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November 19, 2015
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What is Peripheral Neuropathy?

Peripheral neuropathy is damage of the peripheral nerves. Your peripheral nervesthe nerves in your toes and fingertipsare the ones on the periphery of your body. When the nerves are damaged, they don't function properly. People with peripheral neuropathy have decreased or abnormal sensation in their toes and fingers. Sometimes, they develop problems moving these parts of the body as well.

Causes

In the United States, the most common cause of peripheral neuropathy is diabetes. According to the American Diabetes Association, 60 to 70 percent of people with diabetes will develop neuropathy within their lifetime.

Other causes of peripheral neuropathy include:

  • Certain medications, including some chemotherapy drugs.
  • Heredity. Some people have a family history of peripheral neuropathy.
  • Advanced age. Peripheral neuropathy is more common as people age.
  • Arthritis. Certain type of arthritis can cause peripheral neuropathy.
  • Alcoholism. According to the US National Library of Medicine, up to half of all long-term heavy alcohol users develop peripheral neuropathy.
  • Neurological disorders. Certain neurological disorders, including spina bifida and fibromyalgia, are associated with peripheral neuropathy.
  • Injury. Acute injury to the peripheral nerves may also cause peripheral neuropathy. 
Symptoms

The most common symptoms of peripheral neuropathy include burning, numbness, tingling, or shooting or stabbing pain in the toes and/or fingertips. Any change in sensation in the fingers or toes may be a symptom of peripheral neuropathy. Be sure to report any abnormal sensations to your doctor. Those sensations may be the first sign of another problem, such as diabetes.

Home Care

If you have peripheral neuropathy, it is important to inspect your feet regularly. Because decreased sensation may develop eventually, you might not notice an injury or infection. Someone who has diabetes and peripheral neuropathy with loss of protective sensation, for instance, could step on a tack without noticing it. Regularly inspect your feet so you can note any injuries or infections and seek appropriate medical attention as needed.

If you're unable to properly inspect your own feet, enlist a family member or friend to help you. It's absolutely essential that any injuries are caught and treated promptly. Otherwise, an infection can develop and progress.

People with peripheral neuropathy should wear properly fitted shoes and avoid walking barefoot to prevent injury. If you have diabetes, it's important to control your blood sugar as well, because out-of-control blood sugar leads to increased nerve damage. Take your insulin or medication as prescribed and follow the recommended diet.

When to Visit a Podiatrist

Everyone with peripheral neuropathy of the feet should see a podiatrist. Podiatrists are doctors who are specially trained to preserve the health of the feet.

Diagnosis and Treatment

A podiatrist, family physician, internist, or physician who specializes in diabetes can diagnose peripheral neuropathy. The diagnosis is made on the basis of a physical exam, health history, and your reporting of symptoms. The doctor may order a blood test to check your blood sugar level because high blood sugar levels and diabetes are an important cause of peripheral neuropathy.

There is no known cure for peripheral neuropathy. The goal of treatments are to slow the progression of the disease, to maintain foot health, and to decrease pain (if present) and improve the quality of life.

The podiatrist may prescribe oral medication to help with pain. He or she will also perform a thorough foot check to look for any injuries or infections and will teach you how to do the same. Your podiatrist will also show you how to take care of your feet at home. People who have peripheral neuropathy should have their feet examined by a podiatrist at least once per year. 

If you also have diabetes, the podiatrist will work closely with you and other health-care professionals. Controlling the patient's blood sugar levels with diet, exercise, and medication (if needed) can slow the progression of peripheral neuropathy and maintain foot health. 

Prevention

The best thing you can do to prevent peripheral neuropathy is to keep your blood sugar levels under control. Peripheral neuropathy is common in people with diabetes, but the degree of neuropathy generally corresponds to the degree of blood sugar control. Someone whose blood sugar is kept under tight control will usually have much better sensation in their fingers and toes than someone with poorly controlled diabetes.

Content Courtesy of APMA

November 06, 2015
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What is a Diabetic Foot Ulcer?

A diabetic foot ulcer is an open sore or wound that occurs in approximately 15 percent of patients with diabetes and is commonly located on the bottom of the foot. Of those who develop a foot ulcer, 6 percent will be hospitalized due to infection or other ulcer-related complication.

Diabetes is the leading cause of non-traumatic lower extremity amputations in the United States, and approximately 14-24 percent of patients with diabetes who develop a foot ulcer will require an amputation. Foot ulceration precedes 85 percent of diabetes-related amputations. Research has shown, however, that development of a foot ulcer is preventable.  

Causes

Anyone who has diabetes can develop a foot ulcer. Native Americans, African Americans, Hispanics, and older men are more likely to develop ulcers. People who use insulin are at higher risk of developing a foot ulcer, as are patients with diabetes-related kidney, eye, and heart disease. Being overweight and using alcohol and tobacco also play a role in the development of foot ulcers.  

Ulcers form due to a combination of factors, such as lack of feeling in the foot, poor circulation, foot deformities, irritation (such as friction or pressure), and trauma, as well as duration of diabetes. Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack of ability to feel pain in the feet due to nerve damage caused by elevated blood glucose levels over time. The nerve damage often can occur without pain, and one may not even be aware of the problem. Your podiatrist can test feet for neuropathy with a simple, painless tool called a monofilament.

Vascular disease can complicate a foot ulcer, reducing the body's ability to heal and increasing the risk for an infection. Elevations in blood glucose can reduce the body's ability to fight off a potential infection and also slow healing. 

Symptoms

Because many people who develop foot ulcers have lost the ability to feel pain, pain is not a common symptom. Many times, the first thing you may notice is some drainage on your socks. Redness and swelling may also be associated with the ulceration and, if it has progressed significantly, odor may be present.

When to Visit a Podiatrist

Once an ulcer is noticed, seek podiatric medical care immediately. Foot ulcers in patients with diabetes should be treated to reduce the risk of infection and amputation, improve function and quality of life, and reduce health-care costs.

Diagnosis and Treatment

The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing, the less chance for an infection.

There are several key factors in the appropriate treatment of a diabetic foot ulcer:

  • Prevention of infection
  • Taking the pressure off the area, called “off-loading”
  • Removing dead skin and tissue, called “debridement”
  • Applying medication or dressings to the ulcer
  • Managing blood glucose and other health problems

Not all ulcers are infected; however, if your podiatrist diagnoses an infection, a treatment program of antibiotics, wound care, and possibly hospitalization will be necessary.

To keep an ulcer from becoming infected, it is important to:

  • keep blood glucose levels under tight control;
  • keep the ulcer clean and bandaged;
  • cleanse the wound daily, using a wound dressing or bandage; and
  • avoid walking barefoot.

For optimum healing, ulcers, especially those on the bottom of the foot, must be “off-loaded.”  You may be asked to wear special footgear, or a brace, specialized castings, or use a wheelchair or crutches.  These devices will reduce the pressure and irritation to the area with the ulcer and help to speed the healing process.

The science of wound care has advanced significantly over the past ten years. The old thought of “let the air get at it” is now known to be harmful to healing. We know that wounds and ulcers heal faster, with a lower risk of infection, if they are kept covered and moist. The use of full-strength betadine, hydrogen peroxide, whirlpools, and soaking are not recommended, as these practices could lead to further complications.

Appropriate wound management includes the use of dressings and topically-applied medications. Products range from normal saline to growth factors, ulcer dressings, and skin substitutes that have been shown to be highly effective in healing foot ulcers.

For a wound to heal, there must be adequate circulation to the ulcerated area. Your podiatrist can determine circulation levels with noninvasive tests. 

Tightly controlling blood glucose is of the utmost importance during the treatment of a diabetic foot ulcer. Working closely with a medical doctor or endocrinologist to control blood glucose will enhance healing and reduce the risk of complications.

Surgical Options: A majority of non-infected foot ulcers are treated without surgery; however, if this treatment method fails, surgical management may be appropriate. Examples of surgical care to remove pressure on the affected area include shaving or excision of bone(s) and the correction of various deformities, such as hammertoes, bunions, or bony “bumps.”

Healing time depends on a variety of factors, such as wound size and location, pressure on the wound from walking or standing, swelling, circulation, blood glucose levels, wound care, and what is being applied to the wound. Healing may occur within weeks or require several months.

Prevention

The best way to treat a diabetic foot ulcer is to prevent its development in the first place. Recommended guidelines include seeing a podiatrist on a regular basis. Your podiatrist can determine if you are at high risk for developing a foot ulcer and implement strategies for prevention.

You are at high risk if you have or do the following:

  • Neuropathy
  • Poor circulation
  • A foot deformity (e.g., bunion, hammer toe)
  • Wear inappropriate shoes
  • Uncontrolled blood sugar
  • History of a previous foot ulceration

Reducing additional risk factors, such as smoking, drinking alcohol, high cholesterol, and elevated blood glucose, are important in prevention and treatment of a diabetic foot ulcer. Wearing the appropriate shoes and socks will go a long way in reducing risks. Your podiatrist can provide guidance in selecting the proper shoes.

Learning how to check your feet is crucial so that you can find a potential problem as early as possible. Inspect your feet every day—especially the sole and between the toes—for cuts, bruises, cracks, blisters, redness, ulcers, and any sign of abnormality. Each time you visit a health-care provider, remove your shoes and socks so your feet can be examined. Any problems that are discovered should be reported to your podiatrist as soon as possible; no matter how simple they may seem to you. 

The key to successful wound healing is regular podiatric medical care to ensure the following “gold standard” of care:

  • Lowering blood sugar
  • Appropriate debridement of wounds
  • Treating any infection
  • Reducing friction and pressure
  • Restoring adequate blood flow

Additional information is available from the American Diabetes Association.

Content Courtesy of APMA

By The Foot & Ankle Institute
October 30, 2015
Category: Uncategorized

Tips to Keep Feet Warm and Cozy All Winter Long


Whether you're slogging through deep snow and sub-zero temperatures in the north, or contending with dampness, chill, and muddy conditions in the south, it's important to take care of your feet all winter long. You'll want them to be healthy and ready for action when spring finally arrives.

Most Americans will have walked 75,000 miles by the time they turn 50. Is it little wonder, then, that APMA's 2010 foot health survey found that foot pain affects the daily activities—walking, exercising, or standing for long periods of time—of a majority of Americans?

"Each season presents unique challenges to foot health," said Matthew Garoufalis, DPM, a podiatrist and APMA past-president. "Surveys and research tell us that foot health is intrinsic to overall health, so protecting feet all year long is vital to our overall well-being."

APMA offers some advice for keeping feet healthy in common winter scenarios:

  • Winter is skiing and snowboarding season, activities enjoyed by nearly 10 million Americans, according to the National Ski Areas Association. Never ski or snowboard in footwear other than ski boots specifically designed for that purpose. Make sure your boots fit properly; you should be able to wiggle your toes, but the boots should immobilize the heel, instep, and ball of your foot. You can use orthotics (support devices that go inside shoes) to help control the foot's movement inside ski boots or ice skates.
  • Committed runners don't need to let the cold stop them. A variety of warm, light-weight, moisture-wicking active wear available at most running or sporting goods stores helps ensure runners stay warm and dry in bitter temperatures. However, some runners may compensate for icy conditions by altering how their foot strikes the ground. Instead of changing your footstrike pattern, shorten your stride to help maintain stability. And remember, it's more important than ever to stretch before you begin your run. Cold weather can make you less flexible in winter than you are in summer, so it's important to warm muscles up before running.
  • Boots are must-have footwear in winter climates, especially when dealing with winter precipitation. Between the waterproof material of the boots themselves and the warm socks you wear to keep toes toasty, you may find your feet sweat a lot. Damp, sweaty feet can chill more easily and are more prone to bacterial infections. To keep feet clean and dry, consider using foot powder inside socks and incorporating extra foot baths into your foot care regimen this winter.
  • Be size smart. It may be tempting to buy pricey specialty footwear (like winter boots or ski boots) for kids in a slightly larger size, thinking they'll be able to get two seasons of wear out of them. But unlike coats that kids can grow into, footwear needs to fit properly right away. Properly fitted skates and boots can help prevent blisters, chafing, and ankle or foot injuries. Likewise, if socks are too small, they can force toes to bunch together, and that friction can cause painful blisters or corns.

Finally—and although this one seems like it should go without saying, it bears spelling out—don't try to tip-toe through winter snow, ice, and temperatures in summer-appropriate footwear. "More than one news show across the country aired images of people in sneakers, sandals, and even flip-flops during the severe cold snap that hit the country in early January," Dr. Garoufalis said. "Exposing feet to extreme temperatures means risking frostbite and injury. Choose winter footwear that will keep your feet warm, dry, and well-supported."

Content Courtesy of APMA

You notice: Dry, flaky feet

You notice: Dry, flaky feetClickboxProductions/iStock
It could beThyroid problems, especially if moisturizer doesn’t help. When the thyroid gland (the butterfly-shaped gland in the base of your neck) goes on the fritz, it doesn’t properly produce thyroid hormones, which control metabolic rate, blood pressure, tissue growth, and skeletal and nervous system development. Thyroid problems cause severe dryness of the skin, says Marlene Reid, DPM, a foot specialist in Naperville, Illinois. When we see cracking on the feet, or if moisturizer doesn't improve dryness over a few days, we usually refer patients to their primary doctor to make sure their thyroids are OK. Brittle toenails can also signal thyroid complications.

You notice: Bald toes

You notice: Bald toesstevedangers/iStock
It could be: Arterial disease. If the fuzz on your toes suddenly disappears, it could signal poor blood circulation caused by peripheral arterial disease (PAD). Signs of PAD can include decreased hair growth on the feet and ankles, purplish toes, and thin or shiny skin,” says Suzanne Fuchs, DPM, a podiatric surgeon at North Shore University Hospital in New York. A buildup of plaque in the leg arteries, PAD affects about 8 million Americans. Symptoms are subtle, but doctors can check for a healthy pulse in the foot or spot PAD on an X-ray. If I take an X-ray of a broken foot, and I see a hardening of the arteries, 99 percent of the time, the same thing is happening in the heart blood vessels, says Gary A. Pichney, DPM, a podiatric surgeon of The Institute for Foot and Ankle Reconstruction at Mercy Medical Center.

You notice: Ulcers that don't heal

You notice: Ulcers that don't healkupicoo/iStock
It could be: Diabetes. Uncontrolled glucose levels can damage nerves and cause poor circulation, so blood doesn’t reach the feet. When blood doesn’t get to a wound caused by, say, irritating shoes, the skin doesn’t heal properly. “Many, many people with diabetes are diagnosed first because of foot problems,” says Reid. Other signs of diabetes may include tingling or numbness of the feet. Ask your doctor about getting your blood sugar levels tested.

You notice: Enlarged, painful big toe

You notice: Enlarged, painful big toeThamKC/iStock
It could be: What you ate. Gorged on wine and steak? The painful aftermath could be gout, a type of arthritis that usually affects the joint of the big toe. Foods high in purine, a chemical compound found in red meats, fish, and certain alcohol, can trigger an attack by raising levels of uric acid in the body. Uric acid is normally excreted through urine, but is overproduced or under-excreted in some people. You'll see the deposition of the uric acid in the joint, most commonly the big toe or the ankle, says Bob Baravarian, DPM, a podiatric foot and ankle specialist at Providence Saint John's Health Center in Santa Monica, California. The patient will wake up with a hard, red, swollen joint. It's extremely painful.€ A doctor may prescribe anti-inflammatory drugs for short-term relief and suggest a low-purine diet for long-term prevention. 

You notice: Tiny, red lines under the toenail

You notice: Tiny, red lines under the toenailcoloroftime/iStock
It could be: A heart infection. Red streaks underneath the toenails or fingernails could be broken blood vessels known as splinter hemorrhages. These occur when small blood clots damage the tiny capillaries under the nails. They can signal endocarditis, an infection of the heart's inner lining. People who have an existing heart condition, have received a pacemaker, or who have chronically suppressed immune systems (such as cancer patients receiving chemotherapy, HIV patients, and diabetes patients) are at higher risk of developing endocarditis. The infection can result in heart failure if left untreated. If you notice splinter hemorrhages on your toenails or fingernails, and haven't experienced any recent trauma to the nail, see your doctor to check your heart and blood circulation.   

You notice: Clubbing

You notice: ClubbingCourtesy American Podiatric Medical Association
It could be: Lung cancer or heart disease.Another symptom that appears in both toes and fingers, clubbing is often associated with lung cancer, chronic lung infection, heart disease, or intestinal disease. Lung cancer and heart disease decrease vascular resistance, which means blood flow to the small arteries in the toenails and fingertips will increase. Tissue swells and results in the clubbed appearance (rounder, wider fingers and toes). Though patients are typically aware they have a disease that is causing the clubbing, it's best to get checked if you see any abnormalities. 

You notice: Pitted toenails

You notice: Pitted toenailstiler84/iStock
It could be: Psoriasis. If you find tiny holes, grooves, or ridges in your toenails, you may have nail psoriasis. Though most people who experience nail psoriasis also have skin psoriasis (an autoimmune disease that makes skin patchy and irritated), 5 percent of people with nail psoriasis aren't affected elsewhere. If you've never been diagnosed with psoriasis, but your toenails have little pits in them, you should get them checked out, says Pichney. Other symptoms include white patches and horizontal lines across the nails. To treat psoriasis, your doctor may prescribe topical creams or steroids to be injected under the nail. 

You notice: Spooned nails

You notice: Spooned nailsCHeitzFlickr
It could be: Anemia or lupus. Do you have a depression in the toenail deep enough to hold a water droplet? Also known as koilonychias, spoon-shaped toenails or fingernails can indicate iron deficiency, as well as hemochromatosis (overproduction of iron), Raynaud’s disease (which affects blood supply to the fingers and toes), and sometimes lupus (an autoimmune disease in which the body’s immune system attacks cells, tissues, and organs). Spooned nails occasionally appear in infants, but normalize in the first few years of life. If you notice spooning, contact your physician, who will administer a blood test to identify the exact cause.

You notice: A straight line under your toenails

You notice: A straight line under your toenails© Dr Ph Abimelec
It could be: Skin cancer. A dark, vertical line underneath a toenail could be acral lentiginous melanoma, or hidden melanom€”a form of the skin cancer that appears on obscure body parts. (Other hidden melanomas include eye melanoma and mouth melanoma.) “It will be a black line from the base of your nail to the end of the nail, says Pichney. It should be seen by a podiatrist or dermatologist. You want to make sure it’s not fungus, which is usually yellow brown and sporadic throughout the whole nail. Although only 5 percent of all diagnosed melanoma cases are the hidden kind, hidden melanoma is the most common type in dark-sk
By Foot & Ankle Institute
August 10, 2015
Category: Uncategorized

Ten tips on how to look after your feet, with special advice for those over 60

Your feet take the weight of your whole body, so foot problems can quickly lead to discomfort and affect the way you walk. This can in turn cause knee, hip and back pain. The good news is that looking after your feet can prevent most of these problems. Investing a bit of time and thought into caring for your feet now can prevent them causing you pain later.

Wash your feet often

Don’t go to bed without washing your feet. If you leave dirt on the skin’s surface, it can become irritated and infected. Wash your feet every evening with soap and water.

Dry your feet well

Dry your feet thoroughly after washing them, especially between the toes which is where germs such as Athlete's foot can easily breed. Then, apply a moisturising foot cream (not body lotion).

Remove hard skin

Gently remove hard skin and calluses with a pumice stone or foot file regularly. 

Cut toenails carefully

Always trim your toenails straight across, never at an angle or down the edges. This can cause ingrown toenails.

Shoe shop in the afternoon

Shop for shoes in the afternoon. Feet swell as the day goes on and if shoes fit in the afternoon when your feet are at their largest, you can be assured they will always be comfortable.

Footwear tips for work

If you have to wear heels at work, wear comfortable shoes to and from the office and only wear your smart shoes once you're in the office. Also, try to vary the heel height, between low, medium and high. Read how to choose the right footwear for work.

Limit time wearing high heels

Be shoe savvy. Wear high heels and pointed shoes for special occasions only, and always wear the right shoes for the job (so no sandals for mountain climbing).

Change your socks often to avoid foot odor

Change your socks daily. Read advice from the Institute of Chiropodists and Podiatrists on buying socks.

Watch out for foot bugs in communal changing areas

Wear flip-flops to avoid catching athelte's foot and verrucas when you use public areas such as gym showers, swimming pools or hotel bathrooms. 

Take care with flip-flops

But don't wear flip-flops all the time. They don't provide support for your feet and can give you arch and heel pain if you wear them too much.

Foot pain advice for over-60s

If you're over 60, foot care becomes even more important. Age takes its toll: your skin thins, your joints begin to stiffen and your feet become more vulnerable to the cold.

Not only that, but as podiatrist Emma Supple says: "Physically, it gets more difficult for us to get to our feet, and failing eyesight doesn’t help."

Emma says: "Go to see a professional for a foot MOT every six monthsand never put up with foot pain as if it is normal. Your feet shouldn’t hurt." Schedule an appointment with a podiatrist today if you've been experiencing foot pain. 

*courtesy http://www.nhs.uk/Livewell/foothealth/Pages/Healthyfeet.aspx



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