Peripheral neuropathy is a common effect of diabetes. The blood sugar can cause the nerves to swell, affecting the nerve fibers within. Also, because diabetics suffer from problems with the microvascular circulation, there is a reduced amount of blood flow to the nerves. Neuropathy is not excusive to diabetes, however. Chemotherapy can cause neuropathy, which often continues after treatment stops. Alcoholism can also cause neuropathy. Unfortunately, there are also many forms of neuropathy that are not able to be attributed to a particular disease.

There are a number of pharmaceuticals that have been used for years to help alleviate the pain and numbness from neuropathy. Neurontin, Lyrica, and Cymbalta are a few of the better known and used medications. These are antidepressant medications that have an effect to moderate nerve pain. Unfortunately, because the medication often provides side effects, people are confronted with the decision of taking the medication and having relief or feeling exhausted and cloudy all day.

Medical foods are specially formulated supplements intended for the dietary management of a disease that has distinctive nutritional needs that cannot be met by normal diet alone. Two medical foods commonly used in podiatry are Neuremedy and Metanx.

Neuremedy is a fat soluble form of Thiamine (Vitamin B1). Thiamine deficiency is well-documented in those who can suffer from neuropathy, such as diabetics and the elderly. Resolving a thiamine deficiency can result in resolving the symptoms of peripheral neuropathy. Neuremedy delivers a bioactive form of thiamine that is readily absorbed and used by the body. I recommend that people try a two month course of Neuremedy to assess how effective it works. Neuremedy is dispensed from the office by many podiatrists and can also be purchased online.

Metanx is another medical food that is indicated for the distinct nutritional requirements of diabetic patients with peripheral neuropathy. Metanx regulates homocysteine and helps the blood vessels to produce a natural vasodilator called nitric oxide. As a result, blood flow increases in the vessels that carry important nutrients and oxygen to the nerves. This has been found to alleviate the symptoms associated with peripheral neuropathy. Metanx is available at all pharmacies by prescription.

When it comes to alleviating neuropathy symptoms, don’t stop at pharmaceuticals that can provide adverse reactions. Ask your podiatrist if a medical food can help to alleviate your pain and numbness.

First of all, the comments I heard were that he had to be PRETTY drunk to not feel his dog chewing off his toe (yuck!). That may be why he passed out, but he didn’t feel it for another reason. What he didn’t know is that he is diabetic…with a blood sugar level of over 500! Blood sugar should be kept at or below 120 for a controlled diabetic. With uncontrolled diabetes comes a syndrome called Peripheral Neuropathy. Neuropathy is a syndrome where the nerves become numb as the small vessels in the foot are affected by the high blood sugar levels. The foot becomes so numb that he wouldn’t feel a splinter, a bump, an infection, or even a dog chewing it off.

So how did chewing his toe off save his life? According to the article, the infection was in the bone. This type of infection could have spread up his leg putting his entire limb in danger. In fact, it could have put him into sepsis which could kill him. By the dog performing the amputation, he removed the infected section and prevented this from happening.

The take home message is this…if you notice a problem in your feet, whether you are diabetic or not, do not wait until your dog operates on you! Although much less newsworthy, you should visit a podiatrist to make sure that you are not putting your life or your limb in jeopardy.

For those who want more on the story, watch the video below (again…it’s pretty gross!)

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23 million people in the United States have diabetes, almost 8% of the population. There are 1.6 million new cases of diabetes every year. Why is a podiatrist so concerned about this? Not only can diabetes affect your eyes, heart and kidneys, but your feet are at great risk.

60-70% of people with diabetes end up with some form of nerve damage in their feet known as peripheral neuropathy. This causes a numb or painful feeling in the feet and legs and can affect one’s life dramatically. Think about the feeling you get when you hit your “funny bone.” Now think of that in both feet, constantly, 24-7…not too pleasant. Fortunately, we’ve had some success in treating diabetic peripheral neuropathy. In my office, I use a medical food called Neuremedy which is a fat-soluble form of thiamine, often deficient in diabetics. Another treatment is Microvas therapy. This non-invasive treatment helps to stimulate the small blood vessels to bring more oxygen and nutrients to the nerves, effectively reversing peripheral neuropathy.

Diabetes is responsible for 60% of non-traumatic lower extremity amputations. It’s been well documented that once someone has an amputation of part of the foot, there’s a very high chance that the other foot will be amputated within five years. Diabetics lack the ability to heal as well as those without. A simple crack in the skin or ingrown toenail can become a limb threatening injury. Diabetics should not wait to seek attention for anything on their feet, whether a callus or a diabetic wound or ulcer. In our office, a patient who calls with a diabetic concern is treated as a medical emergency.

All diabetics should establish a good relationship with their internist and/or endocrinologist to manage their overall diabetic control. It is also vital for a good relationship with a podiatrist and opthalmologist before there is a problem. An ounce of prevention is truly worth a pound of cure.

It was the first full conference of this type brought to the Federation. As presenters, we get energized with the excitement when attendees hear our material for the first time. In fact, sitting in on many of the talks given by my colleagues, I always pick up new ideas even though I have heard this material many times. We all look forward to returning next year.

The most striking thing I learned over the course of the weekend was that I was speaking to a room full of highly educated foot specialists. Of course I was…I’m a podiatrist myself! But these foot specialists are not considered to be podiatrists in the province of Ontario. They are chiropodists.

In the United States, chiropody was the precursor to podiatry with the designation having changed in the late 60′s. Chiropody is also the term used by the British, but the scope there is now similar to what a podiatrist does in the US. Of course in the US, podiatrists manage all ailments of the foot and ankle. We manage and care for our patients’ conditions with both conservative therapy, such as custom orthotics and bracing, and also surgical means.

In Canada, podiatry does exist in all provinces. In Ontario, however, podiatrists are restricted from performing bone surgery. The other strange thing is that no new podiatrists could be licensed to practice in Ontario since 1991. Even a podiatrist trained in the states are now licensed as a chiropodist. This group is now being discriminated against by the podiatrists who remain, numbering less than fifty. Sound ridiculous? It is!

The potential for podiatry and chiropody to unite and become more integrated in the health fabric of the area is great. It is the short-sighted outlook of these podiatrists who can’t see that as their numbers decrease, so will their relevance. When they retire, their practices will have no value. No child can go to school and take over the family business.

Why can’t chiropody and podiatry work together? Both professions can coexist as podiatry. The two, non-surgical and surgical can complement one another in a powerful way, just as ophthalmology and optometry do in the states. The infighting and underhanded methods being used by the podiatrists in Canada are ultimately going to hurt the profession across the country.

I support chiropody and it is time to change their designation to podiatrist. It’s time to stop confusing the public and start working together to strengthen a united profession.

In my Houston podiatry practice in the Galleria area, I have treated many soccer players, from kids running after the ball to collegiate and semi-pro players. There are a few common foot and ankle injuries that are most common to these athletes.

One of the most common situations I see is not an injury from playing soccer at all, but from the shoes. Soccer players notoriously wear their shoes too tight. This causes problems with their toes forming painful corns and calluses, toenails getting bruised from the added pressure, and even ingrown toenails that become painful and infected. Soccer players insist that the shoes need to be tight to allow them to feel the ball. The truth really lies in the culture of the sport and the athletes would be better served with well fitting shoes.

During game play, sprained and broken ankles are common, as they are with most turf sports. Ankle injuries occur because of the starting, stopping and pivoting motions of the foot. When a soccer player makes a sudden pivot, they stand a good chance of being off balance and rolling their ankle. This injury can be prevented by wearing an ankle brace or taping the ankle. Ankle injuries that occur should be cared for immediately. Early immobilization and therapy to restore strength and balance have been proven to allow for the most complete recovery and return to play. Of course an ankle fracture is more serious and required immediate attention.

Turf toe is another common soccer injury. Although more associated with football, it is common whenever the great toe joint can become overextended. This creates a jamming of the joint and severe chronic pain. This can keep a soccer player on the sidelines, but can be controlled. The mechanics must be addressed with a custom orthotics to redistribute the pressure on the great toe joint. A thin carbon steel insole can also support the joint and can reduce the pain significantly in a matter of days.

The World Cup will do doubt trigger an increase in youth and adult involvement in soccer.  An understanding of the possible injuries, prevention, and early detection and treatment will lead to a much more thorough enjoyment of the sport.

These 12 inch platform heels designed by Alexander McQueen are so over the top that models refused to wear them, citing them too dangerous to walk in.  I can’t blame them.  First of all, the foot is just not shaped that way.  Second, all I can think about is that this is what a female Herman Munster should be wearing!

But then again, Lady Gaga wore these heels in her video for Bad Romance and seemed to move around fairly well in them, possibly with some trick photography.  Singer Kelis did wear them on the red carpet.  Of course the originals are far too pricey for the average woman, but LF and Jeffrey Campbell have made a similar version for the masses.

What do you think?  Would you give them a try?  Would you let your daughter wear them?  Let me know!

Ah, yes…bathroom surgery. No big deal, these operators insist, I’ll just dig out the corner. What? No, my toe always bleed when I trim them. Isn’t that normal. Huh? Doesn’t happen to you? Hmmm…you must be doing something wrong. But what’s the telltale sign of a bathroom surgeon? When their spouse/child/pet steps on their foot and they fall down in tears!

It’s true…when you have an infected ingrown toenail it seems as if a big target is then painted on your foot. Everything WILL hit it! It’s one of Murphy’s most reliable laws. I’d like to offer some compelling reasons to retire from the not-very-lucrative specialty that you have chosen.

Most bathroom surgeons know that their success rate isn’t so good. Your operation may temporarily help the pain, but how long does it stay gone? Not very long! Within a month you’re back at it again? If you had your appendix out and it kept growing back every month and you nnede to have it out again and again (without anesthesia), would you be happy? I think not!

When patients come into the office with an ingrown toenail, I’ll offer a recommendation about what needs to be done. If the toe is infected, our choices are limited. Next, we’ll make sure the toe is good and numb before we proceed with any procedure. The procedure will be painless, but I’ll be honest that the numbing requires an injection which is uncomfortable. Once the toe is numb, the procedure generally takes under 5 minutes with little bleeding. You’ll leave, usually in the same shoes you came in, with a bandage on your toe.

As you can see from her colorful outfit (well, kinda black really) topped off by shoes that have NO heel.  She’s forced to walk on her toes with her heel suspended behind.

These shoes (which by the way, she’s been seen in before) can cause stress on her Achilles tendon, causing it to inflame, and even cause heel pain.  Also, because the pressure is forced to the ball of her foot, she also opens herself to possible stress fractures.

That’s just the issues in her feet!  She also can have pain and problems with her knees and back because of her altered gait and weight distribution.  They’re also a major fall waiting to happen!!

I’m pretty sure her shoes are not going to be mainstream, especially here in Houston, but I’d hope that Lady Gaga is careful of how much she wears her extreme footwear before she starts hobbling around the stage rather than dancing.

People assume that because they keep a clean house that there are no dangers lurking. Take one patient who came in with a splinter that she couldn’t get out. There was definitely a hole where a splinter could have entered and x-rays showed some soft tissue changes. What did I pull out of her foot? A toothpick! A WHOLE toothpick! She was flabbergasted! Needless to say she was a bit grossed out, but felt much better.

I’ve also pull out many, many thick wiry hairs from the foot. Pet hairs, especially short-haired dogs like black labs, have hairs like wires.  You’d be amazed how often they can get into a bare foot and cause a full, painful foreign body reaction to form. They’re also tough to get out, since they cut and snap easily.  Be careful when you brush your pup!

These are extraordinary examples.  Mostly I’ll find a wood splinter or glass sliver.  Most of the time I can get it out in the office but if it is particularly deep, we’ll need to go to the operating room.

If you step on something, unless it’s easily accessible, you must come in to get it checked.  Sometimes a tetanus shot is necessary and antibiotics may be prescribed.  For diabetics, a foreign body is truly a medical emergency, since it can easily become infected.

It is so easy to write a splinter off as nothing more than a nuisance, but if it gets more painful with time, it is a sound idea to give the office a call.  We’ll get you in immediately!

During the Celebrity Apprentice, Michaels won his task as project manager to donate a nice sum of money to the charity he is playing for, appropriately the Juvenile Diabetes Association. He demonstrated how someone living with diabetes can live an exceptional life with the proper control. We also through him the lows when diabetes is put on the back burner and his sugars levels dropped too low.

The most heart-wrenching moment of the season was when he learned that his daughter might be diabetic. Type-1 diabetes can be passed to children. Every parent wants their children to be safe and healthy and the agony that Bret was in, blaming himself for his daughter’s potential illness, was palpable.

As a parent, a fan, and a podiatrist in Houston, TX, I wish a full and speedy recovery to Bret Michaels. I hope he continues to share his experiences to raise awareness of those living with diabetes.