Part 5: The Foot Check [Guest Author Dr. Peter Ceponis]
“Be sure you put your feet in the right place, then stand firm.”
By now, during these times of physical (social) distancing, you have no doubt adapted to a new routine. The most appropriate military analogy to our current living and working conditions is that of a “Tent Routine.” This baseline routine must be flexible, as stressors will be injected. Taking initiative to react and adjust the routine can foster resiliency and trust amongst the tent crew. One way to do this is through adopting buddy checks.
The foot check is one such check. It is a simple act whereby one soldier inspects another’s foot health, under times of physical and mental stress. This simple act is both a key enabler of individual health, and a method to maintain team effectiveness.
During military training you learn how to live and work together in multiple situations. In buildings, tents, command posts—all under physical and mental stress. The bonds between military colleagues grow iron-clad over time, like a family. The challenge of getting your job done under all these circumstances means you are physically around your colleagues a lot, at times 24/7 for days on end.
Physical distancing during the time of COVID-19 is likely creating a similar situation in many homes where you and your family’s busy daily routine are severely disrupted. Paradoxically, your family unit is probably (physically) closer than ever due to the “shelter-at-home” orders. One advantage of proximity is the ability to rapidly recognize a change in your family member’s mental or physical health.
Visible versus Invisible Symptoms
Some mental or physical changes cannot be readily observed. You have to ask about them. Case in point: the mandatory daily foot check. The rigorous physical training that Canadian Armed Forces soldiers undergo can create a perfect storm for injury. During military training, the combination of exhausting marches, a heavy backpack, adverse weather, and mental strain can all precede a collapse in your tent for a few precious hours of sleep, often in your wet clothes. This may go on for days on end, on the backdrop of not wanting to let your course mates down on a patrol. Even more serious, on an operational deployment.
Soldiers are taught to do a daily self-check and ensure that they are “good-to-go” from head to toe. It is a soldier’s obligation. However, the chain of command recognizes that self-checks can fall through the cracks. Soldiers may neglect their own health, especially their feet, because of fatigue and a desire to push through. Enter the Medical Technician, most commonly referred to as a Medic.
The Foot Check
At the end of a difficult day of soldiering tasks, except for those on watch, everyone heads for their tent. The Medic has one final job to finish. They tell every soldier to take off their boots and socks, sit down, and prepare to have their feet inspected. This practice has anecdotal roots to preventing trench foot in WWI.
The Medic moves from soldier to soldier inspecting their feet. If visually abnormal, it may involve a localized foot examination for important markers like sensation to touch, or skin integrity. If these are abnormal, it may prompt a systemic check for fever or another symptom. If a threshold is hit, the Medic initiates treatment or involves a higher medical authority.
All sorts of problems from simple (athlete’s foot, unchanged socks) to complicated (infection, frostbite) are caught and dealt with to maintain the fighting force. Sometimes, the Medic gives that soldier time on the sidelines to recover, to get back in the game.
[Photo credit: Canadian Armed Forces. WO Jerry Kean, 5 Cdn Div Public Affairs]
Check your “Tent-Mates”
So should you ask your family to remove their footwear for inspection during your tent routine? Maybe not! You are pushing through a different challenge. Watch for likely problems given the scenario. You may observe that the first casualties of physical distancing are emotional and mental wellbeing.
During your tent routine, try to recognize the issues likely to cause an increased mental burden on your family. Perhaps these are related to self-isolation; separation from friends, school, work, and/or extended family; spending more time around each other; or awaiting a COVID-19 test result. Think about these situations for a minute. Chances are you can understand the tremendous stress involved and empathize with your family member. You may be experiencing the same feelings as well. Observe them closely, like the Medic after a patrol.
Next, consider asking your family some questions you may not usually think of during normal times. Such as, how is your mood? Are you anxious about anything? What is stressing you out during the pandemic that doesn’t usually stress you out? Do you want to talk about anything on your mind? It’s OK to explore mental health and talk it out. Sometimes, this is all it takes to make someone feel better.
A good Medic will find a suitable place and time to ask. It may not be during the Daily Brief. It may need to be a more private moment during the day.
Lastly, follow it up and close the loop. If mental health changes from stress seem to be lingering, you may need to help your family member dig deeper for help than what can be found at home.
Sometimes these tools are available from reputable on-line resources such as Toronto’s Center for Addiction & Mental Health. Their website offers coronavirus-specific advice at: https://www.camh.ca/en/health-info/mental-health-and-covid-19.
A good Medic will push you to engage a higher medical authority when that help is warranted. This may be booking with your family doctor, calling Telehealth, or accessing a mental health counsellor via family doctor or work.
Trench foot can develop and be dealt with, but prevention is the best medicine.
Your mental and emotional health are the same. Don’t ignore them.
Mental and emotional challenges should not be allowed to grow unchecked. There are many practical solutions available.
Be observant, open, and to the best of your abilities look after yourself and your family “tent-mates.” Self care starts with you and starts at home.
About the Author
Major Peter Ceponis has served as a Medical Officer in the Canadian Armed Forces since 2010, with his military experiences focused on Army and Navy medicine. In 2017, he completed fellowship training in Hyperbaric & Undersea Medicine at Duke University to serve as a Consultant in Diving & Submarine Medicine for the Forces. More recently he deployed to Baghdad, Iraq as a NATO Medical Advisor, and is now the Brigade Surgeon at Garrison Petawawa.
Peter cares deeply about physical and mental health. Combined with public health expertise, he strives to optimize both individual and population level outcomes. His contributions to over 20 peer-reviewed publications, invited speaking events, and mentoring of medical trainees highlight a personal goal of communicating sound information.
With a rich background in research, medical planning, and clinical support to soldiers, Peter contributes practical medical advice to The Gasparotto Group.
The Gasparotto Group helps organizations create cultures that develop highly effective leaders and build strong, resilient teams.