Foot, Ankle & Lower Leg Center: November 2011

Tuesday, November 29, 2011

Diabetic? Regular checkups are key to spotting foot ulcers...

Posted on: The Florida Times-Union

Nearly 24 million Americans have diabetes with 15 percent of them developing foot ulcers each year. This results in 60,000 amputations annually.

Why so many? Part of the problem is that diabetics have decreased feeling in their feet and often do not realize that they have an ulcer or a wound. In addition, patients and families may not know how quickly diabetic foot ulcers can break down, become infected and spread into deep tissue.

It has been shown that early recognition of foot ulcers is a very important factor in preventing amputation and loss of limbs. For this reason, it is recommended that diabetics have their feet checked at every visit to their primary care doctor, endocrinologist or podiatrist.

If an ulcer is found, there is standard treatment available that’s best provided by a wound care physician. The treatment may include debridement (removing unhealthy tissue); applying dressings to keep the wound moist to encourage the body’s own healing process (autolysis); use of special shoes and boots to prevent continued damage to the involved area; treatment of any infection; good blood sugar control and proper nutrition, and evaluation for possible peripheral artery disease or other diseases or illnesses.

Delaying treatment can be a serious error and diabetics need to be careful when trying to treat the wound themselves. Cleansing wounds with some products can be too harsh and can damage tissue. Allowing wounds to get too dry or too wet can slow healing. Always check with your doctor on any home treatment.

While standard treatment is important, it doesn’t always work. Studies show that only 25 percent of diabetic ulcers will heal within three months, despite the best of care. In cases that are slow to heal, or getting worse, it is important to seek advanced treatment from a comprehensive wound care center.

The Center for Wound Care and Hyperbaric Medicine at Baptist Medical Center-Beaches offers advanced treatment options including: using specialized dressings to promote healing; performing regular aggressive debridement; applying total contact casts (the most effective “off-loading”); using negative pressure wound treatment devices; using bio-engineered skin substitutes (artificial skin grafts) and using hyperbaric oxygen treatment for selected wounds.

The cure rate with these advanced treatments is very high. In the largest study to date, more than 1,000 diabetics with “critical limb ischemia,” hyperbaric oxygen treatment has been shown to heal nearly 75 percent of these most serious of diabetic foot ulcers. Success depends on good teamwork and a multi-disciplinary approach, early recognition and referral, as well as good patient education.

The goal of treatment is always the prevention of amputation, preservation of function and maintaining quality of life.

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!

Wednesday, November 23, 2011

Diabetic neuropathy--- the agony of da feet

Posted on: Harvard Health Publications

[Editor's note: In recognition of American Diabetes Month, Harvard Health Publications is collaborating with MSN.com on its Stop Diabetes initiative. Today's post, published on World Diabetes Day, is the first of several focusing on this all-too-common disorder.]

People tend to think of diabetes as a silent, painless condition. Don’t tell that to the millions of folks with diabetes-induced tingling toes or painful feet. This problem, called diabetic neuropathy, can range from merely aggravating to disabling or even life threatening. It’s something I have first-hand (or, more appropriately, first-foot) knowledge about.

High blood sugar, the hallmark of diabetes, injures nerves and blood vessels throughout the body. The first nerves to be affected tend to be the smallest ones furthest from the spinal cord—those that stretch to the toes and feet.

Diabetic neuropathy affects different people in different ways. I feel it as a tingling in my toes. Moving my feet and wiggling my toes helps the tingling disappear for a while. Others have it much worse. Diabetic neuropathy can cause a constant burning feeling in the feet; sharp pain that may be worse at night; and extreme sensitivity to touch, making the weight of a sheet unbearable. It can be sneaky, too, and completely rob the feet of their ability to sense pain.

The truly scary thing about diabetic neuropathy is a 10-letter word we usually associate with horrific accidents or Civil War battlefields—amputation. When sensory nerves in the feet become damaged, a blister, cut, or sore can go unnoticed, allowing time for the wound to become infected.

Infections that cause tissue to die (gangrene) and that spread to the bone may be impossible to treat with cleansing and antibiotics. Diabetes accounts for about 70,000 lower-limb amputations in the United States each year.

Protecting your feet

So far, there isn’t a cure for diabetic neuropathy. To get a handle on ways to help prevent it from appearing and for coping with it when it does, I spoke with Dr. Christopher H. Gibbons, director of the neuropathy clinic at the Joslin Diabetes Center in Boston.

The most important thing you can do is keep your blood sugar as close as possible to your daily and longer-term targets, says Dr. Gibbons. This can stave off the onset of diabetic neuropathy. It also helps keep foot problems in check. Other strategies include:

Control blood pressure. Like high blood sugar, high blood pressure damages blood vessels. This interferes with circulation to the feet, and contributes to nerve damage.

Stop smoking. Smoking interferes with blood circulation, and so compounds the effects of nerve and blood vessel damage.

Stay active. If you can walk or run, do it. If your feet hurt too much, exercise your arms and legs.

Slim down. For people who are overweight, losing weight improves the body’s ability to control blood sugar and it also takes some pressure off the feet.

Several prescription medications are available for treating diabetic neuropathy. “Keep in mind that these drugs only treat pain; they don’t do anything to slow or reverse diabetic neuropathy,” cautions Dr. Gibbons. Non-drug options that work for some people include acupuncture, biofeedback, and transcutaneous nerve stimulation.

Check your feet:

If you have diabetes, your doctor should examine your feet at least once a year. In addition to looking for obvious problems, he or she will check them for the loss of sensation.

On the other 364 days, you should check your own feet. Look for blisters, cuts, cracked skin, ingrown toenails, or anything else that could give bacteria entry to your body. Clean and fix any problem, and then keep an eye on it. If a wound doesn’t heal, see your doctor right away.

If your joints aren’t as flexible as they used to be, and you have trouble seeing the bottom of your foot, Dr. Gibbons recommends this trick: place a mirror face-up on the floor. Hold your foot over it and voila—you can see the bottom without contorting yourself.

More information on diabetes-related foot problems and good foot care is available from the American Diabetes Association and the Joslin Diabetes Center.

Saturday, November 12, 2011

Study: Shoe Trends Increase Doctor Visits

Posted on: WMDT-TV

Video on Doctor Visits

http://www.wmdt.com/category/201130/video?autoStart=true&topVideoCatNo=default&clipId=6437487#.Tr8qk4XCroc.email

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WMDT 47 NEWS- New numbers released by the American Academy of Orthopedic Surgeons show more and more women suffering from foot and joint problems from the shoes that they wear.

The average height of heels has grown from 3 to 5 inches which has caused a boost in doctor visits to 75 percent in 5 years.

WMDT spoke with Dr. Peter Cuesta, a podiatrist at Eastern Shore Podiatry.

"Wear them for events wear them for church or going out on an evening but when you're going to the super market don't wear high heels."

The study found that women who wear high heels on a daily basis have shorter calf muscles, thicker and stiffer Achilles tendons, and could suffer from joint degeneration later on in life.

"Most of your body weight is standing on the balls of your feet because that's what the shoes make you do bunching up your calf muscles and making your calf's look good that's the idea but the long term effects on your feet are quite damaging," said Cuesta.

So if you aren't sure when it's time to put away the pumps… just listen to your feet.

"your feet don't have to hurt and if they do pain is there as a warning to us that something is going wrong and it should be addressed something very simple can be taken care of early on or could require surgery," Dr. Cuesta warns.

AAOS reports that more than 7 out of 10 women have developed a bunion or other painful foot deformity.

9 out of 10 women's foot deformities can be tied to bad shoes.

Friday, November 11, 2011

The Basics of Diabetic Footcare

Foot Care and Diabetes

Posted on: ThirdAge

If you’re one of the over 25 million Americans who suffers with diabetes, even a small problem with your feet could mean big health problems. Diabetes can cause nerve damage that takes away the feeling in your feet. The disease can also reduce blood flow to the feet, making it harder to heal a foot injury or resist an infection. A simple pebble in your shoe that leads to a blister or sore could be the first step to an infection or a wound that won’t heal. In the worst case scenario, the last step could mean amputation.But there are guidelines that can help you avoid serious complications. Here’s what to do:

Check Your Feet Each Morning: Look carefully for any cuts, blisters, redness, swelling, or nail problems. You can use a handheld magnifying mirror to look at your soles. If anything looks unusual anywhere on your foot, make an appointment to see your doctor before your day begins in earnest.

Soak Your Feet In Lukewarm Water: Don’t make it hot! But be sure to keep your feet especially clean, washing them at least once daily without scrubbing. It’s a good idea to use a soft washcloth or sponge. Pat or blot your feet softly. Don’t forget to dry gently between your toes.

Keep Your Feet From Becoming Too Dry: Moisturize the top and soles of your feet daily. This will help to keep feet from becoming dry, which could lead to cracked skin. But avoid putting any cream between your toes. That could lead to a fungal infection.

Pay Attention When Cutting Nails: Cut them straight across and file the edges. Don’t cut nails too short, as this could lead to ingrown toe nails. It might be worth the investment to visit a podiatrist for professional nail cutting. Avoid salons if they’re over-zealous.

Wear Clean, Dry Stockings Or Socks: Avoid the wrong type of socks. Tight elastic bands can reduce circulation. Also, nix thick or bulky sports socks because they can irritate your skin.

Keep Your Feet Warm In Bed: If your feet are cold at night, don’t be tempted to use a heating pad. Instead wear cotton socks without tight elastic bands.

Become A Shoe Detective: Always inspect your shoes before putting them on; shake them out and feel around on the inside. You don’t want anything hiding inside that might irritate your feet.

Stay Warm And Dry: Don’t let your feet get wet in snow or rain. Wear warm socks and shoes in winter.

Don’t Go Barefoot: Even when you’re just walking around at home, it’s best to wear slippers or shoes. This way you’ll avoid accidents, even little ones, that could hurt your feet and your health, big time.

Wednesday, November 9, 2011

Best foot forward

If kids are having trouble keeping up, their feet could be to blame

Posted by: The Vancouver Sun

Jesse Heinz, 16, was prescribed shoe inserts four years ago and saw improvements within a year.

Photograph by: Bruce Stotesbury, For Postmedia News

When Lorelee Heinz saw that her son Jesse, then about 12, was falling behind on the soccer field, she looked beyond the obvious. The boy was a little heavy and his knees were angling inward slightly. So, Heinz had his feet checked by a podiatrist, who prescribed shoe inserts to assist with the boy’s flat feet.

Within a year, Jesse developed arches in his sole. His legs have since straightened. Now at 16, he’s a fitness nut willing to try anything. "It absolutely helped him immensely," said the Saanich woman. But Heinz is a bit of an exception. Parents, who are so often vigilant about things like their children’s teeth, willing to resort to braces to achieve that perfect smile, will often overlook their kids’ feet.

"It’s quite common for children to get their teeth, their hearing and their eyes examined," said Victoria podiatrist Dr. Marshall Baer. "But they don’t routinely get their feet examined." But the feet of our children undergo transformations and growth every bit as profound as the development of their teeth.

The foot, according to the B.C. Podiatric Medical Association, is one of the most complicated parts of the body, with 26 bones, wrapped up with ligaments, muscles, blood vessels and nerves. Within just the first year of a baby’s life, the foot will develop to reach almost half its adult size.

According to Dr. Ron Fisher, a physical medicine and rehabilitation specialist at the Queen Alexandra Centre for Children in Saanich, children’s feet are constantly changing all the way through their teens. "The foot structure is so complicated," said Fisher. "And there is an awful lot of things that can go wrong and a lot we can improve upon, in particular, if we catch things early enough."

Gym class in school and team sports like soccer, where the foot is flexing and being stressed, are good places to watch for a child’s foot problems. Things to watch out for include whether children are refusing to participate in activities they once enjoyed, or whether they’re keeping up with their peers or falling behind. And at any time, if a child complains of pain in their feet, it should be examined by their family doctor or a specialist.

Fisher recalls one young patient, a seven-year-old girl, who was unable to keep up in gym class, falling behind and feeling bad about herself. But it wasn’t until her mother pressed her that she revealed that her feet hurt — by the time she finished the class, she just couldn’t run anymore. "She had a legitimate problem," said Fisher. "She had some ligament problems in her foot and needed a support and she should be perfectly fine. "And she’ll probably outgrow that and she probably won’t need orthotics or special shoes once her feet have fully matured," he said.

Fisher said it’s important for parents to be aware and ask their children questions about their feet. Are they hurting? Are your ankles sore? Are you having trouble running?

A visit to a doctor or a foot specialist can usually determine whether the problem is real. Examination with tools such as X-rays can usually detect an issue like fused bones that might require surgery. He said improperly formed feet can lead to a large number of adult health problems.

Those can include problems with ankles, knees, hips and back as the foot fails to properly support the weight of the body. He’s even seen one case of chronic headaches traced to foot deformities. But Fisher is also cautious about aggressively screening children for foot problems. Surgery can lead to a lifetime of medical intervention. And very often, issues can be misidentified as problems when they are really just normal development.

For example, flat feet in children are, for him, usually no cause for concern. Fisher said all children start with flat feet — they don’t begin to develop an adult arch until they are six to 10 years old and it will continue to develop into their teens. Then as people pass into senior years, the feet usually flatten out again.

Nevertheless, he said, he is perfectly happy to hear from parents concerned enough to seek medical advice about their children’s flat feet. "That’s perfectly fine; at least they noticed something and they probably read an article or saw something on TV," he said.

Victoria podiatrist Dr. Martin Cole is also cautious about flat feet, saying only a foot specialist should identify them as a problem. But in general, foot problems treated early can prevent an adult life of problems throughout the body, said Cole.

"A lot of times, they will end up having to have orthotics or devices when they are in their 20s," he said. "(But) if you catch an early deformity and you can just put something in their shoe at the right time, you will keep their cartilage aligned in their knees and their back as they grow up."

Signs of trouble

The American College of Foot and Ankle Surgeons lists five warning signs a child may be experiencing foot problems.

- Your child complains of pain.

It is never normal for a child to have foot pain. Injuries can seem minor, but if pain or swelling lasts more than a few days, the child’s foot should be examined by a physician.

- Your kids can’t keep up with peers.

If children lag behind in sports or backyard play it may be because their feet or legs are tired. Muscles in the feet and legs tire easily if feet are not functioning well.

- Your kids voluntarily withdraw from activities they usually enjoy.

If they are reluctant to participate it may be due to heel pain, a problem typically seen in children eight to 14. Repetitive stress from sports may cause muscle strain and inflammation.

- They don’t want to show you their feet.

Children may feel pain or notice a change in the appearance of their feet or toenails but say nothing because they fear a trip to the doctor’s office. Parents should regularly inspect their children’s feet, looking for calluses, growths, discoloured skin or redness or swelling around the toenails.

- Your child often trips or falls.

Repeated clumsiness may be a sign of in-toeing, balance issues or neuromuscular conditions.

Monday, November 7, 2011

Many Diabetes Patients Wear the Wrong Shoes

Posted on: WebMD via The Coastal Source

Many patients with diabetes fall short on foot care and footwear, according to a new study.

Failure to perform recommended foot care and wearing inappropriate footwear can set diabetes patients up for foot ulcers. Ulcers are painful and potentially serious. They can sometimes lead to amputation.

Most diabetes patients polled for the study said they know proper foot care and properly fitting shoes are important. But they don't always follow through, according to Stephen Ogedengbe, MD, a researcher at the University of Benin Teaching Hospital in Benin City, Nigeria.

He presented the study at the American Association of Clinical Endocrinologists' meeting in San Diego.

''There is no such thing as perfect footwear for persons with diabetes mellitus," he tells WebMD. "However, there are shoes which can help prevent or delay the onset of foot ulceration in diabetes. There are also shoes which can cause or help accelerate the development of foot ulceration."

Survey on Diabetes Footwear

The study was conducted in Lagos, Nigeria. Ogedengbe and colleagues asked 41 patients with type 2 diabetes, on average about 57 years old, to answer questions about their footwear habits and foot care.

The researchers found some good news:

90% had education about footwear
83% wash and dry their feet, a practice recommended daily
51% do the recommended routine self-exams of their feet

However, about 56% told the researchers they always or occasionally walk around the house without shoes, which is not recommended. Nearly 15% did so outside, too.

Next, researchers evaluated the participants' shoes. They found 68% of the footwear to be inappropriate.

Among the shoes that didn't pass muster, Ogedengbe says, are:

Shoes with pointed tips or toes
High heels
Thong-style sandals or flip-flops

Besides inappropriate shoe styles, he tells WebMD, some wore shoes that were the wrong size.

Despite these flaws in shoe wear, 73% of the patients thought their inappropriate footwear was acceptable.

Footwear Tips for Diabetes Patients

Here are Ogedengbe's tips for finding proper footwear.

Avoid shoes with pointed toes.
Don't buy shoes with too flat a sole or high heels because they don’t allow for even distribution of foot pressure.
Look for styles that have soft insoles.
Choose leather, canvas, or suede styles to allow adequate circulation of air. Don't buy plastic or other materials that don't allow the shoe to ''breathe."
Look for such features as laces, buckles, or Velcro. These make it easier to adjust the shoe.

Second Opinion

''The study [result] doesn't surprise me," says David G. Armstrong, DPM, MD, PhD, professor of surgery and director of the Southern Arizona Limb Salvage Alliance at the University of Arizona College of Medicine, Tucson.

He reviewed the findings for WebMD but was not involved in the research. He serves on the scientific advisory board for Vasyli, a manufacturer of orthotics.

The study confirms what Armstrong observes with some patients, he tells WebMD. "The doctor and nurse can tell the patient something [about proper footwear]. Just because we tell them doesn’t mean they are going to be motivated to make changes."

What may help, he says, is to let those with diabetes know that the risk of foot ulcers is as high as 25%, according to the American Diabetes Association.

Wearing properly fitted shoes can help reduce that risk, Armstrong says. "The problem here is the neuropathy is silent," he says. With nerve damage in the feet, there is a loss of feeling in the feet.

Get an evaluation by a foot doctor every year, Armstrong says. "Doing that alone, just seeing the podiatrist, reduces your risk of getting a wound and then getting amputation by anywhere from 20% to 70%."

Proper shoes don't have to look like ''Frankenstein shoes," he says. He differs with Ogedengbe in that he does allow women with diabetes to wear heels, within reason.

Thursday, November 3, 2011

Rashlike Pigmentation on the Foot

Published by: LiveStrong.com

Photo Credit Hemera Technologies/PhotoObjects.net/Getty Images

Certain rashlike pigmentations on the foot are merely aesthetic concerns and pose no particular health risks. Other types of pigmentations or rashes are serious and need immediate medical attention. Do not attempt self-diagnosis for any type of skin rash or unusual pigmentation.

Diabetic Dermopathy

Diabetes weakens blood vessels and capillaries. Broken capillaries create a splotchy, rashlike appearance. This condition is called diabetes dermopathy. Dermopathy can occur on the lower legs as well as the feet. Diabetes dermopathy is not usually a serious condition and does not require medical intervention, although improved blood glucose control can prevent or reduce symptoms, according to DermNet NZ. If rashlike pigmentation or any other unusual symptoms appear on your feet, consult your medical provider for diagnosis.

Venous Stasis

A condition known as venous stasis dermatitis can cause a reddish-brown pigmentation in the skin of the lower extremities, according to PodiatryNetwork.com. When veins lose elasticity and impair circulation, tiny blood vessels may break and leak hemoglobin subcutaneously. Iron molecules from the hemoglobin can stain the skin, giving the appearance of brown pigmentation in a freckle-type pattern. Unless the condition causing the circulation problem is addressed, venous stasis dermatitis can progress to a more serious condition known as venous stasis ulceration.

Cancer

Writing on her website, Dr. Angela Drury, DPM, FACFAS states that pigmentations on the feet are usually moles or freckles, but pigmentations may be cancerous lesions. Examination by a podiatrist or dermatologist is recommended. According to Drury, two types of skin cancer can occur on the foot: melanoma and the precancerous condition actinic keratosis. Melanoma can appear anywhere on the feet, even under the toenails. Actinic keratosis is often mistaken for plantar warts. Treatment for either one of these conditions is by freezing with liquid nitrogen or surgical removal.

Age Spots

Brown pigmented areas can appear on parts of the body most often exposed to the sun, including the feet. These pigmented areas are called age spots. Although they are not directly related to the aging process, they do more often appear in older people because of the accumulation of sun damage over time. According to MayoClinic.com, age spots can range in size from freckle-like to more than 1/2 inch in diameter. At times these spots occur in clusters, making them more prominent. Spots and lesions should be examined by a medical physician to rule out cancer or other serious conditions, MayoClinic.com advises.