There are several important things for a diabetic to keep in mind for both their general and foot health. Daily monitoring of blood sugar, and regular check-ups by your primary care physician are key factors to good health. Diabetics who are well controlled stave off some of the more adverse long-term effects of diabetes including: neuropathy (loss of sensation in the feet and hands), vision changes and kidney failure. Neuropathic changes in the feet can eventually lead to ulceration (large open wounds) and to amputation of the toe or leg. As the foot becomes neuropathic there is a loss of both the ability to react to pressure and to pain. Neuropathic changes are concerning because it can be considered a loss of protective sensation. When one loses the ability to feel, one looses the ability to help protect the body from danger. Your podiatrist can help you to identify any changes in protective sensation via testing with a Semmes Weinstein 10g monofilament. Once neuropathic changes are evident several things can be done at the home to help promote healthy feet. In addition, skin biopsies that measure the amount of nerve fibers “Epidermal Nerve Fiber Density - ENFD” testing can be done in the doctor’s office with a small amount of local anesthesia. These are excellent baselines tests to determine the fiber density and six-months later determine if medication is helping.
Some helpful hints:
1: Daily inspection of the feet, use a mirror to note any changes on the sole. Note any color changes, cracking, or any evidence of trauma. If concerning call.
2. Keep your feet moisturized by using a good foot cream, or lotion.
3. Check the bath water using your elbow or a thermometer, too hot of water can lead to burns to neuropathic feet and the hands.
3. Nails should be kept trim, cut straight across, and filed smooth. When the nails become problematic please have your podiatrist cut them or demonstrate the proper method of nail care.
4. A podiatrist should address any problematic corns and calluses, or lesions.
5. Wear supportive and properly fitting shoes. A protect slipper or shoe should be worn in the home. Don’t forget to wear socks.
Good foot health can be accomplished by teamwork with your primary care physician, your podiatrist and yourself.
Monday, January 24, 2011
Wednesday, January 12, 2011
Gout!
Gout
“The Gout” James Gillray
Once called the “king of diseases, the disease of kings”, gout has been around since antiquity. Identified in 2640 BC by the Egyptians and later recognized by Hippocrates in fifth century BC, Gout is derived from the Latin word ‘gutta’ meaning ‘drop’.
Historically, gout is associated with an individual’s having the money to enjoy a diet abundant in meats, cheeses and wine hence the nickname of “Rich man’s disease”. A painful condition of the joints, gout is caused by increased levels of uric acid a product of purine [protein] metabolism. Foods rich in purines, such as meats and cheeses, certain wines and fishes, can help to precipitate gouty attacks. Gout is caused either by the body over producing uric acid or not being able to excrete uric acid fast enough to prevent build-up. Most commonly middle-aged men are affected by gout, although often the disease is seen in women. Hence the term ‘under-excreters or over-producers. This is often the way to tailor drug treatment to manage the gouty attacks and prevent a recurrence. Lab work and on occasion, a urine sample will help determine the type of patient and tailor the drug treatment.
The classical presentation of gout is described as a toe that is very red, swollen and warm. The toe is so painful that that even the touch of a light bed sheet is agonizing. Depositing into the joint space, uric acid crystals cause an inflammatory response responsible for the hallmarks of a red, swollen, and painful joint. Usually gouty attack occurs in one joint, most commonly the big toe (‘great toe’ or ‘hallux’). Gout of the big toe joint is known as Podagra. Drinking plenty of fluids, maintaining a healthy BMI (basal metabolic index = weight), and minimizing alcohol consumption can help to minimize gouty flare-ups. Typically, the painful joint resolves in several days with medications, dietary changes and rest. More information on diet can be found here: http://www.mayoclinic.com/health/gout-diet/MY01137
“The Gout” James Gillray
Once called the “king of diseases, the disease of kings”, gout has been around since antiquity. Identified in 2640 BC by the Egyptians and later recognized by Hippocrates in fifth century BC, Gout is derived from the Latin word ‘gutta’ meaning ‘drop’.
Historically, gout is associated with an individual’s having the money to enjoy a diet abundant in meats, cheeses and wine hence the nickname of “Rich man’s disease”. A painful condition of the joints, gout is caused by increased levels of uric acid a product of purine [protein] metabolism. Foods rich in purines, such as meats and cheeses, certain wines and fishes, can help to precipitate gouty attacks. Gout is caused either by the body over producing uric acid or not being able to excrete uric acid fast enough to prevent build-up. Most commonly middle-aged men are affected by gout, although often the disease is seen in women. Hence the term ‘under-excreters or over-producers. This is often the way to tailor drug treatment to manage the gouty attacks and prevent a recurrence. Lab work and on occasion, a urine sample will help determine the type of patient and tailor the drug treatment.
The classical presentation of gout is described as a toe that is very red, swollen and warm. The toe is so painful that that even the touch of a light bed sheet is agonizing. Depositing into the joint space, uric acid crystals cause an inflammatory response responsible for the hallmarks of a red, swollen, and painful joint. Usually gouty attack occurs in one joint, most commonly the big toe (‘great toe’ or ‘hallux’). Gout of the big toe joint is known as Podagra. Drinking plenty of fluids, maintaining a healthy BMI (basal metabolic index = weight), and minimizing alcohol consumption can help to minimize gouty flare-ups. Typically, the painful joint resolves in several days with medications, dietary changes and rest. More information on diet can be found here: http://www.mayoclinic.com/health/gout-diet/MY01137
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