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
Monday, December 13, 2010
If the shoe fits ....
If the Shoe fits…. All good stories start with “Once Upon a Time” and end with a slipper and a “Happily Ever After” or so we are taught by the Cinderella story. Cindy was lucky she had a Fairy Godmother for the perfect fit, but what do the rest of us do when it comes to finding shoes? Several simple steps will make buying the next pair of sneakers, pumps or loafers a shoe-in.
1. Shoes go last: Shop for shoes at the end of your day as feet swell, increasing the size. A later fitting may lead to a more comfortable wearing shoe. It is also important to try on shoes while standing as your feet change shape.
2. Measures twice wear always: Measure your feet twice a year using either a Ritz stick or a Brannock Shoe Measuring Device. Both devices measure the width and the length of your foot. Your local podiatrist will be able to properly measure your feet, and help you in your shoe search. If you are at a shoe store, see if one of the sales-people is a “certified fitter”.
3. Ball to bend: The ball of your foot, which describes the joint of your big toe, should correspond to the bend in the shoe. You can test the bend of a shoe by holding the heel steady while flexing the toe box (where the toes go). The bend in the shoe should correspond with the bend at your big toe joint.
4. Wiggle room: You should have enough space to allow your toes to move. Your toes are an important agent in walking and help your foot to better support and balance the body.
5. Test so they last: Test the shoes before you buy them by walking/jogging around the store. If the shoe is uncomfortable in the store try a different size or forgo the shoe for something more comfortable. Then when you take them home, walk on a carpeted surface, testing the shoe again for a longer period of time. The carpet will prevent scratches to the bottom of the shoe, so you can return as necessary.
6. Diabetic Shoe: Don’t forget if you are a diabetic, you should look for shoes without seams inside. Your podiatrist can give you suggestions on brands of shoes or make you a ‘diabetic type’ shoe if you need this. In addition, avoid socks with too much elastic as these can cut off circulation to the feet.
May your shoes and your feet live “Happily Ever After”.
1. Shoes go last: Shop for shoes at the end of your day as feet swell, increasing the size. A later fitting may lead to a more comfortable wearing shoe. It is also important to try on shoes while standing as your feet change shape.
2. Measures twice wear always: Measure your feet twice a year using either a Ritz stick or a Brannock Shoe Measuring Device. Both devices measure the width and the length of your foot. Your local podiatrist will be able to properly measure your feet, and help you in your shoe search. If you are at a shoe store, see if one of the sales-people is a “certified fitter”.
3. Ball to bend: The ball of your foot, which describes the joint of your big toe, should correspond to the bend in the shoe. You can test the bend of a shoe by holding the heel steady while flexing the toe box (where the toes go). The bend in the shoe should correspond with the bend at your big toe joint.
4. Wiggle room: You should have enough space to allow your toes to move. Your toes are an important agent in walking and help your foot to better support and balance the body.
5. Test so they last: Test the shoes before you buy them by walking/jogging around the store. If the shoe is uncomfortable in the store try a different size or forgo the shoe for something more comfortable. Then when you take them home, walk on a carpeted surface, testing the shoe again for a longer period of time. The carpet will prevent scratches to the bottom of the shoe, so you can return as necessary.
6. Diabetic Shoe: Don’t forget if you are a diabetic, you should look for shoes without seams inside. Your podiatrist can give you suggestions on brands of shoes or make you a ‘diabetic type’ shoe if you need this. In addition, avoid socks with too much elastic as these can cut off circulation to the feet.
May your shoes and your feet live “Happily Ever After”.
If the shoe fits ....
If the Shoe fits…. All good stories start with “Once Upon a Time” and end with a slipper and a “Happily Ever After” or so we are taught by the Cinderella story. Cindy was lucky she had a Fairy Godmother for the perfect fit, but what do the rest of us do when it comes to finding shoes? Several simple steps will make buying the next pair of sneakers, pumps or loafers a shoe-in.
1. Shoes go last: Shop for shoes at the end of your day as feet swell, increasing the size. A later fitting may lead to a more comfortable wearing shoe. It is also important to try on shoes while standing as your feet change shape.
2. Measures twice wear always: Measure your feet twice a year using either a Ritz stick or a Brannock Shoe Measuring Device. Both devices measure the width and the length of your foot. Your local podiatrist will be able to properly measure your feet, and help you in your shoe search. If you are at a shoe store, see if one of the sales-people is a “certified fitter”.
3. Ball to bend: The ball of your foot, which describes the joint of your big toe, should correspond to the bend in the shoe. You can test the bend of a shoe by holding the heel steady while flexing the toe box (where the toes go). The bend in the shoe should correspond with the bend at your big toe joint.
4. Wiggle room: You should have enough space to allow your toes to move. Your toes are an important agent in walking and help your foot to better support and balance the body.
5. Test so they last: Test the shoes before you buy them by walking/jogging around the store. If the shoe is uncomfortable in the store try a different size or forgo the shoe for something more comfortable. Then when you take them home, walk on a carpeted surface, testing the shoe again for a longer period of time. The carpet will prevent scratches to the bottom of the shoe, so you can return as necessary.
6. Diabetic Shoe: Don’t forget if you are a diabetic, you should look for shoes without seams inside. Your podiatrist can give you suggestions on brands of shoes or make you a ‘diabetic type’ shoe if you need this. In addition, avoid socks with too much elastic as these can cut off circulation to the feet.
May your shoes and your feet live “Happily Ever After”.
1. Shoes go last: Shop for shoes at the end of your day as feet swell, increasing the size. A later fitting may lead to a more comfortable wearing shoe. It is also important to try on shoes while standing as your feet change shape.
2. Measures twice wear always: Measure your feet twice a year using either a Ritz stick or a Brannock Shoe Measuring Device. Both devices measure the width and the length of your foot. Your local podiatrist will be able to properly measure your feet, and help you in your shoe search. If you are at a shoe store, see if one of the sales-people is a “certified fitter”.
3. Ball to bend: The ball of your foot, which describes the joint of your big toe, should correspond to the bend in the shoe. You can test the bend of a shoe by holding the heel steady while flexing the toe box (where the toes go). The bend in the shoe should correspond with the bend at your big toe joint.
4. Wiggle room: You should have enough space to allow your toes to move. Your toes are an important agent in walking and help your foot to better support and balance the body.
5. Test so they last: Test the shoes before you buy them by walking/jogging around the store. If the shoe is uncomfortable in the store try a different size or forgo the shoe for something more comfortable. Then when you take them home, walk on a carpeted surface, testing the shoe again for a longer period of time. The carpet will prevent scratches to the bottom of the shoe, so you can return as necessary.
6. Diabetic Shoe: Don’t forget if you are a diabetic, you should look for shoes without seams inside. Your podiatrist can give you suggestions on brands of shoes or make you a ‘diabetic type’ shoe if you need this. In addition, avoid socks with too much elastic as these can cut off circulation to the feet.
May your shoes and your feet live “Happily Ever After”.
Monday, November 8, 2010
Ankle Sprains
Ankle Sprains & Treatment
Ankle sprains occur to anyone in almost any sport or activity. The majority of ankle sprains occur during contact sports with the top four being: basketball, football, soccer and running. But ankle sprains can occur in other activities such as in dance and even just walking outside on uneven sidewalks. Most of us ignore the sprain and take it easy for the next couple of days. But this type of “treatment” doesn’t treat the inflammatory process behind the sprain.
Inadequate treatment of an ankle sprain can cause the ankle to become prone to sprains and later can develop into lateral ankle instability due to the laxity of the ligaments around the ankle. The anterior talo-fibular ligament is the most sprained ankle ligament contributing to the instability. By taking care of an ankle sprain correctly with proper treatment will help reduce the risk of lateral ankle instability.
This can be prevented by using the simple acronym RICE that stands for:
Rest the injured ankle from any type of weight bearing activity and this is best accomplished by using crutches or even various casting options.
Ice the injured location for about 20 minutes at a time to help reduce swelling and to prevent further injury. A simple ‘frozen bag of peas’ or several ice cubes wrapped in a towel will suffice.
Compression by using a gel wrap or elastic bandage will help support the ankle.
Elevate the injured side by keeping it above the heart level, which helps to reduce both swelling and bruising.
By following the RICE treatment and by taking anti-steroidal anti-inflammatory drugs (NSAIDs) to help with pain management and reduce swelling and inflammation, the injured ankle will have a better chance of recovery and will prevent the risk of developing ankle instability. More severe ankle sprains that involve more ligaments and possibly bone will need the attention of a podiatrist. Trainer or your family doctor, who can evaluate the ankle with other diagnostic tools such as ultrasound and x-rays.
Please email us with any questions of comments.
Ankle sprains occur to anyone in almost any sport or activity. The majority of ankle sprains occur during contact sports with the top four being: basketball, football, soccer and running. But ankle sprains can occur in other activities such as in dance and even just walking outside on uneven sidewalks. Most of us ignore the sprain and take it easy for the next couple of days. But this type of “treatment” doesn’t treat the inflammatory process behind the sprain.
Inadequate treatment of an ankle sprain can cause the ankle to become prone to sprains and later can develop into lateral ankle instability due to the laxity of the ligaments around the ankle. The anterior talo-fibular ligament is the most sprained ankle ligament contributing to the instability. By taking care of an ankle sprain correctly with proper treatment will help reduce the risk of lateral ankle instability.
This can be prevented by using the simple acronym RICE that stands for:
Rest the injured ankle from any type of weight bearing activity and this is best accomplished by using crutches or even various casting options.
Ice the injured location for about 20 minutes at a time to help reduce swelling and to prevent further injury. A simple ‘frozen bag of peas’ or several ice cubes wrapped in a towel will suffice.
Compression by using a gel wrap or elastic bandage will help support the ankle.
Elevate the injured side by keeping it above the heart level, which helps to reduce both swelling and bruising.
By following the RICE treatment and by taking anti-steroidal anti-inflammatory drugs (NSAIDs) to help with pain management and reduce swelling and inflammation, the injured ankle will have a better chance of recovery and will prevent the risk of developing ankle instability. More severe ankle sprains that involve more ligaments and possibly bone will need the attention of a podiatrist. Trainer or your family doctor, who can evaluate the ankle with other diagnostic tools such as ultrasound and x-rays.
Please email us with any questions of comments.
Wednesday, June 9, 2010
What Do Summer and Sun Exposure Mean for Your feet?
Summer season is here and everyone is excited about spending some time in the sun. Whether it is just some play time with the kids in the backyard, enjoying the pool, or maybe even planning a vacation with the family and enjoying some peaceful time on a beautiful beach. Although, all of those scenarios seem like a way to spend a great summer, what many people tend to forget is protecting their skin from harmful sun exposure. We have all heard of the importance of protecting our skin from the sun due to the harmful UV radiation and the possibility of skin cancer. Unfortunately, any area of exposed skin is fair game for the cancer of the skin. It is hard to believe that skin cancer can also rise from the skin on our toes, feet, ankles, and legs. The number of individuals who forget to lather up the skin on those areas specially the toes and the feet might surprise you.
After prolonged sun exposure, irregular skin cells grow and begin to differentiate over time. If unattended and untreated, they have the potential of spreading to other parts of the body including other tissues and organs in a process called metastasis. Different types of skin cancer exist including: basal cell carcinoma, squamous cell carcinoma, and malignant melanoma; with basal cell carcinoma being the most common skin cancer amongst all. Melanoma, which rises from skin melanocytes, is the least common and yet the most dangerous type of skin cancer with the ability to metastasize.
Skin cancer presents itself in many forms, some common presentations on the foot include: scaly, shiny, waxy, crusty, or simply a small, red lesion. The areas that one should pay close attention to on the feet in terms of screening for potential skin cancer include but are not limited to the dorsum of the foot, area underneath/surrounding the toenails, and the heels.
Risk factors for skin cancer involve light-complexion and fair skin, family history of skin cancer, age (more common in those over the age of 40), and finally the areas that sunburn easy.
The ABCDE’s of skin lesions, are some important features to look for and they entail: asymmetry, border, color, diameter, and elevation of the lesion. Asymmetry is seen where one half of the lesion has a different appearance/texture compared to the other half. Be on the lookout for irregular borders of the lesion, a star like border is a common example. Color of the lesion should be assessed and any color difference compared to the surrounding skin should be noted. Any lesion with the diameter of 6mm or larger should be brought to your physicians’ attention. Last but not least, any elevation of any lesion is alarming.
Different types of skin cancer whether melanocytic or nonmelanocytic require a different type of treatment with some having surgical excision as the best definitive treatment approach. Early detection is the key with skin cancer as it is with many other health conditions. So, here is our friendly advice: enjoy your summer and your time off with your family, however, do not forget sun protection (at least SPF 30) and regular skin screenings. Try and stay out of the sun when UV rays are most intense, mainly between the hours of 11am and 3:30 pm. If a mole or a skin lesion on your lower extremities looks suspicious to you and fits the ABCDE criteria above, be sure and consult your podiatrist. Finally, have a fun, safe, and an amazing summer!
After prolonged sun exposure, irregular skin cells grow and begin to differentiate over time. If unattended and untreated, they have the potential of spreading to other parts of the body including other tissues and organs in a process called metastasis. Different types of skin cancer exist including: basal cell carcinoma, squamous cell carcinoma, and malignant melanoma; with basal cell carcinoma being the most common skin cancer amongst all. Melanoma, which rises from skin melanocytes, is the least common and yet the most dangerous type of skin cancer with the ability to metastasize.
Skin cancer presents itself in many forms, some common presentations on the foot include: scaly, shiny, waxy, crusty, or simply a small, red lesion. The areas that one should pay close attention to on the feet in terms of screening for potential skin cancer include but are not limited to the dorsum of the foot, area underneath/surrounding the toenails, and the heels.
Risk factors for skin cancer involve light-complexion and fair skin, family history of skin cancer, age (more common in those over the age of 40), and finally the areas that sunburn easy.
The ABCDE’s of skin lesions, are some important features to look for and they entail: asymmetry, border, color, diameter, and elevation of the lesion. Asymmetry is seen where one half of the lesion has a different appearance/texture compared to the other half. Be on the lookout for irregular borders of the lesion, a star like border is a common example. Color of the lesion should be assessed and any color difference compared to the surrounding skin should be noted. Any lesion with the diameter of 6mm or larger should be brought to your physicians’ attention. Last but not least, any elevation of any lesion is alarming.
Different types of skin cancer whether melanocytic or nonmelanocytic require a different type of treatment with some having surgical excision as the best definitive treatment approach. Early detection is the key with skin cancer as it is with many other health conditions. So, here is our friendly advice: enjoy your summer and your time off with your family, however, do not forget sun protection (at least SPF 30) and regular skin screenings. Try and stay out of the sun when UV rays are most intense, mainly between the hours of 11am and 3:30 pm. If a mole or a skin lesion on your lower extremities looks suspicious to you and fits the ABCDE criteria above, be sure and consult your podiatrist. Finally, have a fun, safe, and an amazing summer!
Sunday, June 6, 2010
Platelet Rich Plasma Therapy: Way to a Rapid Recovery
Platelet Rich Plasma therapy (PRP) is a new way of healing that has been deserving of much debate in the past year upon its effectiveness. It is a non-surgical, cutting edge injection therapy that is to promote healing of bone, soft tissue, cartilage, and nerves. The injection is composed of platelet extracts from whole blood. Athletes such as Tiger Woods received several of these injections in 2009 to promote healing of a tendinitis condition that he had acquired after an Achilles tendon injury in the year prior. Another well known athlete that had the advantage of PRP therapy is Troy Polamalu who received the injections for the treatment of a strained calf after a knee injury.
PRP is able to promote healing by mediating the degree of inflammation in the affected area. After an injury is sustained by a tissue, an inflammatory response begins causing redness, heat, and swelling. This aids in preventing infection and allows the tissue to become prepared for healing. The healing process begins after the inflammation period is over. Platelets play a major role in both the inflammation and the healing process. Platelets are capable of inhibiting inflammation, and therefore allowing the healing process to begin much earlier by producing several growth factors in the tissue including those that aid to stimulate the growth of new blood vessels.
According to a research done by Dr. Grambert, of Indiana University School of Medicine, more than one injection may be needed for complete healing and results may be seen in as many as 4 to 6 weeks. He also has found success in treating patients with plantar fasciitis using PRP accompanied by a tear in the plantar fascia which aids in lengthening. Boot immobilization is then followed to allow the patient full recovery. This treatment regimen has provided his patients with promising results, where 85% of his 89 plantar fasciitis cases returned to normal activity with no limitations within six weeks.
Another advantage of PRP is that, it is an affordable treatment for most patients. Platelet Rich Plasma therapy is ongoing debate and it is currently being researched on in many labs and by many practitioners across the country, however, its promising results should not be foreseen.
PRP is able to promote healing by mediating the degree of inflammation in the affected area. After an injury is sustained by a tissue, an inflammatory response begins causing redness, heat, and swelling. This aids in preventing infection and allows the tissue to become prepared for healing. The healing process begins after the inflammation period is over. Platelets play a major role in both the inflammation and the healing process. Platelets are capable of inhibiting inflammation, and therefore allowing the healing process to begin much earlier by producing several growth factors in the tissue including those that aid to stimulate the growth of new blood vessels.
According to a research done by Dr. Grambert, of Indiana University School of Medicine, more than one injection may be needed for complete healing and results may be seen in as many as 4 to 6 weeks. He also has found success in treating patients with plantar fasciitis using PRP accompanied by a tear in the plantar fascia which aids in lengthening. Boot immobilization is then followed to allow the patient full recovery. This treatment regimen has provided his patients with promising results, where 85% of his 89 plantar fasciitis cases returned to normal activity with no limitations within six weeks.
Another advantage of PRP is that, it is an affordable treatment for most patients. Platelet Rich Plasma therapy is ongoing debate and it is currently being researched on in many labs and by many practitioners across the country, however, its promising results should not be foreseen.
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