Monday, November 7, 2011

Diabetic Shoes…”They are not just for diabetics anymore.”

The diagnosis of “diabetes” sends shivers thru most people. While definitely not a death sentence as it has been in the past, the word conjures up the images of needles, tasteless food, the possibility of dialysis and blindness. While this blog won’t attempt to delve into the finer points of the disease, it will focus on just one aspect that will make life easier and attempt to make you aware how to make your diabetes a bit “easier on your feet”.

A common side effect of diabetes is a phenomenon called “diabetic neuropathy”. This is a disease entity that causes your feet to lose the normal sensation of pressure, pain and proprioception. While this might not seem like a big deal compared to other aspects of the disease, if left unchecked, it can lead to infection, amputation and even death.

In addition to checking your feet every day and keeping them clean, warm and dry, diabetic shoes are a simple thing to help extend the life of your neuropathic feet.
The shoes themselves are composed and function in several ways to accomplish this.
First and foremost. If you believe your feet to be neuropathic, you need to visit a or certified Pedorthist to make sure the shape of the shoes fit the shape of your feet. Easily said but not easily done by most people. The diabetic shoes help to accomplish this in several ways.

1) The shape : This is easily done as the shoes have a wider , and higher toe box to make sure that the toes are not being rubbed into the front or top of the shoes. This prevents the formation of blisters and callouses , that in a diabetic can and will lead to disaster. The soles are also a bit more substantial to allow better wear and more shock absorption, as well as a firmer ”footprint “ of the shoe as it contacts the ground.

2) The insoles: These are composed of several special material that cushion, comfort and cradle the foot so that with each step, the foot does not rub against the inside of the shoe. These materials are often “heat sensitive” and form impressions of things such as depressed metatarsals and help to distribute the weight of the foot in a more even pattern as the foot goes thru the gait cycle. Your foot specialist will frequently check these insoles to make sure they are wearing properly, and change them several times a year.

3) Fastening system or “Laces vs. Velcro straps”: If you can’t feel pressure on your feet how is one to know if they are laced too tightly?? Diabetic shoes usually have either one or two wide straps with which the use of Velcro not only make the shoes easy to lace, but help to make sure they are not too tight on the top of the feet. Let’s not forget that neuropathy can also affect the hand as well as the feet. If you can’t feel your fingers, how would one be able to tie shoe laces. This fastening system is also a tremendous boon for the millions of people with moderate to severe arthritis).

To sum up… The triad of daily foot inspection, proper sock s and use of diabetic shoes will go miles in helping to keep your feet ready to take that next big step toward tomorrow, as you deal with the daily struggle against diabetes.

Blog submitted by Rob Kosofsky DPM.

Sunday, July 24, 2011

Killer Lemonade

Everyone enjoys a nice cold glass of lemonade in the summers, especially with our heat lately. Recently, a friend of mine went through a local fast food drive thru and ordered sugar free lemonade. She is diabetic and is very careful with her daily sugar intake to keep her glucose levels in check. She took 2 sips and knew it was a little too sweet. So she pulled out her tester to see what the sugar level was and it read over 400! Had she assumed it was just a really good tasting sugar free drink, she was have ended up in a coma! So when she spoke with the restaurant manager they couldn't understand why she was so upset. Their offer for a free replacement they thought should have been enough. She tried to explain the problem and got "I don't understand what the problem is"!!!!!


So if you are reading this and you don't understand the problem, let me fill you in. If you are diabetic, sugar is not your friend! Especially excess amounts. Your body does not have a good way of processing that sugar. And excess sugar in the system causes harm to all vital organs. When that sugar gets to a certain high level, you can become groggy, light headed, feel faint and possibly end up in a coma or worse.

Now, let's say you don't end up in a coma, but you thoroughly enjoy that lemonade and you happen to have an open sore on your foot. Well, bacteria love sugar so basically you just gave them a meal of a lifetime! This causes more bacteria to grow leading to infection that could lead to a hospital stay, surgery or even amputation.

Wow! All that from a simple lemonade! Well, lesson here is to always ask for diet. And if you aren't sure about it, return and just get water. At least with water, you never have to worry about the sugar or calorie content!

Monday, July 4, 2011

Don't Step on That!!

It's 104 degrees in the shade in Dallas Texas these days. That makes our surrounding surfaces quite hot. In fact, it's about time for one of our local news crews to cook an egg on the sidewalk. So if it's hot enough to make a "smothered and covered" on the sidewalk, then you have absolutely no need to walk barefoot to check the mail if you are diabetic (and even if you aren't).

When diabetic patients lose the feeling in their feet, they often think it is ok to walk around barefoot. "It's ok, I can't feel it anyway". That's not the case. I will see time and again in the summers, diabetic patients who walk barefoot on sidewalks or concrete for just a few steps that cause 3 degree burns to those precious feet.

Now as I've discussed in previous blogs, any open wound can cause infection that leads to amputation. Burns are among the worst. Most of the time they do get infected. And if they are extensive, meaning covering the majority of the foot, that is high alert for amputation. And I'm not talking taking off a toe or two, the whole leg. Just for walking barefoot.

If this does happen to you, seek treatment immediately. The wounds need to be cleansed properly and antibiotics started right away. And a good wound care regimen is necessary to heal those wounds.

Be smart when it's hot. Wear your shoes!

Sunday, February 13, 2011

Diabetic Patients Need All We Can Give

It cannot be said enough, that everything that can be done must be done to prevent a diabetic patient from losing a limb. Here are some of the techniques that FAANT uses in this battle.

1. Vascular testing
With this exam, we are testing the blood flow status of the lower extremities, or the "plumbing" part of the legs. This non painful test applies pressure cuffs at different intervals to the feet and legs and gives us a picture of the amount of blood making its way to the toes. This study should be performed every one to two years to catch changes in blood flow that can occur in diabetic patients and enables us to treat this change aggressively. A dramatic loss in blood flow to the feet can lead to amputation.

2. Xray exams
Plain ol' xrays can play a significant role in protecting those diabetic feet. We are looking for changes like severe arthritis, breakdown of joints, infection, bone spurs and anything that can put your feet in jeopardy that can't be seen outside the skin.

3. Neurologic exam
Three things can be tested easily in the office: Light touch, vibration and proprioception (big word for you know where you are in space). Testing for these 3 things will give us a basic idea of what you feel and what you don't feel. And guess what...80% of the time, you don't feel what you think you do.

4. Bio-engineered tissue and grafts
When there is an ulcer, technology has given us the ability to get it healed quickly with bio-engineered tissue like Apligraf, Dermagraft and Theraskin. These products, when placed on a healthy wound, reduce the healing time dramatically.

5. Shoes, boots and stuff
To keep those feet healthy, we will often prescribe diabetic shoes with protective inserts to reduce pressure and possibility of ulcers. At times, it might be necessary to use walking boots, total contact casts, post op shoes and offloading pads to reduce pressure and save those feet.

6. Good old fashion exam
Actually examing your feet for signs of change or worsening. This is our single best tool. When we see things change, we must act to prevent further change that can lead to amputation. If a new callus pops up, we must stop it from ever forming again. Sometimes this is impossible, but there are so many things that can be done to keep that callus from becoming an ulcer. And don't think that those bunions and hammertoes goes unnoticed. They must be watched on a regular basis and sometimes surgically corrected to save those tootsies.

As we continue to strive to save more and more lower extremities, all of these things are nothing if you as a diabetic patient do not do your part. You must maintain control of your blood sugar, take your mediations as prescribed and check your feet every single day.

Wednesday, February 9, 2011

New Guidelines for Exercise in Type 2 Diabetes

New guidelines were published in late 2010 that stress the crucial role that physical activity plays in the management of Type 2 diabetes. Exercise is important and you should not let foot pain slow down your exercise program. The physicians at Foot and Ankle Associates of North Texas, in Grapevine, Texas, encourage our diabetics to exercise and can help you reach your goals with better shoe gear, functional foot orthotics and even physical therapy to get you on the road to better diabetes control! Do not use foot pain as an excuse not to exercise, contact us and get started today! The guideline are crystal clear on the importance of regular, vigorous exercise!

Developed by a panel of 9 experts, the new guidelines are published concurrently in the December issue of Medicine & Science in Sports & Exercise and Diabetes Care.

"High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently," the expert panel writes, "but it is now well established that participation in regular physical activity improves blood glucose control and can prevent or delay Type 2 diabetes mellitus, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life."

Most of the benefits of exercise are realized through acute and long-term improvements in insulin action, accomplished with both aerobic and resistance training, the experts write.

For people who already have Type 2 diabetes, the new guidelines recommend at least 150 minutes per week of moderate to vigorous aerobic exercise spread out at least 3 days during the week, with no more than 2 consecutive days between bouts of aerobic activity. These recommendations take into account the needs of those whose diabetes may limit vigorous exercise.

Sheri R. Colberg, PhD, writing chair, professor of exercise science at Old Dominion University, adjunct professor of internal medicine at Eastern Virginia Medical School, Norfolk, Virginia, and regular Diabetes In Control contributor, stated that, "Most people with Type 2 diabetes do not have sufficient aerobic capacity to undertake sustained vigorous activity for that weekly duration, and they may have orthopedic or other health limitations." "For this reason, the ADA [American Diabetes Association] and ACSM [American College of Sports Medicine] call for a regimen of moderate-to-vigorous activity and make no recommendation for a lesser amount of vigorous activity."

The panel specifically recommends that such moderate exercise correspond to approximately 40% to 60% of maximal aerobic capacity and states that for most people with Type 2 diabetes, brisk walking is a moderate-intensity exercise.

The expert panel also recommends that resistance training be part of the exercise regimen. This should be done at least twice a week -- ideally 3 times a week -- on nonconsecutive days. The panel also recommends that people just beginning to do weight training be supervised by a qualified exercise trainer "to ensure optimal benefits to blood glucose control, blood pressure, lipids, and cardiovascular risk and to minimize injury risk."

Regular use of a pedometer is also encouraged. In a meta-analysis of 8 randomized controlled trials and 18 observational studies, people who used pedometers increased their physical activity by 27% over baseline. Having a goal, such as taking 10,000 steps per day, was an important predictor of increased physical activity, according to the expert panel.

Finally, the new guidelines emphasize that exercise must be done regularly to have continued benefits and should include regular training of varying types.

Physicians should prescribe exercise, Dr. Colberg said in a statement. "Many physicians appear unwilling or cautious about prescribing exercise to individuals with Type 2 diabetes for a variety of reasons, such as excessive body weight or the presence of health-related complications. However, the majority of people with Type 2 diabetes can exercise safely, as long as certain precautions are taken. The presence of diabetes complications should not be used as an excuse to avoid participation in physical activity."

The physicians at Foot and Ankle Associates of North Texas encourage our diabetics to exercise and can help you reach your goals with better shoe gear, functional foot orthotics and even physical therapy to get you on the road to better diabetes control! Do not use foot pain as an excuse not to exercise, contact us and get started today!