Diabetic diagnosis.....now what?

Diabetes is a disease in which a person has a consistently high blood sugar, either from the body not making enough insulin to counteract it (Type 1 Diabetes), or because the cells don’t react to the insulin that is produced (Type II Diabetes). As of 2007 there are 23.6 million children and adults with diabetes. That’s almost 8% of our population. It’s also the 7th leading cause of death. So its numbers are rapidly growing and the disease itself can lead to a number of complications in the body.

Long term effects of diabetes can include poor blood flow to the legs. This poor blood flow affects the muscles, bones, and nerves. Diabetics can also be more prone to infections and tend to heal slower than someone without diabetes. This presents a problem with even the smallest sore because due to the poor blood flow that would normally bring healing agents, the wound becomes at greater risk of infection. This is where your podiatrist can save the day. Any sore or callus should be examined by your podiatrist to evaluate the seriousness and apply any aid needed to heal. Fixing these wounds by yourself could lead to an infection. It’s also important for diabetics to do daily inspections of their feet to make sure there are no abrasions.

Your podiatrist can also recommend some tips to stay out of trouble. Shoewear that’s more accommodating can be recommended to diabetics so they stay active to keep their sugar in control. It’s important to make sure the foot type is paired with the correct shoe to avoid any blisters or sores that would heal slowly. Diabetic socks could also be recommended. These socks have no seams and help control moisture which helps avoid wrinkles. This helps reduce pressure and blistering in the shoe. These are just a few of the ways that podiatrists are vital to the care of diabetics in avoiding amputation and other complications of diabetes. For diabetic concerns with your feet come by and see Dr. Grimm or Dr. Pattison at Foot Associates of Central Texas.

Podiatrists Decrease Limb Amputation

Continuing our talk on ulcers of the lower extremity, a recent study found that podiatric care decreases the instances of limb amputation. Up to 25% of those with diabetes will develop a foot ulcer. If that ulcer becomes infected and isn’t properly cared for, this can lead to an amputated limb and possibly death. With diabetes affecting 21 million people in the US and 189 million across the globe you can see how this presents a problem.

The study looked at records for 29,000 patients with diabetes, ages 18-64, and compared the risk factors for those who had seen a podiatrist and those who had not. The researchers had found that care by a podiatric physician, which was defined as at least one visit before an ulcer was diagnosed, was associated with a 15% lower risk of amputation and 17% lower risk of hospitalization. Podiatrists are trained to assess your level of risk for an ulcer and make the appropriate prevention plans. This can include offloading pressure on the foot that’s causing the ulcer in the first place.

And this study also points out that podiatrists not only save limbs. After a major amputation, 50% of patients have the other limb amputated within 2 years. And the 5 year mortality rate after limb amputation is at least 50%. This is worse than many types of cancers. So podiatrists can save lives as well as limbs. For concerns about your ulcer or anything else about your feet, come by and see Dr. Grimm or Dr. Pattison of Foot Associates of Central Texas.

Ulcers of the Foot

Ulcers are sores of the skin that are usually accompanied by the disintegration of tissue. They are quite common in the world of podiatry and they can have some difficulty healing unless medical or surgical intervention is taken. When an ulcer goes untreated, this can lead it to becoming infected which brings in a whole new set of problems for the patient.

So how do you get these? The cause of an ulcer can be varied but the main cause is impaired blood circulation. Chronic wounds and ulcers can be caused by cardiovascular issues or external pressure from a wheelchair or bed. Other causes include bacterial infections, viral infections, fungal infections or cancers.

How do I know if I have one? An ulcer is any open wound so close daily inspection will detect an ulcer either by sight or feel. If it’s infected there will be some swelling, redness, and fever with it. If neuropathy is present, then you may not feel the wound which is why a regular foot inspection is quite important.

What can a podiatrist do for this? Prevention of ulcers focuses on patient education and offloading pressure points in the foot. High pressure can break down the skin in that area and develop into an ulcer. Your podiatrist will use orthoses, shoewear modifications or padding to accommodate the foot. An x-ray may be done to evaluate the bone structure. Fixing the cause of an ulcer is an important step in the treatment plan. Ulcers constantly have their dressing changed and are debrided. Your podiatrist will want to cut away the dead tissue to allow for the healing process to continue. Some medications also help expedite growth of the wound area. If an ulcer is infected, antibiotics may be recommended as well as a hospital stay if it’s serious enough. If you have a wound in question or any other concerns with your feet, don’t hesitate to visit Drs. Grimm and Pattison at Foot Associates of Central Texas.

Podiatric Surgery

A recent article in the Wall Street Journal looked at an increasing trend among women to request cosmetic foot surgery. The article discusses women going to extreme surgical measures to fit into their high heels without pain. The problem with this is that the true function of podiatric surgeons is to relieve pain and correct deformities. Their training doesn’t really focus on procedures to allow women to fit into a narrower shoe. Those that support the procedures claim that by doing these surgeries before joints become arthritic, they are preventing future deformities from occurring. But any surgery carries a risk with it of course.

So what falls under the umbrella of podiatric surgery? Patients that complain of joint and ligament problems are offered a plethora of surgical solutions to fix their muscles, bones, and joints.

These can include:

-Debridement –removing dead tissue or foreign material from and around a wound to expose healthy tissue.

-Bunionectomy –the procedure of removing a bunion, which is a misalignment of the joints causing appearance of an enlargement of bone and soft tissue, at the joint at the base of the big toe.

-Tenotomy –the cutting of a tendon. This and other related procedures are also known as tendon release, tendon lengthening and heel-cord release of the Achilles tendon.

-Fasciotomy –a procedure to cut away the fascia, a thick band of connective tissue, to relieve tension or pressure.

These are just a few of the foot and ankle procedures that your podiatrist can perform. For these and any other questions about surgery and your foot care, come by and see Dr. Grimm or Dr. Pattison.

Flip-Flop Front

Now that we have looked at what the summer sun can do to your feet, let’s talk about what sandals can do to them. With the warm Austin weather, some of us wear sandals year-round. A recent article in USA Today discusses the research of Justin Shroyer, a kinesiology professor at the University of Louisiana-Lafayette. He studied more than 100 people that wore flip-flops to observe how their legs and feet were affected. Some of his findings included:

-Flip-flops cause the muscles on the front of the shin to work harder, in effort to grip the shoe in place. This prolonged use could lead to other deformities of the toes later on.

-Flip-flops shorten your stride length and can cause pain in the lower leg

-Flip-flops with heel cups and arch support help induce a more natural walk

The mistake most of us make is wearing sandals as our daily shoe. They are mainly made to go to the pool or beach. Yet we run errands, walk the dog, stand up all day, or walk all over campus in sandals. You’re better off wearing a shoe with good support that stays on your foot. If you must wear sandals more often than that there are a few things you can look for. Avoid the thong-type sandals. Opt for a wide strap across the foot, and preferably one that goes around the heel to help the sandal to stay in place. Also look for a heel cup and good arch support. The American Podiatric Medical Association has put out a list of sandals with a “Seal of Acceptance” if you need help in the right direction.

http://www.apma.org/MainMenu/RecommendedProducts/SealofAcceptance/Seal-Flip-Flops.aspx

For any of your foot concerns, come by and see Dr. Grimm or Dr. Pattison for your foot care needs.