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Contraindications for Ice
Since the foot is not well endowed with large muscles or fat, the use of ice has the potential to cause harm. Too much ice can literally freeze the skin and small blood vessels, and injure nerves. Essentially, cryotherapy can result in frostbite unless ice is applied with caution.
In many situations, ice is not indicated and should be avoided because it can further injure the foot. Those with rheumatoid arthritis, Raynaud’s Syndrome, or any type of paralysis should not use ice. Also avoid ice on areas of reduced sensation. Limit or avoid the use of ice over areas where a large nerve passes close to the skin surface, such as under the ankle bones on the inside and outside of the foot.
A very few number of people have cold allergies and can have adverse reactions to cold. Most people already know the condition exists because of previous adverse reactions to cold, including pain and skin rash. Those with high blood pressure should also be cautious when using ice as it can raise blood pressure.
Care should be taken in using ice boots or other strap-on ice packs because these are often used for too long. They are often used for convenience allowing the person to be active during cryotherapy—itself a contraindication as rest and elevation are often what is required. Do not put these devices on before going to sleep for obvious reasons.
For acute injuries, especially during the first twenty-four hours, certain remedies should be avoided. These include the use of heat in any form, whether a hot bath, heating pad, or heating gel. Heat can aggravate inflammation. An aggressive massage can also create heat and should be avoided. Stretching should not be used for acute problems.
Differentiating between the need for heat or cold is relatively easy—if your foot is hot, cool it; if it’s cold, heat it. In general, cooling is the best therapy for acute problems. Cold therapy is easy to use, inexpensive, but often overlooked because of its simplicity.
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