healing scab. The scab forms a protective roof, under which fibroblasts, the first cells to arrive at the scene of a skin injury, lay down a delicate collagen matrix. New skin cells (epithelial cells) then migrate from the wound’s edges, along this bed of collagen, forming a fresh new layer of skin. Every time you surf, however, the scab and underlying collagen gets washed away, so the wound never gets a proper chance to heal.
Another thing you probably noticed is that when walking along the beach, sand and other stuff gets trapped in your sea ulcer. Besides causing pain, this foreign material also interferes with the normal healing process. While most sea ulcers are not infected, if allowed to get dirty and stay dirty long enough – bacteria can set up shop causing you additional grief.
The best strategy for getting a sea ulcer to heal is to keep it clean and dry, so a scab can form, allowing the normal wound healing process to take place. Various goops and ointments, including the brand name medicine such as Neosporin®, Bacitracin®, Bactroban®, Betadine®, and other products such as aloe vera, and vitamin E, have been tested to see which is best at wound healing. But truth be known, overall, none of them are real stand-outs over simply keeping the wound clean and dry. Because Neosporin® can cause skin allergies, and Bactroban® is expensive and may require a prescription, Bacitracin® is probably the best choice among the lot.
If you have a sea ulcer, stay out of the sea -at least for a little while. It could take two weeks or longer to noticeably improve, but each dry day will help. If a classic swell comes, put antibiotic ointment on it, a well-padded bandage, and wear a booty. When you get out of the water, don’t stand around wet, talking to your friends. Give immediate attention to your wound. Wash it thoroughly in fresh water, preferably warm water, which will increase circulation to the area. Get it meticulously clean. Then dry it, using the sun or a blow drier. Finally, cover it with a loose-fitting bandage that allows lots of air to reach it. Frequently check it during the day, and before going to bed to be sure it is clean and dry. Change your dressing often. Usually this will do the trick. Rarely, taking an oral antibiotic (e.g., Doxycycline, Bactrim) may needed to knock out a deep-seated infection.
The best strategy for preventing sea ulcers is to not get cut in the first place, and if you do get a cut, to take care of it. Particularly in the Tropics, take care of your feet, you’ll have trouble surfing with out them.
[April 1991 issue Surfer Magazine, Issue #7, Summer 1991 Surfing Medicine]