Foot, Ankle & Lower Leg Center: October 2011

Thursday, October 27, 2011

Beware of the Diabetic Heart Attack of the Foot

Posted by: The Huffington Post

Diabetes can wreak havoc on the foot, resulting in infection, leading to foot/leg amputation. While every patient with diabetes has a theoretical risk, it's the presence of more advanced diabetes that truly makes the foot susceptible to a catastrophic event.

I would like to introduce a term called the "Diabetic Heart Attack of the Foot" to illustrate the severity and seriousness of two advanced diabetic foot problems that may cause limb-threatening events:

1. Foot wound (medical term: foot ulcer)

2. Diabetic foot fracture (medical term: charcot foot).

Similar to a heart attack, a "foot attack" may occur as a relatively mild (but still serious) event that involves active management, or more severe, which can result in immediate hospitalization and limb salvage surgery/possible amputation.

Diabetes (and more so, poorly-uncontrolled diabetes) may lead to two distinct serious medical problems that interfere with normal function of the foot. They are:

Peripheral Neuropathy (decreased or loss of sensation to feet): Without sensation to the foot, a person may not feel things on the bottom of the foot, or inside of the foot. This leads to stepping on objects that can puncture the skin and cause infections.
Peripheral Arterial Disease (decreased or loss of blood supply to the foot): Proper circulation is necessary to maintain healthy feet. When blood supply becomes diminished it can result in poor skin texture and healing difficulties -- the most dangerous is gangrene.

The effect of diabetes on the foot doesn't happen overnight. They occur slowly over time.

Diabetic foot wounds

Sores/wounds on the foot are called "ulcers" and often a strong indicator of advanced diabetes that occur when with sensory and/or circulation problems. Most commonly, these wounds occur on the bottom of the foot under pressure points (such as the ball of the foot) and on the toes. These wounds may be shallow and small or deep and wide.

The simple presence of a wound is serious because bacteria may propagate and cause an infection. Signs of an infection are redness, swelling, malodor and/or pus (yellowish colored drainage). Infection may progress and cause tissue death and gangrene. Bone infections occur with deep wounds. Both gangrene and bone infections often require invasive surgery.

Diabetic foot fractures

Patients who have sensation difficulties can develop "silent" fractures in the foot, a medical term called charcot foot. Simply put, these fractures often occur from altered walking mechanics (from loss of sensation). In many circumstances, the bones heal in an incorrect position, leading to a severe disfiguration of the foot. When the foot becomes structurally deformed, pressure spots occur which can then lead to diabetic foot ulcer/wounds (explained above).

The "Diabetic Heart Attack Of The Foot" (foot wounds and/or foot fractures) are serious events that when they occur should not be taken lightly by both patient and doctor. They indicate that the diabetes has advanced to a point where the limb becomes at risk for major problems and complications leading to foot amputation/limb loss.

If you are diabetic, it is important that you take steps to learn how to protect your feet.

Please call the Foot, Ankle & Lower Leg Center office in Las Vegas anytime @702-878-2455 between Monday – Friday and we would be happy to set up an appointment for you. Please visit our website @ FallCenter.com or www.walkwithdiabetes.com. The Foot, Ankle & Lower Leg Center has Diagnostic imaging: Digital X-Rays, Ultrasound or Advanced Imaging will be used to aid in the diagnosis.

Dr. Anthony Ricciardi at the Foot, Ankle & Lower Leg Center has completed training in endoscopic/minimally invasive surgery for chronic heel pain and nerve pain, foot and ankle joint replacement for restoring pain free motion, arthroscopic surgery, bunion surgery, fracture repair, flat foot correction, external fixation for complex deformities and extensive experience in peripheral nerve surgery including diabetic peripheral neuropathy and reconstructive surgery of previously failed foot surgical procedures. In addition to his surgical training Dr. Ricciardi focuses on sports medicine of the foot and ankle through regenerative techniques using the patient’s own blood/platelets for healing chronic foot and ankle problems (pain) as a result of repetitive sport injuries. This cutting edge technology enables patients to continue training with little or no down time. Dr. Ricciardi continues to be active in teaching and training other podiatric surgeons on innovative surgical techniques in foot surgery. Dr. Ricciardi is Board Certified by the American Board of Podiatric Surgery, a Fellow of the American College of Foot and Ankle Surgeons and Fellow of the Association of Extremity Nerve Surgeons. Dr. Ricciardi’s vision is to bring each patient the most current state of the Art Technology and personalized treatment options to meet their Foot and Ankle needs (from conservative care to surgical options). Dr. Ricciardi believes in quality service and puts his patients first!

Tuesday, October 25, 2011

Heel pain? Try stretches, orthotics, new shoes

http://abclocal.go.com/kabc/video?id=8387980

Posted on: KABC-TV/DT

LOS ANGELES (KABC) -- Two million Americans suffer from plantar fasciitis. It's one of the most common complaints people have when it comes to foot pain. But there are steps you can take to not only treat it, but prevent it.

Walking: Our feet average 115,000 miles of it in our lifetime. But with overuse feet can develop heel pain often caused by plantar fasciitis, an inflammation of the tissue on the bottom of the feet.

"Usually for the first week or two they'll write it off and say this is going to get a little bit better, they'll stretch maybe, but usually the symptoms don't go away," said sports physical therapist Christine Panagos.

Athletes and people who are either overweight or stand for long periods of time are most prone to plantar fasciitis.

Wearing old, worn-out shoes is another culprit. Make sure to replace yours every three to six months.

Early intervention includes a good balancing and stretching program.

Wednesday, October 19, 2011

A Shoe for Every Sport

Keep on top of your game with this tip sheet about sport-specific shoes.

http://www.apma.org/A-Shoe-For-Every-Sport

Recommended by the American Podiatric Medical Association, Inc. (APMA)

Friday, October 14, 2011

Don't Commit a Boot Blunder

Nothing is worse than finding the perfect pair of fall boots and having them hurt your feet. Trendy and comfortable boots are out there, follow these boot buying tips from today’s podiatrist and avoid a boot blunder!

http://www.apma.org/boot-tips

Saturday, October 8, 2011

Obesity and your feet

By GET WELL BAHAMAS

THE average person's feet will walk 99,439 miles in a lifetime, a distance equivalent to going four times around the world. In each foot there are 32 joints, eight arches, 26 bones and more than hundred muscles and tendons. Although the feet contain more than a quarter of all the bones in the human body most people give little thought to protecting and caring for their feet until there is a problem.

According to podiatrist Dr Monique Mitchell, there is a definite link between obesity and foot problems both in America where three million people are overweight or obese and here in The Bahamas where more than 70 per cent of the population is overweight or obese.

"The Orthopedic Society of the United States has done numerous studies on how obesity affects the feet. These studies indicate that the higher the body mass index (BMI) or the more weight you carry, the more problems persons tend to have with their feet. One study showed that more than 40 per cent of participants could relate the pain that they had in their feet to the fact that they had put on weight," Dr Mitchell recently told participants of Get Well Bahamas.

"As a podiatrist one of the common things that I see every day is heel pain and one of the things that relates to the heel pain is weight gain. When patients say they've started to experience heel pain in the last couple of months I ask what has changed in that time and they usually say, 'Oh, I've put on some weight'," Dr Mitchell said.

* Foot pain

While foot pain is usually the result of weight gain, it can also be the cause of weight gain perpetuating an unhealthy cycle unless measures are taken to correct the problem.

"A study by the American Podiatric Medical Association found that 72 per cent of Americans were fat or they were getting fat because they had foot pain. And what happens when you have foot pain? You can't walk and you can't exercise because your foot is hurting and if you don't exercise you are going to put on weight," Dr Mitchell said.

She explained that when excess weight affects the feet it usually affects other joints in the lower body as well.

"The most active joints in your lower extremities are the big toe joint, the ankle joint and the knee joint and when you have pain in the big toe eventually you're going to have pain in the ankle and eventually you're going to have pain in the knee and you're going to have pain in the hip. So everything hinges on each other. When God made this body it was fearfully and wonderfully made so everything was made to function in sequence," she said.

* Common foot problems

According to Dr Mitchell, some of the most common foot problems that podiatrists see are the result of patients being overweight, for example, heel pain and posterior tibial tendonitis where the arch of the foot collapses and the foot becomes very flat. Other common foot conditions related to obesity include ingrown toenails, swelling, venous insufficiency and even arterial problems.

* Footwear

While these types of foot problems require medical care from a trained specialist one way everyone can protect their feet and related joints is by wearing the right shoes or athletic footwear.

"Physical activity is vital not only to lose weight but for healthy living. You eat every day so you have to move every day and in order to move you need your feet. Walking is an excellent exercise. Everybody can do it and we thank God we live in a country where we can do it every day all year round, but you must have the proper footwear," Dr Mitchell said.

"You want a sneaker that has structure in the middle and an in-sole that conforms to the shape of the feet. It should fit so that you have room at the front and it should have laces so it can attach to your foot properly. That's the type of footwear that you want to wear."

On the contrary, when exercising, she said one should avoid wearing footwear like sandals or sweet waters - sneakers with a flat bottom and no structure in the middle, that don't support the feet.

Dr Mitchell said those types of footwear will only cause foot pain and should not be used for exercise or even for working in all day.

* Foot care

Along with having the proper footwear Dr Mitchell said it's important to keep the feet clean and dry to avoid infections and foot odor.

"It has been proven that persons who are overweight tend to have more fungal infections or infections on the feet and that's probably only because they tend not to pay attention to something like this. Sometimes they'll tell me "I can't reach my foot but if you lose weight you'll be able to reach your feet so you can care for them, clean them and do what you need to do," she said.

* Foot support

She also noted that some feet may require additional support, for example, when there are structural problems such as flat feet or a foot deformity. Since adults can no longer change the shape of their feet without surgery it may be necessary to wear a brace, orthotics or an in-sole to ensure that feet are functioning at best.

* When to see a podiatrist

How can you tell when your feet need medical attention? Dr Mitchell says it may be normal to have some aches and pains in the feet when beginning a new activity, however, if there is persistent pain or swelling in the lower extremity you should come and see a podiatrist. Other conditions that warrant a visit to the foot doctor? Fallen arches, painful bunions, hammertoes or ingrown toenails.

With weight loss and proper foot care Dr Mitchell assured the Get Well Bahamas participants that they would be able to achieve their goals and enjoy the benefits of healthy, happy feet.

Monday, October 3, 2011

Suffer from Diabetes? Take care of your feet...

Posted on: Rapid City Journal

If your feet are talking to you after a long day on them, count yourself lucky.

Jenice Casey and the millions of other diabetics who suffer from peripheral neuropathy of the feet can’t feel their feet. That lack of nerve sensation too often causes wounds that can lead to amputation of the foot or leg.

Diabetes is the leading cause of non-traumatic limb amputation in the U.S., says Dr. Rylan Johnson, a Rapid City podiatrist and surgeon who offers a free class about diabetes foot care through Regional Medical Clinic Endocrinology and Diabetes Education.

“It happens all too frequently,” Johnson said. As diabetes reaches epidemic levels in America, the disease’s foot complications increase as well, Johnson said. Not all diabetics experience neuropathy, however. The problem can develop quickly or slowly and it can vary from patient to patient from some loss of sensation to total numbness.

He encourages diabetics to establish their risk for foot problems with an initial diabetic foot screening, which tests for light touch sensation that a healthy foot can feel, but a person with neuropathy cannot.

“Pain is the driving factor for most foot patients. Diabetic patients don’t have that pain. They don’t have a pain threshold,”Johnson said. “And when you can’t feel your toes, even trimming a toenail can be a dangerous endeavor.”

When feet can’t communicate pain, people will develop tissue breakdown because of the constant pressure of walking and standing on them that quickly turns into an open wound, particularly in diabetics. High or uncontrolled blood sugar levels inhibit the body’s natural capacity to heal itself, Johnson said.

“A diabetic will literally just wear a hole in their foot,” he said. That’s what happened to Casey before she even knew she had an open wound on the bottom of her foot.

The 59-year-old pharmacy technician at Rapid City Regional Hospital was diagnosed with type 2 diabetes 27 years ago. The disease runs in her family, also affecting five of her six siblings, as well as her mother, grandmother, great-grandmother and plenty of aunts and uncles.

She has struggled to manage her blood sugar levels at optimal levels over the years — at first with diet, then oral medication and, more recently, daily insulin injections. Two years ago, she developed one of the most common complications of her disease: foot numbness.

“You feel unbalanced, especially in the middle of the night when you get out of bed … like you’re walking on a sponge or something. You just can’t feel balanced,” Casey said, describing peripheral neuropathy. Casey first learned of the condition during a regular checkup. A small black spot on the bottom of her big toe, once it was debrided, turned out to be an open wound about the size of a pencil eraser.

“I was in and out of a boot for the next six or seven months,”Casey said of the effort to heal that wound. Treatment options include wearing a diabetic boot and shoe inserts that take pressure off the wound area, but that also can lead to new pressure points developing on other parts of the foot. Casey’s foot finally healed in two weeks after Johnson put her in a total contact cast — a hard fiberglass cast that takes all the pressure off the wound area.

A similar problem developed on her other foot shortly after Casey missed one of her regular exams because of illness. “I missed my last one and I almost caused a wound to start on my other foot,” she said. Amputation is Casey’s worst fear, something she knows is all too real of a threat.

She’s back to a strict maintenance exam schedule every six weeks with a doctor, and she examines her own feet every morning when she steps out of the shower. She wears special shoe inserts to protect her feet and skips high-fashion footwear in favor of shoes that leave plenty of room to accommodate a hammertoe and other foot problems.

What’s important is keeping her feet healthy, she said. When she told her daughter that one of her shoe purchases “look like grandma shoes,” her daughter said. “Well, you are a grandma, so I guess you can wear them.”

Diabetic foot neuropathy has changed more than her shoe fashion choices, however. She had to change jobs to avoid long days on her feet, and the once-avid volksmarcher has cut way back on the amount of walking and hiking she does.

“I love to walk and hike. That’s limited now,” Casey said. But preventing a foot problem is much better than trying to heal one, Johnson said.

“Get your feet checked and understand if you are at risk,” he said. “You don’t want your introduction to diabetic foot care to be a wound.”