Monday, November 30, 2009

Don’t Let Hammertoes Dampen Your Holidays

With Black Friday behind us, the holiday shopping season has officially kicked off. Do you ever find yourself kicking off your shoes as soon as you get home because your toes are causing you pain? The pain might be from improperly fitting shoes or toenails that are too long. However, it may also be from hammertoes. Are you scratching your head yet wondering what a hammertoe is? Let’s take a closer look.

Hammertoes are one of the most common deformities affecting the lesser four toes. A hammertoe occurs when the bone in the toe connecting to the foot (proximal phalanx) bends upwards, causing the toe to elevate at the joint where it connects to the middle phalanx (proximal interphalangeal joint). Typical signs include corns (small calluses) on top of the proximal interphalangeal joint and a callus underneath the metatarsal head where the toe connects to the rest of the foot. Causes range from tight shoes or stockings to biomechanical abnormalities arising from a long second toe or muscle imbalances. They affect a single toe or multiple toes, and may become very painful if left untreated.

Conservative treatments for the symptoms caused by hammertoes include the use of anti-inflammatory medications and sometimes corticosteroid injections depending on the level of pain. Corn pads, budin splints, tubing and toe spacers may also be used to minimize rubbing. As with any treatment, it’s important to address the cause to prevent the hammertoe from progressing. Shoes worn when you’re on your feet the most should be assessed for proper fit. Custom molded orthotics may also be necessary to assist your foot in maintaining correct biomechanical function. Severe hammertoe deformities are often corrected via a minor outpatient surgical procedure prior to utilization of orthotic devices.

If you suspect you might have hammertoes, it is important to consult your podiatrist prior to buying any over-the-counter devices. There are numerous splint types and shoe inserts on the market, and they don’t all work for everyone. Podiatrists are trained to determine the type of modifications necessary according to the degree of hammertoe deformity. If you’re certain you have hammertoes or think they might be starting to develop, come on in for a consult. We’ll provide the umbrella of care necessary to prevent them from putting a damper on your holiday season.

Wednesday, November 25, 2009

Friendly Footwear a Must for Those Who Work Standing Up

The average American’s foot pain often gets in the way of daily activities. Perhaps no group suffers from chronic foot pain more than those who are constantly on their feet. According to the American Podiatric Medical Association's (APMA) 2009 foot ailments survey, 44 percent of respondents said they spend at least four hours standing every day. Additionally, nearly 78 percent of Americans have experienced foot problems as a result of wearing uncomfortable or ill-fitting shoes.

"The excess strain put on the legs and feet of those standing for long periods of time can take a massive toll on the body—especially for those working in the health care community," said APMA President Ronald Jensen, DPM. "Without the proper footwear that provides necessary support to the ligaments and joints of the feet, these individuals are subject to a host of ailments that can lead to chronic problems such as metatarsalgia—a pain and inflammation in the ball of the foot."

Excessive standing and walking on hard surfaces like concrete can also increase the incidence of foot problems. However, many footwear companies create products that are specifically made for those who "work standing up." The following footwear products, designed specifically for those who make a living on their feet, have been granted APMA’s Seal of Acceptance. The Seal of Acceptance Program recognizes products which have been found beneficial to foot health and of significant value when used in a consistently applied program of daily foot care and regular professional treatment:

Crocs Work Shoes. The familiar, comfortable feel of Crocs is also available in a professional-looking shoe that conforms to workplace standards. Featuring a closed toe and heel design, as well as arch support and a foot bed that promotes circulation, the Crocs Work Shoe is a top choice for many health and service industry professionals across the country.

Dansko’s Acadia and Stapled Collections. Dansko’s new Acadia collection (pictured) features distressed leather uppers, a removable triple density molded EVA insole and slip resistant out-sole. With a lightweight base and lower profile, this collection is perfect for the active woman. Additionally, the company’s Stapled Collection features a rigid construction and key features that promote good foot health, including a rocker bottom and full arch support.

The Timberland Company - Timberland PRO. Timberland’s PRO Renova series of work footwear—which includes the Professional, Provider, and Caregiver (pictured)—is designed specifically for those at work in the health care community. The Professional Series features Timberland PRO Anti-Fatigue technology, a rocker profile, and an anatomically shaped oblique last for all-day comfort.


*Work Footwear Products Recognized by the American Podiatric Medical Association

Monday, November 23, 2009

You Are What You Eat!

Thoughts of turkey, candied yams, ambrosia and pumpkin pie immediately come to mind with Thanksgiving just around the corner. The holiday season traditionally presents us with opportunities for taking time off to spend with family and friends. We often shift into relaxation mode, making it more difficult to mind which foods we choose to eat. A good nutrition plan combined with regular exercise is essential for achieving and maintaining good health. For both type 1 and type 2 diabetics, it is especially important to not only be weary of how much you eat, but when you eat as well if taking insulin or blood glucose lowering medications. The following are some tips for surviving the holiday season:

~ Think about the timing of your meal. If Thanksgiving dinner does not fall in line with your routine meal schedule, have a snack at your regularly scheduled meal to prevent blood sugar levels from plummeting.
~ Be physically active! Take a walk with family members or sign up to walk the local Turkey Trot 5K in the area. Exercise is the best way to compensate for the additional calories consumed over the holidays.
~ Have raw vegetables to nibble on while cooking or waiting. This will prevent blood glucose levels from plummeting if dinner preparation is taking longer than anticipated.
~ Make selective food choices. Avoid the tendency to sample every dish served. Stick to eating your favorite foods, and everything in moderation.
~ Portion Control. Eat smaller portion sizes to ensure your carbohydrate intake does not exceed the daily-recommended amount of 45-65% of total calories (http://www.mypyramid.gov/guidelines/index.html).

Having trouble deciding how much to eat of something on the Thanksgiving dinner menu since you don’t know its nutritional value? Check out the U.S. Department of Agriculture’s interactive tool, My-Food-A-Pedia (http://www.myfoodapedia.gov/). It will list the total calories, portion size, and even allow you to compare two foods at once. Despite planning ahead, throughout this holiday season you may still find yourself on the brink of overindulgence in food. When faced with that temptation, just remember the old adage – "You are what you eat!"

Tips Provided by American Diabetes Association

Monday, November 16, 2009

Pearls for Ulcer Prevention

One of the most devastating side effects of diabetes mellitus is the peripheral neuropathy that eventually develops when the disease is uncontrolled. Peripheral neuropathy is loss of partial or complete sensation to the extremities. In diabetics it most commonly begins in the feet and is characterized by numbness, tingling, prickling, and sometimes even a burning sensation. Peripheral neuropathy places you at a greater risk for developing ulcers on your feet because you cannot feel when you step on sharp objects. Complete peripheral neuropathy is also often a sign of a more advanced stage of disease. Therefore, your immune system’s response to healing even the smallest of wounds is diminished. That’s why it is important to keep a step ahead of ulcers by preventing them from occurring in the first place.
So what is an ulcer anyway? It is a wound that penetrates through both the epidermal and dermal layers of the skin.
In addition to stemming from puncture wounds caused by stepping on sharp objects, ulcers are also caused by the rubbing of ill-fitting socks and shoes, as well as pressure points from changes in bone structure. Several things can be done to prevent ulcers as outlined in the "Keep Your Feet Fit For Life" checklist. It is essential to incorporate a thorough foot inspection into your daily routine. Don’t forget to look between and beneath your toes! If you have trouble seeing them, do not hesitate to use a mirror to assist you (http://focusonyourfeet.com/products_check.php , http://www.lifesolutionsplus.com/telescoping-self-examination-mirror-p-400.html).
It’s very important to keep ulcers in check. When left untreated, the surrounding subcutaneous tissue can become infected. If the infection is not contained it can spread to the bone. Once the bone becomes infected, the risk of amputating the portion of the toe or foot infected significantly increases.
In addition to following the tips in the "Keep Your Feet Fit For Life" checklist, if you’re diabetic it’s important to visit your podiatrist regularly for a thorough foot inspection. We’ll trim any calluses that build up on the soles of your feet since ulcers can sometimes be sneaky and develop beneath them. Whatever you do, do not trim calluses yourself with a blade or pick at anything you suspect might be a pre-ulcerative wound. You may accidentally introduce bacteria to the site, and this either accelerates progression to an ulcer or makes the pre-existing ulcer take longer to heal.

Monday, November 9, 2009

Move It To Lose It!

Obesity is one of the leading risk factors for type II diabetes. While striving to maintain good nutrition is important, it is just as important to incorporate exercise into your daily routine to prevent those additional pounds from accumulating. Anywhere between 150 minutes of vigorous-intensity or 300 minutes of moderate-intensity cardiovascular activity and 2 days of strength training per week is currently recommended for adults. Older adults 65 years and older should aim for at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity cardiovascular activity and 2 days of strength training per week. It is recommended that children do at least 60 minutes of cardiovascular activity per day, 3 days a week of strength training, and at least 3 days a week of bone strengthening activities such as jumping rope or running.

What counts as strength training?
~Yoga
~Pilates
~Resistance Band Training
~Weight-lifting
~Sit-ups and push-ups (for children)

What counts as moderate-intensity exercise?
~Walking briskly (3 miles per hour or faster, but not race-walking)
~Water aerobics
~Bicycling slower than 10 miles per hour
~Tennis (doubles)
`Ballroom dancing
~General gardening

What counts as vigorous-intensity exercise?
~Race walking, jogging, or running
~Swimming laps
~Tennis (singles)
~Aerobic dancing
~Bicycling 10 miles per hour or faster
~Jumping rope
~Heavy gardening (continuous digging or hoeing)
~Hiking uphill or with a heavy backpack

As you age your metabolism not only slows down, but your schedule tends to become busier as well. Presented with additional responsibilities as your family grows and career expands, exercise may have taken a place at the bottom of your priority list. There’s nothing that says you have to complete all of your cardiovascular activity in one block of time during the day. If your schedule only prevents doing 10 minutes of physical activity at certain times throughout the day, that’s better than nothing! Get creative – can you start walking, jogging or cycling to work one day a week perhaps? Explore joining a walking, running, or cycling group to help you get started or keep it up. Or better yet, start your own with your friends and family! Make November the month that you adopt a lifestyle change that will shape the rest of your life.


Information Provided by the Center for Disease Control

Friday, November 6, 2009

Keep Your Feet Fit For Life Checklist!

Did you know that the feet often provide the first sign of more serious health issues, such as diabetes? That’s why it’s important to have your podiatrist "knock your socks off" and check your feet every time you go in for a checkup. After all, foot and ankle health is important to your overall well-being, mobility, and pursuit of fitness.
People with diabetes need to pay special attention to their feet and watch carefully for any signs of complications. Here’s a checklist of Do’s and Don’ts for you or your family members who have diabetes:

Do’s
~Inspect feet daily for cuts, blisters, scratches, redness and swelling.
~Remember to inform every doctor you visit that you have diabetes.
~Wash feet daily; always dry carefully between the toes.
~Powder feet, lightly after bathing.
~Cut toenails straight across.
~Keep feet warm and dry.
~Use a good skin lotion to protect your feet from cracking and drying, but not between toes.
~Wear loose-fitting socks to bed if feet are cold; never use heating pads or hot water bottles.
~Wear comfortable, well-fitting shoes.
~Inspect the inside of shoes for foreign objects and torn lining each time you put them on.

Don’ts
~Don’t walk barefoot, even indoors!
~Don’t smoke. Smoking reduces blood circulation; this can lead to the loss of a leg.
~Don’t cut corns or calluses yourself.
~Don’t use caustic chemical agents or any other irritants for the removal of corns and calluses.
~Don’t wear open-toed shoes, particularly sandals with thongs between toes.

Family members can play an important role in ensuring that their loved ones keep their feet fit for life. If someone in your family has diabetes, share this checklist with them and remind them to visit their podiatrist. Education and awareness are helpful allies in the prevention of diabetes and its complications.
Tips Provided by American Podiatric Medical Association

Monday, November 2, 2009

What You Eat Affects Your Feet!

Has someone ever said to you – "watch your sugar intake, it may hurt your feet someday?" You may have some recollections from childhood of your mother or father limiting your candy intake, especially around Halloween, because the sugar is bad for your teeth. Most of us grew up associating high sugar intake with cavities. November is diabetes awareness month, and we are going to kick it off with a brief overview of what diabetes is and how it affects your feet.

There are two types of diabetes, and type 2 is the most prevalent form of the disease. Type 1 diabetes is caused by an inability of the body to produce insulin, and with type 2 diabetes the body either does not produce enough insulin, or the cell receptors start to ignore the insulin over time. So why is too much sugar such a bad thing? In people without diabetes, the cells in the pancreas secrete insulin that carries the sugar from foods to cells throughout the body. The sugar is then utilized to provide energy for the cells. In people with diabetes, the lack of sugar getting into the cells will weaken the immune system, and the excess sugar in the blood affects the skin, ligaments, joints, nerves, and arteries through a process know as glycation (non-enzymatic gylcosylation). Essentially, the sugar in the blood attaches to proteins and lipids passing by, forming a complex molecule that disrupts normal metabolic pathways eventually hardening nerves and vessels. The glycation process leads to problems in the heart, kidneys, nerves, eyes, and feet.

Some of the first signs of type 2 diabetes are seen in the feet. Loss of sensation in any part of your feet combined with tingling sensations can be one of the earliest signs. While many other things can cause those symptoms, if you don’t already go to your primary care provider for a physical annually, it’s a good idea to start. You primary care provider can order a fasting plasma glucose test with your blood work. Fasting plasma glucose levels of below 100 mg/dl are normal, 100-125 mg/dl indicates pre-diabetes, and 126 mg/dl indicates diabetes as per the American Diabetes Association guidelines (http://www.diabetesarchive.net/pre-diabetes/faq.jsp). Yellowing, thickened toenails with persistent toenail fungus and excessive calluses caused by low-impact activity are also warning signs that should be checked out by your podiatrist. Ulcerations of the tissue beneath the calluses may be present, and if treated improperly they can easily become infected. Therefore, once diagnosed with diabetes it is essential that you follow-up with your podiatrist every few months for foot care.