Minor Injury and Illness Units

You have been supplied with a walking boot to help provide support, protection and stability. This will help you gradually increase weight bearing activity on the injured limb.

Your clinician will let you know how much weight you are able to put on your injured foot and ankle during your appointment. This may gradually increase over time, depending on your pain. Take care not to put any weight on your foot when the boot has been removed. You might need crutches to help you to balance when walking.

To put your boot on:

• Open the Velcro straps and undo the padded liner.
• Slide your foot into the boot, making sure the sole of the foot is touching the bottom of the boot and the heel is pushed to the back
• Tuck the padded liner in around your foot and ankle, adding extra padding if needed
• Tighten all Velcro fastenings, making sure your foot feels secure inside the boot.

Caring for your walking boot:

• You can wear a thin cotton, knee-high sock beneath the boot for warmth, however the boot should be worn underneath other clothing.
• The padded lining is detachable to enable handwashing.
• Regularly check your foot and ankle for pressure areas from the bootstraps. The swelling is likely to vary, so you will need to adjust the straps for comfort.

When to remove your boot

Your clinician will let you know when you can safely remove your boot; this will include washing, sleeping and physiotherapy activity.

Exercise

It is important to exercise all joints that are not immobilised in your boot; and to repeat these exercises every hour until you regain mobility. This will help to reduce swelling and stiffness, maintain some muscle strength and improve circulation. This might be painful and difficult to start with but should improve within the first week.

• Wiggle your toes regularly.
• Fully straighten and bend your knee.
• Gently clench the muscles in the back of your calf and thigh to improve blood flow.
• Move your hip.

Driving

It is not safe to drive whilst wearing a boot.

After your boot has been removed

Due to the long period of time your limb has been immobilised, you may experience some of the following on removal of the boot, so don’t panic if:

• your leg feels thin and strange; this is normal
• you experience swelling, discomfort and stiffness in the affected limb. This is normal and may continue for several weeks. You may find it helpful to keep the limb elevated.
• your skin is dry and itchy. Try not to scratch and use baby oil or moisturiser.
• your skin is more sensitive than usual. Be careful if going in the sun and apply a sun block.

Physical activities such as manual labour or sport should be avoided during the first few weeks after your boot has been removed.

DVT signs and symptoms

Please be aware that immobilisation and reduced mobility results in a higher risk of developing Deep Vein Thrombosis (DVT).

It is important to stay as active as possible. Drink plenty of fluids and be aware of the following signs and symptoms. Contact the Emergency Department immediately if you experience any of the following:

• pain in the calf, thigh or chest
• sudden onset of shortness of breath with no physical exertion
• swelling of the leg
• increased/ decreased warmth of the leg
• redness in the leg
• bluish skin discoloration.

Pressure Ulcer

A pressure ulcer (or sore) is a type of injury that breaks down the skin and underlying tissue. A small number of high-risk patients are at increased risk of developing a pressure sore when wearing a walking boot. To reduce this risk:

• move your leg every two hours to avoid resting on the same area for long periods
• if you notice any discomfort, especially at the edges or heel, please contact us as soon as possible to arrange a review.
• make sure the top or bottom of the boot is not rubbing and leaving red marks
• don’t rest your leg on the heel for long periods of time. Elevate the leg, placing a pillow under the leg when resting.

Calf tears and strains

A calf strain is a tear in either of the two main calf muscles at the back of your lower leg; the gastrocnemius, the large muscle closest to the surface, and the soleus, which sits deeper behind the gastrocnemius.  These muscles join onto your Achilles tendon.

When you strain your calf muscle, you may feel a sudden tearing or stabbing pain.  With minor strains you may be able to carry on with your activity, but you may feel tightening and stiffening in your calf muscles.  If the strain is severe, the pain may be so bad that you can’t stand on your leg and you may get swelling and bruising in your calf and ankle.

Treatment

Elevation and pain relief are essential, especially within the first 24 hours, to help speed up the healing process.

Gently pulling up the toes and ankle, and then pointing them whilst sitting or lying, will help to gradually restore movement.

You can increase the stretch by pulling your foot up with a towel or belt, holding for 30 seconds – then repeating.

Wearing a pair of shoes with a slightly raised heel may help you to walk a little easier to begin with.

We recommend to use PRICE advice for the first 2 weeks:

• Protect your injury from further harm.
• Rest the injured area immediately and then gradually re-introduce pain-free movement so you don’t lose too much muscle strength.
• Ice packs or a bag of frozen peas wrapped in a towel can be applied to the injured area to reduce swelling and bruising. Don’t apply ice directly to your skin.
• Compressing the injured area if swollen can help with pain relief. Using a football sock or hiking sock is adequate.
• Elevate the limb above the level of your heart to control swelling. Keep the area supported and try to keep it elevated as much as possible until the swelling goes down.

For the first 72 hours after an injury there are certain things that you shouldn’t do:

• Heat Don’t use heat packs, hot water bottles or heat rubs on the affected area, as well as saunas or hot baths. Heat encourages blood to flow to the area, the opposite effect of using ice and may potentially make your injury worse.
• Alcohol Don’t drink alcohol because it can increase bleeding and swelling in the area, slowing down healing.
• Running Any form of strenuous exercise may cause more damage.
• Massage This can increase bleeding and swelling.

Further treatment

A nasty tear to the muscle can take up to three months to fully recover in some cases. You may have been referred to physiotherapy for treatment, but this is not always required.

The following diagram (to be sourced) shows a stretch you can start to do when standing with your feet flat in an upright position is achievable. You should try to repeat this stretch 10 times, holding for up to 30 seconds. This can be repeated 2-3 times through the day.

It is very important that you see your doctor immediately if, after following advice in this leaflet, your symptoms do not improve and you notice that the calf becomes increasingly tender, red and hot to the touch.

Deep Vein Thrombosis (DVT)

Please be aware that a lack of movement means you have a higher risk of developing Deep Vein Thrombosis (DVT).

It is important to stay as active as possible. Drink plenty of fluids and be aware of the following signs and symptoms. Contact the Emergency Department immediately if you experience any of the following:

• pain in the calf, thigh or chest
• sudden onset of shortness of breath with no physical exertion
• swelling of the leg
• increased/ decreased warmth of the leg
• redness in the leg
• bluish skin discoloration.

Call 999 or attend the Emergency Department if you develop chest pain or breathlessness whilst having symptoms of a DVT.

What is Paronychia?  

A paronychia is an infection of the finger or toe where the nail and skin meet at the side or base of the finger or toenail. Paronychia is sometimes called ‘whitlow’.

This infection can follow an apparently minor trauma to the finger or toe, such as a splinter or thorn. It can also be a result of nail-biting, finger-sucking, or biting and picking at the skin next to the nail.

Pus can develop around and under the nail, usually because of a bacterial infection. It may be painful, and the fingertip or toe can look red and feel hot when touched.

What treatments are available? 

Treatment depends on how serious the infection is, and whether it has started to spread.

Soaking the infected finger in warm salted water four times a day will usually resolve the infection in a few days. Painkillers, such as ibuprofen or paracetamol will help to ease the pain in the finger.

Some treatments like fusidic acid can help reduce the infection in the finger, but if an incision has been made in the skin to drain pus, an antibiotic may be prescribed to help with the infection.

If the infection continues in the same finger for six weeks or more, it is called chronic (meaning persisting) paronychia. There may be an underlying skin condition or the infection might be caused by a yeast or fungus, rather than bacteria. We would advise seeing your GP if the problem persists, as there are a variety of treatment options including:

• avoiding skin irritants, such as certain soaps or detergents and stop biting your nails and finger sucking.
• treating underlying skin conditions.
• steroid creams, antifungal creams or antifungal tablets.

What do I need to do after I go home?

If you have been discharged from the MIIU with antibiotics or cream, you must complete the course of cream or antibiotics; even if the infection seems to have cleared before the course is due to finish.

Stop the medication if a reaction starts and seek appropriate medical advice depending on the severity of the reaction.

• do not bite your nails or suck your fingers or thumbs, as this will only increase the risk of returning or worsening infection. Dry your hands well after washing them and do not wear gloves or artificial nails for prolonged periods. When cutting your nails, ensure you do not cut them too short.
• regular pain relief, following the packet instructions
• warm salted water baths 3-4 times a day, and dry thoroughly afterwards

When should I return to the MIIU or ED?

Generally, paronychia is an infection that can be managed by your GP or MIIU however, you should return in the following situations:

• you develop a fever or become generally more unwell.
• you finger or toe is becoming more red and painful, or a swelling develops and the pre-existing swelling becomes bigger.
• you develop pain further up the finger or cannot bend one of the finger joints fully.
• you develop increasing pain when bending the finger.

Shingles is an infection that causes a painful rash. Get advice from 111 as soon as possible if you think you have it. 

Check if you have shingles

The first signs of shingles can be:

• a tingling or painful feeling in an area of skin
• a headache or feeling generally unwell

A rash will usually appear a few days later. In rare cases shingles can cause pain without a rash.

Usually you get the shingles rash on your chest and tummy, but it can appear anywhere on your body including on your face, eyes and genitals.

The rash appears as blotches on your skin, on one side of your body only. A rash on both the left and right of your body is unlikely to be shingles.

The blotches become itchy blisters that ooze fluid. A few days later, the blisters dry out and scab. The rash can be red, but this can be harder to see on brown and black skin.

The rash may be in and around your eye, making it sore and red. It can affect your sight or hearing and make it hard to move one side of your face. The skin remains painful until after the rash has gone.

Ask for an urgent GP appointment or get help from NHS 111 if:

• you think you might have shingles
• you might need medicine to help speed up your recovery and avoid longer-lasting problems. This works best if you start taking it within three days of the shingles rash appearing.

You can call 111 or get help from 111 online.

A pharmacist can help with shingles

You can also speak to a pharmacist if you think you have shingles. They can provide the same treatments you would get from a GP, if you need it.

Treatment for shingles

Treatment for shingles depends on how severe your symptoms are and whether you’re at risk of complications.

If you have a mild rash you may not need any treatment. You may be offered medicine (antiviral tablets) to help speed up your recovery from shingles if:

• you have a weakened immune system
• your pain or your rash is moderate or severe
• the rash is affecting other areas of your body apart from your chest, tummy and back.

You usually need to start taking the medicine within three days of your rash first appearing.

Treatment for shingles can also include medicines to help relieve pain, such as painkillers, steroid tablets or medicines that help with nerve pain.

If you have shingles, you may be able to get antiviral tablets from some pharmacies without seeing a GP.

How to treat shingles symptoms yourself

If you have shingles, there are things you can do to help with the symptoms.

Do

• take paracetamol to ease pain
• keep the rash clean and dry to reduce the risk of infection.
• wear loose-fitting clothing.
• use a cool compress (a bag of ice cubes or frozen vegetables wrapped in a towel, or a wet cloth) a few times a day.

Don’t

• do not let dressings or plasters stick to the rash
• do not wear clothes with rough fibres that can irritate your skin

How long shingles lasts

It can take up to 4 weeks for the shingles rash to heal.

Your skin can be painful for weeks after the rash has gone, but it usually gets better over time.

Stay away from certain groups of people if you have shingles

You cannot spread shingles to others. But people could catch chickenpox from you if they have not had chickenpox before or have not had the chickenpox vaccine.

This is because shingles is caused by the chickenpox virus.

Try to avoid:

• anyone who is pregnant and has not had chickenpox before.
• people with a weakened immune system – like someone having chemotherapy.
• babies less than 1 month old.

Complications of shingles

Most people recover from shingles without any problems. But it can sometimes cause complications, such as:

• post-herpetic neuralgia, where pain lasts for several months after the shingles rash has gone
• the rash becoming infected, which may need to be treated with antibiotics
• scarring or changes in skin colour after the rash has healed
• muscle weakness
• eye problems, which can lead to sight loss
• Ramsay Hunt syndrome, a rare condition where shingles affects your facial nerve, causing weakness on one side of your face and sometimes hearing problems

You can reduce the risk of complications by getting treatment as soon as possible after your symptoms start.

Shingles and pregnancy

If you’re pregnant and get shingles, it’s mostly mild and there’s usually no risk to you or your baby.

But a GP should arrange for a specialist to advise on whether you need treatment.

Causes of shingles

You cannot get shingles from someone with shingles or chickenpox.

But you can get chickenpox from someone with shingles if you have not had chickenpox before.

When people get chickenpox, the virus stays in the body. It can be reactivated later and cause shingles if someone’s immune system is weakened.

This can be because of stress, certain conditions, or treatments like chemotherapy.

Shingles vaccine

A shingles vaccine is available on the NHS for:

• people who turned 65 on or after 1 September 2023
• people aged 70 to 79 who have not yet been vaccinated
• people aged 50 and over with a severely weakened immune system
• The vaccine helps reduce your risk of getting shingles.

If you get shingles after being vaccinated, the symptoms can be much milder.

You can get shingles more than once, so it’s important to get vaccinated even if you’ve had shingles before.

Ask your GP surgery if you can get the vaccine on the NHS.

Insect bites or stings are not usually serious and get better in a few days. But sometimes they can become infected or cause a serious allergic reaction.

Bites from some insects can also cause illnesses, such as Lyme disease from ticks, scabies from mites, and malaria from mosquitoes in certain parts of the world.

Check if it’s an insect bite or sting

The main symptoms of an insect bite or sting are:

• pain where you were bitten or stung
• a small, swollen lump on the skin

The lump may look red. It may be more difficult to see on black or brown skin, but you should be able to feel it.

What to do if you’ve been bitten or stung by an insect

You can often treat an insect bite or sting without seeing a GP.

If anything is left on or in your skin, the first thing you need to do is remove it carefully.

How to remove a bee, wasp or hornet stinger

• Brush or scrape the stinger sideways with your fingernail or the edge of a bank card.
• Do not use tweezers to pull out a stinger as you could squeeze poison out of it.
• Wash the area with soap and water.

How to remove a tick

• Using fine-tipped tweezers or a tick-removal tool (if you have one), grasp the tick as close to the skin as possible.
• Slowly pull upwards, taking care not to squeeze the tick or leave any of its mouth in your skin. Dispose of it when you’ve removed it.
• Clean the bite with antiseptic or soap and water.

How to remove caterpillar hairs

• Gently remove the caterpillar using tweezers or a pen. Try not to disturb it as it’ll release more hairs.
• Rinse your skin with running water and allow it to air dry.
• Use sticky tape on the skin to pick up any remaining hairs.
• Take any jewellery off in case your skin becomes swollen.
• Take your clothes off and wash them at a high temperature.

Easing your symptoms

If there’s nothing in your skin, or you’ve removed it, wash your skin with soap and water to help lower the chance of infection.

The bite or sting should get better in a few days. There are some things you can do to ease your symptoms.

Do

• put an ice pack, wrapped in a cloth or a clean cloth soaked in cold water, on the bite or sting for at least 20 minutes, if it’s swollen.
• keep the area raised if you can.
• take painkillers such as paracetamol or ibuprofen if the sting is painful.
• use antihistamines to relieve any itching (but do not use antihistamine cream if you had caterpillar hairs on your skin)
• use a hydrocortisone cream to reduce itching and swelling.

Don’t

• scratch the bite or sting, as it could get infected
• use home remedies such as bicarbonate of soda to treat the bite or sting

A pharmacist can help with insect bites and stings

A pharmacist can advise you about medicines that can help ease the symptoms of a bite or sting, such as antihistamines, steroid creams and painkillers. They can also provide other treatments if you need them, without you seeing a GP.

Ask for an urgent GP appointment, visit your MIIU or get help from NHS 111 if:

You’ve been bitten or stung by an insect and:

• your symptoms get worse or are not getting any better
• you were stung in your mouth or throat, or near your eyes
• you have tummy pain and are being sick
• you feel dizzy or lightheaded
• a large area around the bite or sting becomes red and swollen
• you have a high temperature and swollen glands
• you were stung more than once
• you’ve had a serious allergic reaction to an insect bite or sting before

Call 999 if:

• your lips, mouth, throat or tongue suddenly become swollen
• you’re breathing very fast or struggling to breathe (you may become very wheezy or feel like you’re choking or gasping for air)
• your throat feels tight or you’re struggling to swallow
• your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
• you suddenly become very confused, drowsy or dizzy
• someone faints and cannot be woken up
• a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)
• You or the person who’s unwell may also have a rash that’s swollen, raised or itchy.

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.