Take Care With Basic Care

Feet should be frequently inspected for changes, but diabetics need to be diligent in their foot care.

Feet are not that large and don’t change that much, so what do you look for when inspecting feet?

• puncture wounds
• bruises
• pressure areas
• redness
• warmth
• blisters 
• ulcers
• scratches and cuts 
• nail problems

Some areas of the feet may be difficult to inspect by yourself. Ask a family member for help or use a mirror to inspect feet daily.

Here's some basic advice for taking care of your feet:

• “Always keep your feet warm.
• Don't get your feet wet in snow or rain.
• Don't put your feet on radiators or in front of the fireplace.
• Don't smoke or sit cross-legged. Both decrease blood supply to your feet.
• Don't soak your feet.
• Don't use antiseptic solutions, drugstore medications, heating pads or sharp instruments on your feet.
• Trim your toenails straight across. Avoid cutting the corners. Use a nail file or emery board. If you find an ingrown toenail, contact our office.
• Use quality lotion to keep the skin of your feet soft and moist, but don't put any lotion between your toes.
• Wash your feet every day with mild soap and warm water.
• Wear loose socks to bed.
• Wear warm socks and shoes in winter.
• When drying your feet, pat each foot with a towel and be careful between your toes.
• Buy shoes that are comfortable without a "breaking in" period. Check how your shoe fits in width, length, back, bottom of heel, and sole. Avoid pointed-toe styles and high heels. Try to get shoes made with leather upper material and deep toe boxes. Wear new shoes for only two hours or less at a time. Don't wear the same pair every day. Inspect the inside of each shoe before putting it on. Don't lace your shoes too tightly or loosely.
• Choose socks and stockings carefully. Wear clean, dry socks every day. Avoid socks with holes or wrinkles. Thin cotton socks are more absorbent for summer wear. Square-toes socks will not squeeze your toes. Avoid stockings with elastic tops.”

Citation:
Vittori Foot & Ankle Specialist. (2012). Diabetes and your feet. Retrieved from http://www.vittorifootclinic.com/library/1800/DiabetesandYourFeet.html

Image by Matthew T. Rader. (2008). My feet. Retrieved from http://www.flickr.com/photos/infinite-magic/497036269/

Diabetics Need a Team of Physicians

Diabetes affects almost every family these days. The statistics are profound. Take a look at this staggering infographic that the American Podiatric Medical Association has compiled.

Those recently diagnosed with Diabetes should realize they are not alone. A team of doctors will help keep the disease under control and help guide the individual through medical treatments.  Get to know what each doctor or specialist does to keep diabetes in check.

Primary Care Physician – This is one’s family physician, general physician, or internist. They play the role of coordinator by referring to other specialists. When one is seen by a specialist, progress reports are sent to one’s primary care physician. Primary care physicians and specialists work together and keep each other update on the progress of the patient.

Podiatrists – If you’re reading this blog, you know that we treat lower extremity issues of the foot and ankle. It’s imperative to see a podiatrist at least twice a year to reduce amputation rates by 45 – 85%. Diabetes reduces blood flow to the feet and hinders circulation which is why amputation of the lower extremities happens. Many foot complications occur from diabetes; loss of feeling, burning, tingling, nerve problems, circulation problems, and amputation.

Endocrinologist – These physicians deal with hormones and the changes that occur due to the disease. Diabetes affects the endocrine system and endocrinologists focus on how the body is producing insulin.

Dentist – You might be wondering why seeing a dentist is important, but dentists play a key role in diabetes management. Those with diabetes are more susceptible to gum disease and mouth infections resulting from excess blood sugar.

Ophthalmologist/Optometrist – Diabetes affects the eyes, resulting in diabetic eye disease due to restricted blood flow. Just like managing circulation to the feet to prevent amputation, this disease can be prevented if regular check-ups are done.

Vascular Surgeon – They manage vascular diseases, which increase the longer one has diabetes. It’s important to manage blood pressure, stop smoking, eat right, and exercise to minimize vascular diseases.

Pharmacist – Get to know one’s pharmacist. They check to make sure that all prescriptions prescribed by all doctors won’t counter each other or cause unnecessary problems. They also inform diabetes patients about the risks of each prescription. Even if one is taking over the counter medication, consult the pharmacist first to ensure it won’t react badly with other medications.


Citation:
American Podiatric Medical Association. (2012). Footprints. Retrieved from http://www.apma.org/files/FileDownloads/APMA%20Diabetes%20Special%20Edition%20Footprints_2012.PRINT.pdf
American Podiatric Medical Association. (2012). Diabetes by the numbers. Retrieved from  http://www.apma.org/files/images/kyso12_infographic_800.jpg

Broken Bones: Stabilizing & Medical Treatment

The first thing one should do if they believe they may have broken a bone in their foot or ankle is to stabilize the injury and then elevate it. The second step is to contact your Podiatrist, Dr. Vittori, for X-rays and proper medical treatment of the injury.

Stabilizing the injury:

• Find a splint that will keep the injury from moving around. The splint can be as simple as a pillow wrapped around the foot which can be tied with a bandage.
• Do not wrap the foot too tightly. The injury needs to have blood supply circulating. The signs to be aware of if the injury is wrapped too tightly are if the injury hurts worse, turns blue, or if one is unable to wiggle their toes.
• Elevate the injury by lifting the foot at a level which is higher than the rest of the body. This will reduce swelling and pain.
• Ice can also be used to minimize the swelling and pain. Apply ice that is wrapped in a towel and do not put the ice directly on open skin.
• After the injury is stabilized, contact your Podiatrist, Dr. Vittori, since treatment of broken bones varies depending upon what part of the foot or ankle is broken.

Common treatments of broken bones in the foot or ankle:

• Some broken bones in the foot and ankle require the individual to remain off of the injury by using crutches or flat-bottom shoes.
• Other broken bones require the use of splints and casts.
• The most extreme treatment involves surgery to repair the foot.

Citation:
Image by Matthew Cashmore. (2007). Broken toe. Retrieved from http://www.flickr.com/photos/mattcashmore/515785363/

An Athlete's Worst Fear

A tear in the Achilles tendon is an injury that every athlete fears, as it’s the tendon that is torn the most often. Non-professional athletes are just as likely to tear this tendon or suffer from Achilles tendonitis, which is when the tendon becomes inflamed.  The Achilles tendon is a unique tendon because it can withstand 1,000 pounds of pressure. As the largest tendon in the body, it has to be able to support a person jumping, running, and every type of movement that one can think of. One knows there is a problem when pain occurs after exercising and it doesn’t get better. Pain will be localized near where the Achilles tendon and the heel bone meet. Swelling and stiffness can occur.

There are many ways one can tear the Achilles tendon or get Achilles tendonitis. What should one do if either of these occurs?

First, make an appointment with a Podiatrist to get checked out and get a proper diagnosis. Restricting the movement of the foot and ankle through a bandage or cast along with rest will minimize the pressure that is placed on the tendon. If the Achilles tendon is swollen, anti-inflammatory medication helps to reduce the swelling and minimize pain.

Moving forward, it is often suggested to wear orthotics to help support the muscle and relieve some of the stress that is placed on the tendon while exercising or playing a sport. If the sport or exercise is what is causing severe pain and Achilles problems, one might be advised to play a sport that is not as intense on the limbs, joints, and tendons. Swimming is a great exercise and sport that doesn’t stress the tendons. Proper stretching can’t be stressed enough. Weak muscles can cause tendon problems.

In the case of an Achilles tendon tear, surgery is a treatment option. In those cases, physical therapy is required after the surgery in order to strengthen the muscles groups and tendon. Recovery time of an Achilles tendon tear is much longer than a when the Achilles is inflamed or swollen.


Citations:

Image by Phallin Ooi. (2007). Football. Creative Commons. Retrieved from http://www.flickr.com/photos/phalinn/371857372/
Vittori Foot and Ankle Specialist. (2012). Achilles tendonitis. Retrieved from http://www.vittorifootclinic.com/library/1749/AchillesTendonitis.html

What Tech is Right for Which Ailment?

Podiatrists stay on the cutting edge of technology by using a number of diagnostic procedures to determine a diagnosis and treatment plan. Let’s a look what diagnostic imaging is used for what condition; MRI, X-ray, and ultrasound.

MRI (magnetic resonance imaging) uses large magnet and radio waves to create 3-D images of the foot and ankle. MRI’s are used to look at soft tissues and bones for the following:

• Arthritis.
• Fractures.
• Infections.
• Injuries of the tendons, ligaments, or cartilage.
• Tumors.

X-rays use radiation to look at the bone to determine fractures and the following:

• Evaluate changes in the bones from infections, arthritis, or other bone disease.
• Assess whether a child's bones are growing normally.
• Locate foreign objects (such as pieces of glass or metal) in a wound.
• Determine whether bones are properly set after treating a fracture.

Ultrasounds are not just for determining the sex of a baby. They are used to determine soft tissue problems in the foot and ankle by using sound waves.

• Bursitis.
• Heel spurs or plantar fasciitis.
• Injuries of the ligaments, tendons, or cartilage.
• Morton's neuroma.
• Presence of foreign bodies.
• Soft tissue masses.
• Tarsal tunnel syndrome.
• Tendonitis or tears in a tendon.

Citation:

Image by Liz West. (2004). XRay tech. Retrieved from http://www.flickr.com/photos/calliope/254119847/

Score Your Foot Health - Quiz

Magazines are filled with assessment quizzes. Why not take this quiz from The Foot Health Foundation of America to determine how your feet and ankle are doing and if you should get checked out by a podiatrist. This quiz may pinpoint any warning signs of lower extremity problems. Early detection and preventive measures will keep you up and walking or running longer with no pain. 

To score the quiz, determine which answer best suits you. Add the points associated with each answer. At the bottom of this blog, you will see what the total points mean and if any action should be taken. Please note that this quiz is part fun and part self-assessment. It does not replace a physical exam. 

1.	How much time do you spend on your feet each day?
	a. less than 2 hours	0
	b. 2 - 4 hours	1
	c. 5 - 7 hours	2
	d. 8 hours or more	3
2.	How old are you?
	a. under 40	0
	b. between 40 and 59	1
	c. 60 and over	2
3.	How would you describe your weight?
	a. less than 20 pounds overweight or at ideal weight	0
	b. 20 - 39 pounds overweight	2
	c. 40 or more pounds overweight	3
4.	Have problems with your feet or ankles ever prevented you from participating in:
	- leisure/sports activities
	a. yes	2
	b. no	0
	- work activities?
	a. yes	3
	b. no	0
5.	Have you ever received medical treatment for problems with your feet and/or ankles?
	a. yes	3
	b. no	0
6.	Do you regularly wear heels two inches or higher?
	a. yes	2
	b. no	0
7.	What types of exercise do you engage in or plan to engage in? (check all that apply)
	a. walking	1
	b. field sports (e.g., softball, golf)	2
	c. winter sports (e.g., skiing, ice skating)	2
	d. court sports (e.g., tennis, basketball)	3
	e. aerobics	3
	f. running	3
	g. none (if you chose answer g, skip to question 11)	0
8.	Do you have the appropriate shoes for your sport or sports?
	a. yes	0
	b. no	3
9.	Do you experience foot or ankle pain when walking or exercising?
	a. rarely	1
	b. sometimes	2
	c. often	3
	d. never	0
10.	Do you:
	- exercise in footwear that is more than one year old or in hand-me-down footwear?
	a. yes	3
	- stretch properly before and after exercising?
	a. yes	0
	b. no	3
11.	Do you:
	- have diabetes?
	a. yes	3
	b. no	0
	- experience numbness and/or burning in your feet?
	a. yes	3
	b. no	0
	- have a family history of diabetes?
	a. yes	2
	b. no	0
12.	Do You: (Mark all that apply)
	- sprain your ankles frequently (once a year or more) or are your ankles weak?
	a. yes	2
	b. no	0
	- have flat feet or excessively high arches?
	a. yes	2
	b. no	0
	- experience pain in the achilles tendon or heel or have shin splints (pain in the front lower leg)?
	a. yes	2
	b. no	0
	- have corns, calluses, bunions or hammertoes?
	a. yes	3
	b. no	0
	- have arthritis or joint pain in your feet?
	a. yes	3
	b. no	0
	- have poor circulation or cramping in your legs?
	a. yes	3
	b. no	0

---

Scoring

0-20 Points: Congratulations! Your feet and ankles are very healthy and you can maintain your active lifestyle and/or exercise regimen. With proper attention and care your feet and ankles should remain healthy; however, you may want to schedule an annual exam with a podiatric physician to ensure their long-term health. Furthermore, if you scored points for questions 4, 5, 9, 11 or 12 you should consider visiting a podiatric physician in the near future for a check-up.

21 - 40 Points: Pay Attention. Your feet and ankles are showing signs of wear, placing you in the moderate risk category. Although you can continue your normal activities, you should strongly consider visiting a podiatric physician for a check-up. If you participate in a rigorous exercise regimen on a regular basis or plan to - or if you scored points for questions 4, 5, 9, 11 or 12 - you should visit a podiatric physician soon to safeguard your foot and ankle health.

41 Points or Higher: Caution. Your feet and ankles are at high risk for long-term medical problems and you should contact our office as soon as possible. If you exercise, you should pay particular attention to your feet and ankles until you are seen by our practice. If you have not begun exercising, it is advisable to contact our office before undertaking any type of exercise.

Now that you've assessed the health of your feet and ankles, you are armed with knowledge that will enable you to maintain their health over a lifetime.

Please note: Even if you scored well, this self assessment is not a substitute for a physical exam.

Citation: Vittori Foot and Ankle Specialist. (2012). Self-assessment quiz. Retrieved from http://www.vittorifootclinic.com/library/1925/Self-AssessmentQuiz.html

Prescription Footwear - Not Your Grandma's Shoes

Footwear is nothing to take lightly for diabetics. With 15.7 million people in the United States living with diabetes, proper footwear can be a major factor in keeping the person mobile. Diabetes affects the feet by lose of feeling because blood flow becomes restricted. The impact of diabetes on the lower extremities is profound. Each year, 65,000 limbs are amputated and within three to five years, the risk of another amputation increases to 50%.

Keep moving to keep circulation and blood flowing to the lower limbs to avoid amputation and other complications. Prescription footwear can accommodate, stabilize, and support deformities of the foot. They can also limit the motion of joints in order to decrease inflammation and provide much needed stability. Prescription footwear can also reduce shock and pressure. Pressure can cause ulcers and wounds that may be difficult to treat and close. Open wounds have complication all of their own. But don’t worry; prescription shoes come in many different forms, and can be just as stylish as shoes bought at a department store. Just because one has diabetes doesn’t mean that they have to give up fashionable footwear.

Prescription footwear come in these types:

• “Custom-made shoes. When extremely severe deformities are present, a custom-made shoe can be constructed from a cast or model of the patient's foot. With extensive modifications of in-depth shoes, even the most severe deformities can usually be accommodated.

• External shoe modifications. In these cases, the outside of the shoe is modified in some way, such as adjusting the shape of the sole or adding shock-absorbing or stabilizing materials.

• Healing shoes. Immediately following surgery or ulcer treatment, special shoes may be necessary before a regular shoe can be worn. These include custom sandals (open toe), heat-moldable healing shoes (closed toe), and post-operative shoes.

• In-depth shoes. An in-depth shoe is the basis for most footwear prescriptions. It is generally an oxford-type or athletic shoe with an additional 1/4-inch to 1/2-inch of depth throughout the shoe. This extra volume accommodates inserts, or orthotics, as well as deformities commonly associated with a diabetic foot. In-depth shoes are usually designed to be light in weight, have shock-absorbing soles, and come in a wide range of shapes and sizes to accommodate virtually any foot.

• Orthoses or shoe inserts. Also known as orthotics, an orthosis is a removable insole which provides pressure relief and shock absorption. Both pre-made and custom-made orthotics or shoe inserts are commonly recommended for patients with diabetes, including a special total contact orthosis, which is made from a model of the patient's foot and offers a high level of comfort and pressure relief.”

Citation:
Vittori Foot and Ankle Specialist. (2012). Corrective and prescription shoes. Retrieved from http://www.vittorifootclinic.com/library/1793/CorrectiveandPrescriptionShoes.html

Image by Ephemeral Scraps. (2012). Corrective orthopedic shoe. Retrieved from http://www.flickr.com/photos/biomedical_scraps/6832476313/