Preventative Surgery: Is There Such a Thing??

Is there such a thing as preventative surgery? We usually think of surgery as something that we need to fix a problem that is currently present. That makes perfect sense! Why would we ever need to have surgery when there is no current need for it? To the average healthy person, preventative surgery seems like too much of a risk. Why fix something that doesn't hurt? Every surgeon would agree that in most cases this is correct assumption. Lets think outside the box for a minute. I will give an example to make it easier: I have been seeing a diabetic patient for several months who has a callus on the tip of his toe. His toes bend and don't straighten well. They are stuck in that position (we call those hammertoes). This is why he gets the callus. No biggie right? Shave the callus and all is well right? Say this patient has very little feeling in their foot(they have diabetic neuropathy) and cannot tell if the callus is getting irritated and they do maybe a little more than usual that day. By days end, they may end up with swelling and redness to that toe! Now that is a problem! Shave the callus this time to find a wound under it! If all is working in the patient's favor, we treat the wound and, over time it gets better. Eventually though, a callus forms over the healed skin because nothing in the patient's lifestyle has changed. Over and over this is the cycle. Callus, wound, heals. Callus, wound, heals. That is the best it gets. It heals at least. Here is the sacrifice. Every time the wound heals, scar tissue is left. Scar tissue is not as flexible or forgiving as regular skin. It forms callus more quickly because it is less resistant to friction. Some times it doesn't matter that they are in the best shoes and inserts,(and seeing the best podiatrist here at FAANT!),the skin is just too vulnerable. The worst case is that eventually, and this happens more times than you can imagine, the wound gets infected and the infection gets into the bone! That could lead to an amputation!! Who wants to risk that? Surgery in this case is a feasible option! Even if there is no wound, surgery is a viable consideration. What if we could do a surgery to straighten the toe (while they have no active wound), so that there is less pressure at the tip? We may be able to halt that vicious cycle and make visits to our office much more pleasant! Much needs to be considered health wise to make the best choice for this patient as there are risks with any surgery, especially in a patient with health problems. Is there more risk having this surgery or to continue cycling with a wound that keeps popping up, increasing the risk of infection every time it does? Next time you visit, keep an open mind about this possibility. If preventative surgery is an option for you, we will do all we can to make sure it is done under the best of circumstances!

Healing Diabetic Foot Ulcers

In my practice, I treat a lot of diabetic patients, and I see a lot of diabetic wounds. In this case, the wounds are called diabetic foot ulcers.

When evaluating diabetic foot ulcers, some of the things we look for as foot specialists are signs of infection, size of the wound, lab tests, blood sugar levels, shoes, and circulation of the feet and legs. All of these are important. Also, getting a good history from the patient is very important. We need to know how long the wound has been present, what medications have been given, and if any other treatments have been rendered yet.

As a podiatist, my main goal is to save my patients' feet. So this is a very important topic for me. We need the patient to help us do our job to heal the diabetic foot ulcer. Whether that means staying off of the foot or wearing a special boot, the doctor knows best when it comes to healing the foot ulcer. The longer the ulcer remains open, the higher incidence of infection (whether it be in the soft tissues or in the bone). And once it goes into the bone, that is when amputation occurs.

Dr. Michele Summers Colon, DPM, MS
3503 Lexington Ave.
El Monte, CA 91731
626-442-1223
www.elmontefootdoctor.com

Like our facebook fan page: http://www.facebook.com/drmichelesummerscolondpm

Please feel free to email me if you have any questions or if you would like to schedule an appointment, or you can visit our website or call our office.
dr.michele.colon@gmail.com

Diabetic Foot Infections Can Kill You!

Do you or someone in your family have diabetes? Ignoring your feet can kill you! Take a listen, save a life!

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!

Why Do Diabetics Lose Their Legs?

You have had problems with your foot for years. Your doctor now tells you that the foot needs to be amputated. How did this happen? Do you have to go through with the surgery? What will happen if you keep your foot?

Diabetes is a devastating disease. It can be managed, and many of the complications of diabetes are preventable. This takes much dedication of the patient and a team of doctors. Discovering you have diabetes and making life changes to prevent life threatening complication of the disease is very difficult. Thus, many people still run into problems associated to diabetes. Foot problems are among one the most common complications. 70% of all limb amputations are due to diabetes!

There are several reasons diabetics have foot problems but let’s talk about the three big causes. When the nerves are exposed to high levels of glucose or high blood sugars, they are slowly damaged. Thus, many diabetics suffer from peripheral neuropathy, a disease in which they slowly lose protective sensation in the feet. This can be very dangerous. I have had patients who had glass, needles, tacks and other objects stuck in their foot and they never remember how it happened. I have also had patients burn themselves in the bath tub. Their feet can no longer perceive temperature and they can easily burn or freeze their feet!

Diabetics also suffer from poor circulation. Blood carries many nutrients and oxygen that is essential to keep tissues healthy. Poor blood supply makes it extremely difficult for damaged tissues to heal. When a patient has a wound or ulcer on the foot, their poor blood supply makes it is so hard for the area to heal. Diabetics also have a compromised immune system. The body is weakened in its defense mechanism to fight off infections. Infections kill good tissues and leaves dead necrotic tissue behind. Infections can spread very fast from soft tissue to bone and joints and even into the blood supply. Infections can be life threatening.

When the threat of infection is too severe and can no longer be managed by antibiotics, the doctor may suggest an amputation. To remove all or as much dead tissue as possible helps prevent the infection spreading to other areas of the body. A doctor may also suggest amputation if the foot has become non-functional.

The thought of losing a part of your body is a very difficult concept to deal with. It is not uncommon for the doctor to suggest therapy to help the patient cope with process of surgery and rehabilitation. It is important to note that amputations are a part of medical plan to keep you as health as possible. It is important to discuss your fears and concerns with your doctor and to seek second opinions if you do not feel comfortable with your doctor’s advice. It is your leg and should be fully aware to the risk and consequences of keeping and amputating portions of your limb.

How Should a Diabetic Foot Ulcer be Treated?

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 podiatric physician diagnoses an infection, a treatment program of antibiotics, wound care, and possibly hospitalization will be necessary.

There are several important factors to keep an ulcer from becoming infected:

•Keep blood glucose levels under tight control.
•Keep the ulcer clean and bandaged.
•Cleanse the wound daily, using a wound dressing or bandage.
•Do not walk barefoot.

For optimum healing, ulcers, especially those on the bottom of the foot, must be “off-loaded.” Patients 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 ulcer area 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, peroxide, whirlpools and soaking are not recommended, as this could lead to further complications.

Appropriate wound management includes the use of dressings and topically-applied medications. These range from normal saline to advanced products, such as 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.

Why Do My Legs Hurt?

Peripheral arterial disease (PAD) is becoming more and more prevalent in America. Our love of fast food and convenience has lead to almost 10 million Americans to be diagnosed with PAD. Our body naturally starts forming plaques in our arteries. This is part of the aging process. Unhealthy lifestyles though cause abnormal increases in plaque and as we get older, these high levels of plaque hardens and causes narrowing of the blood vessels. Arteries supply the body with blood rich in oxygen. If the vessels narrow, the body is not getting the appropriate amount of oxygen to the organs and muscles. Thus, those with PAD are four times more likely to have a heart attack and almost three times more likely to have a stroke.

Who is at Risk? Those with diabetes have a significant risk in developing PAD. So much so, that the American Diabetes Association recommend everyone with diabetes over the age of 50 should be tested. Other high risk factors are high blood pressure, high cholesterol, family history of heart disease, or being overweight. Smoking will also increase your likelihood of developing PADS by four times.

The first signs and symptoms of PAD are often first seen in the legs and feet. This is why we highly encourage high risk patients to pay close attention to pain, discomfort or open lesions in the legs and feet. One will often feel like their legs get tired or painful when walking or climbing exercise. When experiencing this pain, it will go away with rest. This is termed intermittent claudicating and is a sign that your muscles are not getting enough oxygen. One may also feel numbness or tingling, coldness, changes in color, hair loss on the legs and feet. These are all be signs of a serious problem, but some people who have PAD do not appear with any of these symptoms. Thus it is very important to still get tested if you are at risk.

How to get tested? If you are experiencing any of symptoms above or are at high risk of getting PAD, you should consult a health care provider. Testing for PAD is noninvasive, pain free, quick and easy! The examiner will either use a standardized machine or manually take your blood pressure on your arm, ankle and other areas on your leg. Significant changes in your blood pressure in your legs and or ankle is diagnostic of PAD.

What to do if you have PAD. It is important to take the steps to adjust your lifestyle to prevent the progression of the disease. It is advised that patients stop smoking, lose weight, and exercise to improve blood flow. All treatment plans should be thoroughly discussed with your doctor to know what options are right for your body. The doctor may prescribe blood pressure medication, encourage physical therapy, and in critical conditions, surgery may be necessary.
Those suffering from PAD are at an increased risk of having several foot issues including non-healing ulcers. PAD patients should visit a podiatrist regularly for foot screenings and management of foot and ankle problems. A growing number of the American population are having foot and leg amputations due to the effects of diabetes and PAD. Many of these amputations are highly preventable when people take the appropriate steps to care for their feet and consult a podiatric physician when suffering from any foot and leg pain or abnormalities.

Obtaining Proper Shoes Through Medicare

Over the years, I have found that unfortunately, one of the best kept secrets among patients with diabetes is the Medicare Therapeutic Shoe Program. People with diabetes are instructed that they need to make sure they wear proper shoes. This is a program that makes this possible! Per Medicare guidelines, patients who qualify can receive one pair of shoes per calendar year, and three pair of accomodative inserts. Three pair of inserts are allowed because over time, they lose their ability to cushion the feet. By dispensing three pair, patients can change the inserts every 4 months, thus insuring that they always have proper cushioning and support in their shoes. While not every diabetic patients on Medicare qualify for this program, the truth is that many do qualify, and there are many who qualify who are not taking advantage of this program.



For a shoe to qualify for the Medicare Therapeutic Shoe Program, it needs to meet certain criteria. These include:

• Have more interior depth than a normal shoe, which allows for at 3/16" accomodative insert.


• Must be made from leather or a material of equal quality


• Must have some form of closure (usually laces or a Velcro closure)


• Must be available in full and half sizes


• Must be available in at least 3 widths.
  

Many diabetic patients are concerned that the shoes will be big, heavy or unattractive to wear. This is simply not the case. The variety of shoes styles available means that it is extremely rare not to be able to find a pair of shoes that meets your need, both medically and aesthetically. On top of that, the shoes are designed to be comfortable!

To qualify for shoes, you need to be examined by your doctor to see if you meet Medicare's guidelines for receiving the shoes. Once it's determined that you qualify, a letter will need to be received from your primary care physician who will certify that you are diabetic and would benefit from receiving the shoes. This is one of the few programs that Medicare offers that is intended to be preventative. Studies have shown that by wearing proper shoes, the risk of developing an ulceration in the foot can be greatly reduced. In other words, you don't have to already have had a foot ulcer to qualify, you just need to be at risk of developing an ulcer. You also do not have to be on insulin to qualify.

Most offices will do a fitting, then order the shoes for you. Once the shoes are shipped to the office, you will be contacted for shoe dispensing. In our office, we recommend that you wear the shoes indoors until you are certain that they are right for you. If for any reason they are not, they can be returned for a more appropriate size or style.

If you have not taken advantage of this program, talk to your podiatrist & see if it is something that you would benefit from. And if you have received a pair of shoes in the past, perhaps it's time for a new pair. Your feet will thank you!

Your 4 Keys To Reducing Your Diabetic Complications

People often worry about the complications that come with diabetes. Here are 4 keys to helping reduce your complication risks.

1. The best way to limit complications of diabetes (all the complications) is strict blood sugar control. You should be monitoring your blood sugar and seeking to have a A1c of 6 or lower. Spikes in blood sugar are not recommended at any time, as this provides opportunity for the complications to start. As you talk with your doctor, you can get an aggressive program to keep blood sugars managed.

2. Exercise helps control blood sugar. Exercise in a diabetic is an important part of your self care. This program should be under the direction of your physician and should include adjustments in medications as necessary, diet changes and carefully monitored exercise. Some key points include not exercising when blood sugars are highest, 30 - 60 minutes after meals and additional carbohydrates may be required to reduce hypoglycemia (low blood sugars). Talk with your doctor and get an exercise program that will work for you.

3. Examine your feet twice a day. The American Diabetes Association recommends you examine your feet daily for new areas of redness, new calluses, blisters, or skin changes. Since you are putting shoes on and taking them off, I recommend checking your feet twice a day. This provides you information on if a certain shoe or activity is causing any of these changes. If changes are noted to the feet, your feet should be checked by a foot and ankle specialist to help improve the problem before it becomes a bigger problem. As you examine your feet, you are performing the most important exercise to reduce wounds, infections and amputations.

4. Play an active part in managing your disease. No matter how good your doctor is, you are the key to good diabetic control. Learn all you can and work to reduce your diabetic foot complications (as well as other complications).

Remember in each of these keys, YOU make the difference. Preventing complications is a process not a destination and must be worked at on a regular basis.

Click here for additional information on diabetic foot complications.