Walking barefoot on sand or soil is not advisable in many parts of the world (not excluding Florida) because of the risk of infection acquired by contact with contaminated soil, and because of the risk of animal bites and stings, or injury.
1. Infections Associated with Walking Barefoot
1.1 Hookworm Infection
Hookworm infection is found in the tropics and sub-tropics. Human hookworm larvae are found in the soil in areas of poor sanitation where people have been defecating. The tiny larvae penetrate intact skin, and migrate to the lungs before settling in the gut. Though mainly a disease of farmers working barefoot, visitors to these areas may acquire light, asymptomatic infections. With repeated infections, severe hookworm anaemia can develop. The diagnosis requires identification in the stool specimen and treatment is with albendazole, ivermectin or thiabendazole.
Strongyloidiasis is a threadworm infection common through warm, wet tropical and subtropical areas: villages and rural areas of South and Central America, Africa and India. Like hookworm, the larvae is excreted in human feces, infection occurs from skin penetration, usually in the feet with migration to the lungs and gut. Unlike hookworm, the larvae are able to mature in the human host to an invasive filariform, invade skin (cutaneous larva currens) and maintain infection indefinitely. Symptoms include an itchy rash at time of infection, episodic itchy lesions and non-specific gastrointestinal symptoms throughout the time of infection. Disseminated infection is more likely to affect those with weakened immune systems (sometimes many years later). The diagnosis requires identification in the stool specimen and/or serology and treatment is with albendazole, ivermectin or thiabendazole with repeated courses often required .
1.3 Cutaneous Larva Migrans ( Creeping Eruption)
Cutaneous Larva Migrans is caused by hookworm larvae from dogs, cats and other animals. Larvae penetrate unbroken skin: a barefoot or bare back walking/lying unprotected on the sand. The infection is limited to the epidermis and typically causes a linear or serpiginous pruritic tract. The disease is not uncommon in tourists, who become infected on beaches in the Americas, Africa, Asia, but most often in the Caribbean. (for more info see outline# 35)
This is caused by the jigger flea which lives outdoors in the sand in Central and South America and West Africa. The flea burrows into the skin, usually on the feet, under the toenails and between the toes causing inflammation and ulceration. The flea is best removed with a sterilized safety pin, preferably by an expert (to avoid secondary infection). If left untreated, gangrene can set in.
1.5 Tetanus (for more info see #36)
Many wounds causing tetanus occur on the feet or legs. Tetanus is a greater hazard for those going on safari, trekking, climbing or exploring.
1.6 Injury and Bacterial Infections
Unprotected feet are subject to cuts, scrapes or other breaks in the skin which can lead to infection. Except for diabetics, this is rarely serious, but it is potentially disabling for the traveler with a limited time in a foreign country.
2. Animal Bites and Stings Associated with Walking Barefoot
Snakes, scorpions and spiders may be a risk to travelers in certain tropical, subtropical and desert areas. (for more info see “Animal Contact” in this outline)
3. Precautions and Risk Avoidance
1) While walking anywhere, including the beach, one should wear shoes, preferably with a strong, thick sole.
2) Never lie on the beach without laying a towel underneath you
3) Do not sit on the ground with wet bathing suits or clothes since this will attract infective larvae (strongyloides).
4) To reduce soil contamination of hookworm larvae (cutaneous larva migrans), expats should ensure periodic deworming of their dog or cat; also, sandboxes and other areas where children play should be protected from dogs and cats that may use them as defecation sites.
5) All travelers should ensure that their tetanus vaccine is up to date since tetanus is prevalent worldwide and correct treatment following injury may not be available in some countries.
6) Seek advice about the local fauna (snakes, scorpions and spiders)
7) Wear boots, socks and long trousers to walk in undergrowth(snakes, scorpions and spiders)
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Pauline Delorme RN
Tel: 613 236-6163. Fax: 613 238-7230.