Check your feet, save your life

Source: Observer-Reporter.com

People with diabetes who develop foot ulcers are more at risk of dying prematurely than those without this complication.

Dr. James A. Marks, medical director of Washington Health System Wound & Skin Healing Center and Hyperbaric Medicine in Washington, said the devastating complication of early death usually begins with neuropathy and subsequent foot ulcers, which may lead to infection and lower extremity amputation even in the absence of vascular disease.

Although not all diabetic foot complications can be prevented, it is possible to reduce the incidence of amputations and early death through early detection, treatment and prevention. Educating patients along with their family members or care takers to the warning signs of diabetic foot disease and the importance of daily foot examinations and the proper foot care is paramount.

One study has found that 25 percent of 600 people surveyed who had suffered an amputation from diabetes said they should have seen a specialist – such as a podiatrist – sooner. Thirty percent of amputees said that paying closer attention to the warning signs would have encouraged them to visit their doctor before signs worsened.

Marks notes that three conditions make people with diabetes vulnerable to what is called Diabetic Foot Disease. These are neuropathy (damage to the nerves which supply the feet), vascular disease (narrowing of the blood vessels which supply oxygen and nourishment to the feet), and foot deformities. When one or more of these conditions is present, then either infection or minor trauma can trigger a more serious problem.

NEUROPATHY: Those suffering from neuropathy do not have normal feeling in their feet, and this can make them unaware of pain or discomfort, for example, shoes that are too tight and rubbing the skin, or, in extreme cases, scalding bath water. Marks said it is vital to have feet checked for neuropathy at least once a year. Neuropathy can also damage the feet in other ways. It can cause muscle weakness leading to a deformity of the bone structure. It can also cause the skin to be dry, resulting in cracks in the skin. Once a crack develops, it becomes an entry point for infection. The risk of neuropathy developing can be reduced by keeping sugar levels as near normal as possible.

VASCULAR DISEASE: It is known that individuals with diabetes are at a higher risk of developing narrowed blood vessels. That risk is increased by smoking, high blood pressure and by abnormalities in cholesterol. To reduce the risk of vascular disease, Marks said to avoid smoking and work with your doctor to keep blood pressure, cholesterol and blood sugar levels as near normal as possible.

FOOT DEFORMITY: Any deformity of the foot can alter the normal pressure distribution so that some areas are subject to abnormally high pressure points resulting in a foot ulcer. Sometimes the skin’s response to high pressure is to become thicker, resulting in a callus or corn. It is important to have corns and calluses evaluated and treated by a podiatrist who is familiar with diabetic foot problems, before they ulcerate.

As of today, Diabetic Foot Disease has no recognizable color or ribbon. According to Marks, the majority of the general population does not have an understanding of the magnitude of this disease. Approximately 85 percent of lower extremity diabetic amputations are preceded by a diabetic foot ulcer and 15 percent lead to an amputation. It is estimated that the five-year mortality rate among those who have had a diabetic foot ulcer or amputation is about 45 to 65 percent.

In comparison to breast cancer, it is estimated that the five-year mortality rate is approximately 14 to 18 percent. The good news is that the pink ribbon has created an awareness that has resulted in a proactive approach and attitude among the general population, especially in regard to prevention and early detection.

Diabetic Foot Disease is a major problem. While the development of a diabetic ulcer cannot always be prevented, ulceration can be stopped from progressing to a major amputation. Given the challenge of treating this high-risk population, public awareness and comprehensive foot care programs can reduce amputation rates by 45 to 85 percent.

The first step in identifying the patient’s risk factors and preventing lower extremity amputations starts with the newly diagnosed or established diabetic patient, and the family-support group. A patient’s medical team should always include a podiatrist who is trained to offer a preventive foot care plan to prevent ulcers, infections, and amputation in the patient with diabetes.

If you believe you have a diabetic foot ulcer, or you know of someone who does, you can receive a professional consultation with a wound care specialist by calling 702-878-2455.

The Foot, Ankle & Lower Leg Center office is located in the Las Vegas and the Henderson area, which we have 2 convenient locations to serve you.  To take the first step to better foot health, call today @702-878-2455.  Please visit our website @ www.FallCenter.com where all of your questions may be answered and to schedule your appointment on-line.

When pain or injury occurs, you deserve highly personalized treatment using the most advanced techniques.  At the Foot, Ankle & Lower Leg Center (FallCenter), you’ll enjoy an unsurpassed level of quality care.  Dr. Ricciardi, Dr. Shalev and Dr. McLeod are proud to provide comprehensive solutions for all types of foot and ankle problems. 

Your quality care begins the minute you arrive, as our staff greets you by name and answers your questions.  Our team of foot and ankle specialists will inspire your confidence and their genuine warmth and compassion will earn your trust.

You’ll receive a prompt and thorough assessment, including on-site diagnostic ultrasound and digital x-rays.  Your treatment plan is designed to resolve your condition without surgery whenever possible.  When surgery is needed, your feet are in the hands of leading foot surgeons with expertise in the latest minimally invasive techniques.  As a result, you’ll be back on your feet and back to your active life as quickly as possible.

Without proper treatment, an injury or chronic condition can keep you from performing even the simplest everyday tasks. To meet patients’ most critical health needs,

Dr. Ricciardi, Dr. Shalev and Dr. McLeod have developed the following treatment programs:  Bunion Solutions, Heel Pain, Diabetic Foot Care and Sports Medicine.

Smoking and Bone Healing – A Risky Surgical Combination

Imagine being on crutches for weeks following foot or ankle surgery. Imagine the inconvenience and potential loss of income. Then, imagine learning that the bone is not mending. In a study comparing the bone healing rates of smokers and non-smokers, the findings revealed that smokers took nearly 50 percent longer to heal after surgery than non-smokers and the bones of some failed to heal. Foot and ankle surgeons are assessing ways to decrease the dangers posed to smokers during and after surgery and improve their bone health.

Smokers are a high-risk group under any circumstances, but particularly so during and after surgery.  According to foot and ankle surgeons, there are ways to reduce the risks to appropriately treat these patients for the best outcomes possible.

In addition to longer healing times, blood clots, wounds that break open and greater risk of infection are other dangers facing smokers. Perhaps the most serious threat to smokers who have foot and ankle surgery, however, is non-union or failure of the bone to mend. Smokers are four times more likely to experience non-union than non-smokers.

The implications for non-union are serious; they can be costly and time-consuming. In some cases, bones that fail to mend can be treated with a non-surgical bone stimulating device, while some patients require additional surgery. Options include internal fixation using screws or plates to stabilize the bone, external fixation or bone grafts. Bone grafts involve harvesting small sections of bone from the patient or a cadaver and implanting them in the non-healing bone.

What do foot and ankle surgeons recommend for smokers facing surgery? It goes without saying that they’d prefer patients to quit smoking. There hasn’t been a great deal of research on the topic, but some preliminary findings indicate quitting smoking for even a few weeks has a significant impact on bone healing. Surgeons who request that patients stop smoking before surgery sometimes conduct pre-operative tests to look for nicotine in the patient’s system. If nicotine is present, surgery is delayed. 

Several studies cited in The Journal of Foot & Ankle Surgery, published by the ACFAS, reveal the high incidence of bone healing complications in patients who smoke; the Journal articles stress the importance of smoking cessation prior to surgery and the critical role of foot and ankle surgeons play in pre-operative patient education. Surgeons are urged to inform their patients of the dangers posed by smoking and warn them that a choice to continue smoking can result in delayed bone healing, bone non-union and possibly more surgery. With wide access to smoking cessation counseling and assistive methods, educated and motivated patients are able to better position themselves for optimal bone healing.

While education is appropriate and possible in the case of scheduled surgeries, many foot and ankle surgeries result from accidents or injuries that require an immediate response. In those cases, surgeons recommend quitting smoking at least during the recovery period. While no definitive studies currently exist that suggest the best time to quit smoking before surgery, growing interest in the topic will likely lead to more answers. In the meantime, foot and ankle surgeons will continue to strategize on how to help their patients who smoke obtain the best surgical outcomes.

Published by: American College of Foot and Ankle Surgeons

The Foot, Ankle & Lower Leg Center office is located in the Las Vegas and the Henderson area, which we have 2 convenient locations to serve you.  To take the first step to better foot health, call today @702-878-2455, Monday thru Friday, between 9am to 5pm and closed for lunch between 1pm to 2pm.  Please visit our website @ www.FallCenter.com where all of your questions may be answered and to schedule your appointment on-line.

When pain or injury occurs, you deserve highly personalized treatment using the most advanced techniques.  At the Foot, Ankle & Lower Leg Center (FallCenter), you’ll enjoy an unsurpassed level of quality care.  Dr. Ricciardi, Dr. Shalev and Dr. McLeod are proud to provide comprehensive solutions for all types of foot and ankle problems. 

Your quality care begins the minute you arrive, as our staff greets you by name and answers your questions.  Our team of foot and ankle specialists will inspire your confidence and their genuine warmth and compassion will earn your trust.

You’ll receive a prompt and thorough assessment, including on-site diagnostic ultrasound and digital x-rays.  Your treatment plan is designed to resolve your condition without surgery whenever possible.  When surgery is needed, your feet are in the hands of leading foot surgeons with expertise in the latest minimally invasive techniques.  As a result, you’ll be back on your feet and back to your active life as quickly as possible.

Without proper treatment, an injury or chronic condition can keep you from performing even the simplest everyday tasks. To meet patients’ most critical health needs,
Dr. Ricciardi, Dr. Shalev and Dr. McLeod have developed the following treatment programs:  Bunion Solutions, Heel Pain, Diabetic Foot Care and Sports Medicine.

Study: People with diabetes need to wear protective shoes indoors too

NEW YORK (Reuters Health) - Diabetic patients too often walk without wearing their custom-made shoes designed to prevent foot sores that can lead to infections and amputations, new research finds.

"It's very important that patients wear prescribed footwear as much as possible," said senior author, Sicco Bus, staff scientist with the Academic Medical Center at the University of Amsterdam in the Netherlands. "High-risk patients are too low in their adherence, and that needs to be improved."

The research, published in Diabetes Care, monitored the walking habits of 107 diabetic patients during a two-week period and found that for nearly a third (29 percent) of the steps patients took, they didn't wear their custom-made shoes.

In the group of mostly white male retirees, patient adherence to the prescribed footwear ranged widely, from 10 to 100 percent.  The diabetic study participants were at high risk for preventable foot ulcers because of decreased feeling in their feet and previously-healed foot ulcers.

Even more alarming, researchers noted, patients failed to wear their ulcer-preventing shoes for 39 percent of the steps taken at home, where the majority of walking occurred.  Patients took an average of about 4,000 steps inside the home and 2,600 steps outside - where they walked in their protective shoes 87 percent of the time.

"Patients generally think they have to primarily wear their footwear when they go outside, even though the doctor tells them to wear (customized shoes) as much as possible," Bus told Reuters Health.  The researchers did not examine whether wearing prescription footwear less often led to increased foot ulcers, but unprotected diabetic feet are considered particularly vulnerable to injury because of decreased sensation, insufficient blood flow, dry cracked skin, foot deformities and slow wound healing.

Researchers assume custom-made footwear helps diabetic feet; a notion never tested with appropriate clinical trials, said Dr. Dereck Hunt, an associate professor of internal medicine at McMaster University in Canada who runs a diabetes clinic.  "We lack high-quality data, so that makes it more difficult for groups to focus on developing strategies to address adherence," Hunt told Reuters Health.

Each year, an estimated 600,000 diabetic patients get foot ulcers, resulting in 80,000 amputations, according to the American Diabetic Association.  And prior research suggests that less than a third of diabetic patients with existing foot problems wear their prescribed footwear 80 percent of the time or more, Bus and colleagues write.

During the current study, the researchers used shoe-implanted monitors that sample temperature to determine when patients were wearing their customized shoes and ankle monitors to record the number of steps taken.  Participants also kept diaries of times when they were inside or outside of the home. The patients were told the objective of the research was to study temperature and not shoe compliance.

Beyond custom-made protective footwear, experts said preventive treatments for foot ulcers typically include appropriate screening for foot deformities or sores, adequate follow up from podiatrists and proper foot care such as callous removal and nail care.  "With a little bit of common sense and technology, we can start to address this problem," said Dr. David Armstrong, professor of surgery and director of the Southern Arizona Limb Salvage Alliance at the University of Arizona.

Some technologies under exploration include shoe implants that ping to remind diabetic patients to wear their custom-made shoes and sensor mats that can detect weaknesses in the soles of feet.  Bus and his colleagues are also exploring whether making patients conscious of their non-compliance might help improve adherence.

Bus also suggests that diabetic patients keep a pair of pressure-relieving shoes or sandals specifically for indoor use.  "I can understand pretty well why patients take off their shoes when they are in the house because I do it myself, too," he said. "These shoes are quite heavy."

SOURCE: bit.ly/WbTnJN Diabetes Care, Copyright (2013) Thomson Reuters.

The Foot, Ankle & Lower Leg Center office is located in the Las Vegas and the Henderson area, which we have 2 convenient locations to serve you.  To take the first step to better foot health, call today @702-878-2455, Monday thru Friday, between 9am to 5pm and closed for lunch between 1pm to 2pm.  Please visit our website @ www.FallCenter.com where all of your questions may be answered and to schedule your appointment on-line.

When pain or injury occurs, you deserve highly personalized treatment using the most advanced techniques.  At the Foot, Ankle & Lower Leg Center (FallCenter), you’ll enjoy an unsurpassed level of quality care.  Dr. Ricciardi, Dr. Shalev and Dr. McLeod are proud to provide comprehensive solutions for all types of foot and ankle problems. 

Your quality care begins the minute you arrive, as our staff greets you by name and answers your questions.  Our team of foot and ankle specialists will inspire your confidence and their genuine warmth and compassion will earn your trust.

You’ll receive a prompt and thorough assessment, including on-site diagnostic ultrasound and digital x-rays.  Your treatment plan is designed to resolve your condition without surgery whenever possible.  When surgery is needed, your feet are in the hands of leading foot surgeons with expertise in the latest minimally invasive techniques.  As a result, you’ll be back on your feet and back to your active life as quickly as possible.

Without proper treatment, an injury or chronic condition can keep you from performing even the simplest everyday tasks..  To meet patients’ most critical health needs,

Dr. Ricciardi, Dr. Shalev and Dr. McLeod have developed the following treatment programs:  Bunion Solutions, Heel Pain, Diabetic Foot Care and Sports Medicine.