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Tuesday, August 25, 2015

Diabetics should see a podiatrist to keep their feet healthy(or just to keep their feet!)


Good foot health does start with the toenails! As foot and ankle surgeons, we never take lightly the role we play in helping our diabetic patient's feet stay safe and from harm by performing what we call "at risk foot care" for them. Just because the title surgeon is in our job description does not mean we are too good to trim toenails. These patients come into the office and have a thorough exam of their feet followed by having the doctor trim their toenails and calluses if needed. Most insurance companies consider this a covered benefit if the patient has certain class findings in addition to the diagnosis of diabetes. I always tell patients that their insurance company does not give a hoot about their toenails. Their insurance is looking for the easiest way to save money, and visits to the podiatrist help keep the cost of hospital admissions for diabetic foot infections, ulcers, and worse yet amputations way down! Insurance companies cover these services to help reduce the risk of ulcerations and amputations to the foot or ankle.

The estimated annual U.S. Burden of Diabetic Foot Ulcers is at least $15 Billion Rice, et al, Diabetes Care, 2014. Proper foot care helps prevent such problems in many diabetic patients. In the last 14 years of private practice, a week has not gone by where I have not had to remove a foreign object, glass, a splinter, or an insulin needle from the bottom of someones foot who was just coming in for foot care. These patients are usually totally unaware of their brewing infection on the bottom of their foot secondarily to their neuropathy. We fix the problem right then and there, no need for the operating room or intravenous antibiotics in a hospital bed, in most cases.  

It has been proven time and time again in peer reviewed literature, that these patients who have diabetes that visit the podiatrist are much less likely to have an amputation of an extremity. Podiatric medical care in people with history of diabetic foot ulcers can reduce the the high level amputation between 65% and 80%. Gibson, et al, Int Wound Journal 2013.  When the primary care physician makes the referral to the podiatrist for at risk foot care, they are playing a huge roll in helping decrease the amputation rate as seen in the study by Weck, et al, in Cardiovascular Diabetology, 2013. Instituting a structured diabetic foot program can yield a 75% reduction in amputation rates and a near four-fold reduction in inpatient mortality. The inverse was also proven by Skrepnek, Mills, Armstrong, Diabetes Care 2014, in which they saw that when foot care is removed from a population, there is a 37% increase in hospital admissions for limb threatening wounds and 45% increase in individual patient charges.

I tell my new diabetic patients I meet in the office for the first time that I rarely have to amputate anything on my established diabetic foot care patients.  The numerous amputations I have performed over the last 14 years have been consults from the hospital when I am on call.  These patient usually have never seen a podiatrist, and have a wound or infection that will require multiple debridements(cutting away dead or infected tissue) with no guarantee of limb salvage.  

If you are not diabetic why should you care? Well caring for our fellow human beings should be innate human response some people are all about the dollars and cents. So here we go: the cost of diabetic foot ulcers is greater than that of the five most costly forms of cancer. Barshes, et al, Diab Foot Ankle 2013.  The Diabetic Foot Ulcer patients are twice as costly to US Medicare as to those with Diabetes alone. Rice, et al, 2014.  But maybe more importantly, you should care because according to the American Diabetes Association, 2014 there are approximately 86 million people to be considered pre-diabetic and you might be one of them!

Every 20 seconds a limb is lost to diabetes according to Bharara, et al, Int wound J, 2009. So in the time it took you to read this blog many limbs have been lost to diabetes. There should be a call to action for anyone who took the time to read this blog. It is undeniable that you know someone with diabetes an aunt, uncle, parent, niece or co-worker.  Pass this information along to them.  Have them see a podiatrist and just be established as a patient.  If you are diabetic and have no class findings the podiatrist may suggest you come in maybe once a year for a foot check. This is a painless process that takes minutes to check your sensation and arterial pulses.  As you may have gathered the overwhelming theme here is prevention.  Prevention is the key to good foot health and decreased medical bills due to diabetes.   

 Help save a limb today and pass it on! I would much rather cut your toenails than have to take you to the operating room to amputate part of your foot.
Thank you for taking the time to read our blog.  You can find more diabetic foot facts at our website at: http://centeranklefootcare.com/id7.html 
Michele McGowan DPM
Center for Ankle and Foot Care
3150 Citrus Tower Blvd Suite B
Clermont, FL 34711
352-242-2502

Wednesday, August 12, 2015

Plantar Fasciitis...The Doctor Is Now The Patient!!!!!

You wake up, step out of bed and then BAM! You feel it, a sharp undeniable  pain on the bottom of your foot near your heel.  Were you asleep for a hundred years, or did you rapidly age overnight?  No, you have plantar fasciitis, most likely.  As a foot doctor we see patients with heel pain about 15 times a day.  It is one of my favorite problems to treat, because people are always in shock on how easy it is to get better if they just follow some simple instructions.

This topic is very close to home for me, because after 2 weeks of a new exercise program P90X3, I developed plantar fasciitis!  The doctor is now the patient! This exercise program is a lot of jumping and up on your heels for different exercises.  It is a great program, but I would recommend some extra stretching of the calf muscles before and after to avoid getting plantar fasciitis.

Many people find it hard to get into the doctors office, but when your foot hurts it sometimes is unavoidable.  If you think you have plantar fasciitis or "heel pain" I would recommend seeing your foot and ankle specialist. But I will share with you what I have done from Friday of this past week, when my pain first started, until today Tuesday, just 4 days later.  My pain has gone from an 8 out of 10 Friday morning to about a 2 out of 10 Tuesday morning.

What Is Plantar Fasciitis?

Plantar Fasciitis is an injury sustained as the result of repetitive stress placed on the bottom of the foot. More specifically, its damage sustained on the fascia—a thin layer of fibrous tissue that protects
other tissues within your feet. Many people develop Plantar Fasciitis from long periods of standing, running, or performing various load-bearing activities. For me it was a new exercise program with a lot of jumping.

 Plantar Fasciitis Symptoms

The most common symptom of Plantar Fasciitis is pain. This can be burning, stinging, stabbing or throbbing pain. Many people experience a dramatic amount of pain when they first get up in the morning, with the sensation lessening throughout the day. For others, the pain is consistent. The pain can be isolated to an area in the middle of foot, or it can radiate outward towards the toes. The heel is the most common area for Plantar Fasciitis pain to show up. Plantar Fasciitis pain can be very stubborn and last for months or even years. Since walking and standing cannot be completely avoided in our lives, the injury can cause serious disturbances in professional and private life.


 Causes of Plantar Fasciitis

The causes of plantar fasciitis can be multi factorial, as you can see below.  But the anatomy of our lower leg plays a major role as well.  If you look at your calf muscle as compared to the front of your lower leg, you will notice a big disparity in muscle size.  The back of our leg muscles are bigger because they have the responsibility of pushing our body forward with each step. But the more we walk or exercise with out stretching, the tighter this muscle group gets!

Several different things can cause Plantar Fasciitis, which makes classifying the condition somewhat difficult. For example, bone spurs, flat feet, high-arched feet, and hard running surfaces are all very different—but each one can be a cause of the condition. Individuals in professions that require you to stand for long periods of time—nursing, for example—are at a higher risk for developing cause Plantar Fasciitis. Another very common cause of Plantar Fasciitis is the type of shoe you choose to wear. Older or poorly constructed shoes can place your feet at a higher risk for stress. Shoes that don't have adequate padding for the heel and arch can be a problem as well. Finally, overweight individuals are at a higher risk for developing Plantar Fasciitis. As you gain weight, this naturally places more stress on the tissues of your feet, and the fascia tends to bear the brunt of this.

 Treatments

Below you will find my recommendations regarding treating and making your heel pain go away
People find it hard to believe that stretching, icing and support can be the perfect combo to relieve and help get rid of their heel pain, but it's true!!!! I know from experience over the last 4 days!

What I always tell patients when they come into the office with heel pain or plantar fasciitis, is that even though it hurts so darn bad the cure really does revolve around stretching believe or not, in most cases.  Sure it can require a medicine by mouth or even a shot with some extra support in shoe gear but it is usually a simple fix.

The fix is simple but, depending in how long it takes you to seek help to get better, could be the deciding factor on how long it actually takes you to get better.  The sooner you seek care, start the stretching exercises and put good support in you shoes, the sooner you are on the road to recovery.

Here are my classic three stretches performed by my lovely stick figure drawings, but simple is always better. I have done these three stretches 4 or 5 times a day for the last 4 days.  Stretching is important for your Plantar fasciitis to get better and stay away.  Yes, that is right, I tell all of my patients that they need to stretch daily after having Plantar facsiitis to prevent it from coming back! These three basic runners stretches should be performed 3-4 times a day when you have Plantar fasciitis.  You should stretch both sides for completeness sake and hold the stretch for 15-20 seconds with no bouncing.

Icing is another thing I tell people to do when they have acute Plantar fasciitis.  But how you ice can be a real key to your success.  You need get a little plastic water bottle and freeze the water inside, then take it out 2 times a day rolling it under the arch of the foot back and forth.  I tell patients this is like physical therapy without a copay.  It is a natural anti-inflammatory and stretches the arch very effectively. I currently have three ice bottles in my freezer and have been rotating the bottles for ice massage non stop when I am home.

These are the two main ways to start treating your Plantar fasciitis right now: stretching and icing. They have been the hallmark of my own treatment over the last 4 days.  But I also have used the following to  help support my fascia while I was standing like inserts and slippers.  Also, there is something called a Plantar fascial night splint that I have worn every day for the last 4 days while I was sitting.

Some people get home and kick off their shoes and then strain the fascia walking barefoot around the house.  Support, even at home has a very positive effect in your outcome and feeling better sooner. Something like a spenco slipper can be a foot saver and is what I have relied on the last couple days to protect  my feet around the house.

Here is a link to our webpage, with our top recommendations for heel pain and plantar fasciitis.  I put my favorite helpers for heel pain available at :
http://centeranklefootcare.com/id114.html














Wednesday, August 5, 2015

The non weight bearing blues! What to do when you are not allowed to run due to a foot injury.

So you just came back from the doctor and they told you that you have a stress fracture, peroneal tendon or Achilles' tendon tear.  Now what? You have been working so hard at staying in shape and then this happens! Most people go through this and feel very helpless.  We are going to try to get you through the next 6-12 weeks with an approach to stay fit when you can't use your feet!

Now what your treating physician says always stands as the best advice, as they are the person that is intricately involved with your specific problem.  This article is meant to give you options to discuss with your doctor about what you can do to stay in shape during your recovery period.

In the world of burning fat, cardio is king.  I can not tell you over the last 13 years in seeing patients, how many times patients get almost angry at me because they hurt their foot or ankle, and require immobilization.  Immobilization can be a walking cast, a fiberglass non-weight bearing cast or even a wheel chair.  Not being able to use your foot or ankle is a real bummer for patients, especially patients that either love to exercise or those who know with out exercise they will be gaining weight!


Cardio always becomes the first concern with patients with a foot or ankle problem, "what kind of cardio can I do, now that I can't use my foot?" One option is to focus on your upper body to help get that cardio kicking.  An example of this would be an arm ergometer, instead of pumping the legs on a bike, you are now relying on your arms to help get that blood pumping. Keeping the heart rate up is the goal with cardio and this is a great way to do so!



Circuit training with upper body weights is another great way to get that heart rate up.  Choose lighter weights at higher repetitions for maximum benefit.  Make an upper body circuit for every other day of the week.  We suggest the following:
Monday: triceps press over the head and triceps kick backs, low weight 15-20 reps X 3
Wednesday:  biceps curls and then alternating biceps curls,  low weight 15-20 reps X 3
Friday:  chest press and then chest flys, low weight 15-20 reps X 3


If what is wrong with your foot or ankle does not involve any stitches or sutures, then you should ask your doctor if it is O.K. to go into the pool. If you can't run on the ground, maybe your doctor will let you run in the pool.  A great device for running in the pool is called a buoyancy belt. This will allow you to run in the pool without any ground reactive force coming into play.

Below are some of these items mentioned above that you can find at Amazon online.  We wish you the best and hope for a speedy recovery! If you would like to learn more about your foot or ankle condition check out our webpage at: http://centeranklefootcare.com/id86.html