On Your Feet

Infections and Horrible Mistakes

2010-11-21T22:41:00.002-05:00

A recent news story tells of a woman whose "minor gynecological procedure" was botched, resulting in her having both legs amputated. According to the link, her colon was perforated. This caused an infection, and she ultimately had gangrene spreading to her feet. Once gangrene sets in, the tissue is for all practical purposes dead. It is a medical emergency. All dead tissue must be removed in order to minimize the damage, and, unfortunately, this patient lost her legs below her knees.

It might seem odd that you could get an infection in a hospital. Generally speaking, hospitals will try to be as sterile as possible where patients will be exposed. However, by making efforts to sterilize the environment, it ensures that only the toughest bacteria can survive. Though a rare occurrence, being infected by these aggressive, antibiotic resistant bacteria is a very serious matter.

The more pressing question on your mind is probably, "Who's to blame?" The answer to that question will be determined in a court of law. Patient privacy prevents us from knowing the full details of how her infection progressed. Perhaps it was due to negligence on the part of the surgeon or hospital.

On the other hand, she might be one of the unlucky one-in-a-million medical catastrophes. While medical science has advanced by leaps and bounds over the years, we still don't know everything. There are no guaranteed successes in medicine. All surgeries carry the risk of infection. While the story above is an extreme case, patients need to realize that surgeries occasionally do not go as planned. Doctors, including podiatrists, make efforts to prevent these kinds of disasters, but the bottom line is that we are still searching for the fountain of youth. Until then, bad things will happen, and it might not be anyone's fault.

Calluses—What You Might Not Know

2010-11-09T15:18:00.002-05:00

We all know what calluses are, and we all have them to some extent. They are the thick areas of skin that appear on the bottom of your feet in places where there is a high amount of friction. Of course, you can find them on your hands as well, depending on your hobbies and occupation. They are basically harmless, since they are your body's way of protecting you from the stresses you are exerting on it.

Your podiatrist's role in treatment of calluses is to get to the root causes. Yes, we can sand them or trim them away (what we call debridement). Another option is to offload the area by applying protective pads. However, it may be fruitful to ask the question, "Why is the callus appearing in the first place?" Perhaps you are walking abnormally, or maybe you have an irregularly shaped foot. Don't be embarrassed if this is the case—nobody's perfect, and that's true of feet too!

Calluses should raise a red flag for people with diabetes. Remember that a callus is the body's response to friction. However, people with diabetes are prone to developing ulcers where the callus began. This is due to a couple of things. First, some people with diabetes lose sensation in their feet, so they don't know if they're inflicting harm on them. Secondly, poor circulation is another side effect of diabetes.

Dueling Surgical Groups

2010-11-01T00:15:00.002-04:00

Today's topic is more relevant to podiatrists than it is to patients, although it may affect patients in the future. I recently was chatting with one of my colleagues in the M.D. program at my university, and we were engaging in a little interprofessional trash talk. After I made light of the fact that the American Medical Association has less than 20% of doctors as members, she retorted that we podiatrists have "dueling surgical groups." This refers the rift between the American Podiatric Medical Association (APMA) and the American College of Foot and Ankle Surgeons (ACFAS).

Without going into too much detail, ACFAS was formerly under the umbrella of the APMA, before they decided to assert their independence and secede from the APMA. Not to be outdone, the APMA believed they needed a surgical group under their auspices and created the American Society of Podiatric Surgeons (ASPS). So now, we have two podiatric surgical societies. While I have described this conflict in cavalier terms, it should be noted that there are good arguments on each side, and I am not endorsing one over the other.

Nonetheless, this is a disaster. For decades, the APMA has lobbied on behalf of the profession to give podiatrists the clinical privileges we enjoy today. In return, podiatrists have united behind the APMA. At the same time, ACFAS has been the premier surgical group for decades. No, this will not result in a civil war. However, as the years go by, this divide could result in podiatrists going in different directions. Because podiatrists have been able to unite in the past, we enjoy tremendous recognition as medical professionals. I hope that despite these differences, we continue to be able to rally behind our common cause.

A Pregnant Woman’s Feet

2010-10-29T10:43:00.002-04:00

Pregnancy causes many changes throughout a woman's body, and the feet are no exception. Fortunately, these changes are relatively benign and can be addressed without extraordinary effort.

The complex process of creating a new life requires that a woman carry extra weight around with her at all times. As with people who are overweight, this causes the mother to alter her stance and pronate, which flattens out her feet, stretching out and irritating her plantar fascia. If left untreated, it may result in pain along the bottom of the heel. However, this can be addressed with orthotics. Your podiatrist will be able provide guidance as to what is the best orthotic for your condition.

Another change has to do with circulation. When our blood circulates through the foot and leg, our veins are designed to carry it back up to the heart using a system of valves and muscles not unlike the locks in the Panama Canal. Under normal circumstances, some of the serum (the watery component of blood) will leak out and accumulate in the feet. It is not uncommon, however, for the drainage mechanism in expectant mothers to not function as efficiently. Consequently, more fluid leaks and accumulates in the feet, resulting in swelling, also known as edema. (See the link for treatment options.) You should not be surprised if you need to buy larger shoes to fit your feet!

One thing you should not change is your exercise routine. In other words, if you're doing it, great, keep it up, but if not, now is not the proper time to start a vigorous regimen. Exercising is associated with shorter and easier labors. However, your body will warn you if you're overdoing it—bleeding, nausea, faintness, and shortness of breath are all signs that you need to cut back. Both your podiatrist and your OBGYN will be able to help you determine an appropriate level of activity.

Ultrasound in Podiatry

2010-09-30T12:12:00.003-04:00

If you have children, you are probably familiar with ultrasounds. After all, it's what the OBGYN uses to take pictures of your baby while he or she is still developing. However, ultrasonography is useful in many areas of medicine to show pictures of body parts below the skin, including podiatry.

"Ultrasound" means that the machine is producing sound at a pitch much higher than what the human ear can detect. The doctor will place a transducer up against your foot, producing sound waves, and the machine detects the echoes that bounce back. Using these echoes, the machine is able to put together a picture of the different tissues in your foot in the same way that dolphins and submarines use sonar to detect other objects and hazards in the water.

So what is it good for? Since ultrasound depicts soft tissue problems, it is useful to diagnose plantar fasciitis and various tendonitis, though the list is longer. Other advantages:

No radiation, unlike X-ray and CT
Live Action—you don't have to wait for the image to develop because it's on the screen instantly
The doctor can direct injections by watching where the needle is going on the screen

Another advantage to ultrasonography is the cost. An in office ultrasound ($100-$160) is significantly cheaper than an MRI which can cost 5 times as much. An MRI is a much more detailed image than an ultrasound, but in many cases they are not necessary. A common misconception amongst patients is that more medicine equals better medicine. While you might like to have the best diagnostic test out there, in the back of your podiatrist's mind is the question: is it worth it? Should we spend more money to get a more accurate diagnosis? Or can we get a good level of accuracy using low-tech methods? Podiatrists will disagree about the answer to these questions, since there are good arguments either way.

Luke McCown, ACL injuries, and Podiatry

2010-09-23T14:44:00.002-04:00

This past weekend, the Jacksonville Jaguars lost their quarterback for the season due to a torn right ACL. The ACL refers to the anterior cruciate ligament, found in the knee, and tearing it is a relatively common injury in football. (Anterior means front or forward, and cruciate simply means it runs diagonally instead of straight up and down.) So why would a foot doctor be interested in a knee injury? As I discussed here, podiatrists are more than just foot doctors. We study the entire lower extremity. While knee surgery is technically outside of our legal scope of practice, many of our patients are athletes and will suffer this injury. Besides, anatomically speaking, the knee is one of the coolest joints in the body.

The knee is marvelously complex. Unlike other joints, it is held together entirely by soft tissue—ligaments, cartilage, and muscles. The ACL is one of these ligaments, and its job is to prevent the lower leg from sliding forward on the thigh by connecting the top of the shin bone (the Tibia) to the bottom of the thigh bone (the Femur). In fact, one of the ways to test for an ACL rupture is for the doctor to pull on the shin of a person lying back to see if it slides forward.

Surgical repair is often necessary for an ACL rupture, since it will not heal on its own. This is where the podiatrist needs to pass the patient on to the orthopedic knee specialist. The repair is performed arthroscopically, meaning a tiny camera is inserted into the joint, minimizing the invasiveness of the procedure. Despite that the procedure is minimally invasive, the patient will still have many months before returning to 100%, and this is why Mr. McCown will spend his season on injured reserve.

One of the clichés of our profession is that podiatrists and orthopedists have an adversarial relationship, fighting over which group is the final authority over which region of the body. However, the truth is that we can work together to our mutual benefit. The podiatrist refers out the patients with knee injuries to the orthopedist, and the orthopedist refers out to the podiatrist patients with the foot and ankle issues. While this is an idealized picture, this sort of multi-specialty cooperation results in much better patient care.

Ingrown Toenail

2010-09-21T17:15:00.002-04:00

After some unanticipated technical difficulties, we here at On Your Feet are back online and proud to resume blogging! We herald our return by discussing one of the more common sights to any podiatrist: the ingrown toenail, also known as onychocryptosis. If you feel pain around the sides of your toenail, or if they appear red, the nail has probably grown into the side of the foot and is digging in. Furthermore, redness is a sign of infection, and your podiatrist will prescribe antibiotics.

Ingrown toenails arise in various ways. Sometimes you cut your nail too short, changing the way it grows. Other times, you might bump your foot, and that is the cause. And then, you might just be born with it.

You can attempt to deal with an ingrown nail on your own by soaking it and wearing shoes with a wider toe box. Your podiatrist can also treat an ingrown toenail surgically. However, to call it a surgery is a bit of an overstatement, since you will be wide awake and perfectly capable of walking out of the office under your own power. The podiatrist will simply numb up your toe, and trim away the portion of the nail causing irritation. He or she might also apply chemicals to ensure that no further nail grows back.

The Arch of Your Foot

2010-08-29T12:59:00.002-04:00

Podiatrists categorize feet by shape. We have an "ideal" foot shape, and anything that is not ideal we say is "deformed." The catch is that almost everybody has some degree of deformity! So don't be insulted if your podiatrist talks about your "deformed" feet—you're just like everyone else.

One aspect of your foot shape is the arch. The arch of your foot begins at the heel bone and goes forward to the ball of your foot—behind the toe joints. Your heel bone should make approximately a 10˚ angle with the floor, though you would need an X-ray to measure this exactly. High arched feet and low arched feet each present their own problems, so consult with Dr. Reddy or a podiatrist in your area to figure out how to best treat your unique feet!

If your foot is arched higher than normal, you have what is known in medical jargon as pes cavus. Some people are born with it, while others will have high arches due to muscle weakness. Muscle weakness, in turn, can be due to diabetes, neurological deficits, or trauma, so it's important to keep open lines of communication between podiatrists and other specialists. High arches can be treated with surgery or with orthotics, depending on the patient.

On the other hand, a flat foot is known as pes planus. Once again, some people are born with flat feet, while others get them later in life. The bones of your feet are held together by ligaments, and the less tension in your ligaments, the easier it is for the bones of your feet to flatten out. Young children have very flexible feet, so if they look flat, don't worry quite yet, because it could be normal! Your podiatrist will tell you if your child will "grow out" of his or her flat feet.

Adult feet can flatten out as part of the aging process or as a result of Charcot neuropathy. Whatever the case may be, definitely consult with your podiatrist, because he or she will tell you how to modify your lifestyle in response to your changing foot.

To Operate or Not to Operate

2010-08-18T13:04:00.002-04:00

They say medicine is an art, not a science. You would like to think that your doctor knows what's best and that his or her recommendations will make you better. In some cases, this is true. We have come a long way in the last century. In other cases, the doctor is tasked to choose the lesser of two evils.

Last week, I was shadowing a podiatrist in a hospital. A 69 year old woman was admitted after being hit by a car. Luckily, her most severe injury was a fractured second metatarsal. (The metatarsals are long bones in the middle of the foot where the toes attach.) The fracture was displaced, meaning one piece of bone was slightly off to the side and not lined up with the other piece.

In general, bones will heal if you line up the pieces. In cases like this, surgery is needed to put the pieces together (called reducing the fracture), and the podiatrist will probably use pins or screws to keep the bone fragments aligned to ensure it heals properly.

However, for whatever reason, the patient refused surgery, and the doctor accommodated the patient's wishes. Ideally, we would like the bone to heal as best as possible. But do we want to put an elderly woman into the kind of trauma that surgery entails? Without surgery, the bone would heal—not properly, but it would heal. On the one hand, the bone might not hold and the woman could be back in the hospital years down the road. On the other hand, considering her activity level, she might happily live out the rest of her days and never worry about it again.

In podiatry school, we are tested with questions that have right and wrong answers. However, in practice, sometimes there are no "right" answers. In complex situations like this, podiatrists will not easily come to a decision, but rest assured knowing they are doing what they believe is best.

Bathroom Surgery

2010-08-03T13:52:00.002-04:00

What follows is a story from what I observed in clinic as a student. A Spanish speaking, uninsured patient came into the clinic with an ingrown toenail. Not terribly exotic, as far as podiatry goes. However, he complicated the matter by attempting to trim away the growth—what the attending podiatrist referred to as "bathroom surgery." She then verbally expressed frustration to the three students in the room, in front of the patient, since the patient's work actually made the procedure more laborious.

I think there are two insights to be gleaned from this.

The first is for patients. Quite simply, leave the surgery to the doctors. Don't try to fix something on your own, because you might make it worse.

The second insight is for the doctors and is a bit more nuanced. When is it appropriate to criticize patients? Would you exploit a language barrier to say things you wouldn't say in front of an English speaking patient? Is it unreasonable for doctors to expect patients to avoid attempting to solve their own medical problems? We self-treat for colds and headaches. Maybe this patient believes (incorrectly) an ingrown toenail is in the same category.

Also, economic considerations will make an uninsured patient more likely to take matters into his own hands. The patient reasons that he can either self-treat or pay for the office visit. If self-treating works, the patient saves money, but if self-treating doesn't work, the patient might not bear any additional costs other than what he would have paid by seeing the doctor from the beginning. So, from the patient's perspective, why not give it a try?

Lastly, the patient simply could be nervous about going to the clinic and wants to avoid going as much as possible.

The intent of this post is not to criticize one doctor. Perhaps she is a phenomenal doctor who was having a bad day. In medical school, we are taught to have empathy for patients, but putting that lesson into practice is clearly difficult. The real lesson is that, while we are talking about the tiniest of ethics violations (if you even consider it a violation), we nevertheless hold ourselves to higher standards as health care professionals. That means having understanding for patients who do things that we discourage, like performing bathroom surgery.

More Fungus Among Us

2010-07-31T17:58:00.002-04:00

Last week, we discussed the symptoms and treatment of Athlete's Foot. This week, we consider a similar condition, infection of the nails. In medical jargon, this is known as onychomycosis.

Nail infections can occur in either the toe or finger nails. However, fungi prefer places that are dark and damp, so toenails are far more likely. As we age, our ability to fight infections diminishes, so nail fungus is more common in the elderly.

Symptoms of fungal infections include:

Nails that are yellow, white, or brown
Nails are losing their shape and/or cracking
Nails lift up off the toe in some cases

Prevention is similar to Athlete's Foot. In short, keep your feet dry and avoid other wet areas where other people are walking bare foot.

Symptoms of fungal nails are similar to other skin conditions, including psoriasis, so your podiatrist might take a sample from the toe to confirm the diagnosis. Once you are certain it is a fungal infection, it can be treated with oral antifungals. Your podiatrist might also prescribe a topical cream, but this may or may not prove effective if the fungus is under the nail. In either case, plan to be using the drugs over several months.

Recently, a new treatment involving lasers has been approved. It is relatively pain free and kills all organisms in one visit. Furthermore, you will not have the side effects you might have by taking the drugs (usually in the liver or kidney). Unfortunately, this procedure is considered aesthetic by insurance companies, and you will have to bear the cost.

Fungus Among Us

2010-07-25T15:14:00.002-04:00

If you enjoy watching Seinfeld reruns, you probably remember the episode where Jerry describes podiatrists as being "knee-deep in fungus." While this is probably exaggerated, fungal infections are still a very common occurrence in the feet, as well as other body parts.

The fungi (plural of fungus) that infect humans are microscopic organisms that are similar to plants. They are distinct from bacteria, however, so antibiotics will not be effective. (In fact, the original antibiotic, penicillin, was extracted from a fungus.)

Fungal infections arise from handling other animals, contact with dirt, or most commonly, are transmitted from other people. Among these human-to-human fungal infections, the most common is tinea pedis, the cause of Athlete's Foot.

Athlete's Foot is commonly transmitted in locker room showers and other common areas where people will walk around barefoot. You can also contract Athlete's Foot by sharing the footwear of an infected person. If you have an infection, you will have itching and burning that usually starts between the toes. It can lead to blistering and cracks in the skin. Also, the infection might spread to the nails, resulting in color changes and a bad odor. If left untreated, the infection spreads across the sole of the foot, resembling a moccasin in appearance.

You can prevent Athlete's Foot by doing the following:

Keep your feet dry. Fungi spread easily in wet areas.
Wear sandals when walking in moist areas like locker room showers.
Always wear dry socks

Fungal infections generally do not go away on their own, so you will need to seek treatment. Fortunately, there are many over the counter topical treatments available. For additional advice, consult with Dr. Reddy or a podiatrist in your area. Lastly, avoid touching the infected area and then touching other body parts, because the infection will spread to the hands, scalp, and armpits if contacted.

What is a Podiatrist?

2010-07-10T22:43:00.002-04:00

The fact that you are reading this site indicates that you already have an idea of what a podiatrist is. Still, it's important that patients know exactly what kind of medical specialty we are. So we'll be taking a break from the usual medically themed blog entries to give a fuller idea of what services you can expect from your podiatrist.

Are podiatrists "real" doctors? YES! Our medical curriculum is almost identical to the curriculum at allopathic and osteopathic medical schools. True, we skip over some content pertaining to psychiatry and OB/GYN, since this is so far removed from our scope of practice. However, we focus much more heavily on the structure and function of the lower extremity than our M.D. colleagues. Rest assured, that when you are talking to a podiatrist, you are speaking to a true authority on the foot and ankle. Accept no substitutes!

A podiatrist is just a foot doctor, right? Podiatry began as a specialty concerning ailments of the feet. However, today, politics is really what determines what body parts a podiatrist can and cannot treat. While the laws vary from state to state, podiatrists in Jacksonville, Florida can practice from the foot all the way up to the hip. (In some states, podiatrists practice on the hand!) There is speculation that, in the future, properly trained podiatrists will perform knee replacement surgeries. However, there has and will always be plenty of business for us in the foot.

How much money do podiatrists earn? I find earnings to be a crass topic to address, but it is nonetheless a common subject of discussion amongst my peers. An older podiatrist told me once, "If you're in this for the money, switch to dentistry." Suffice it to say, however, no podiatrist will ever wonder where his next meal is coming from.

Toe Fractures

2010-06-30T19:51:00.002-04:00

So you've noticed that your toe is red and bruised. Maybe you dropped something on it the other day, or maybe you bumped into a door. Maybe you did nothing at all in particular, other than your usual jogging routine. If your toe is red with throbbing pain, it may be fractured. While we have blogged before about stress fractures, you are probably more familiar with traumatic (also known as acute) fractures, which are caused by sudden blows.

Of course, there are other possibilities. It could be a sprain, dislocation, or other soft tissue injury. Usually, X-ray is necessary for a definite diagnosis, although some fractures may be too small to detect. Other signs of a fracture include a crooked appearance and "pinpoint pain." Pinpoint pain means pain centered at the site of impact. Also, just because you can walk on it doesn't mean it's not broken!

If you suspect you have a fractured toe, seek advice from Dr. Reddy or a podiatrist in your area. Failure to do so may result in the toe never fully healing. This can lead to deformities, arthritis, and chronic pain. So your best bet is to get help sooner rather than later!

Your podiatrist will recommend one or more of the following:

Rest, Ice, and Elevate: this might be all you need
Splinting
Buddy Taping: tape the broken toe to a healthy one next to it
Surgery: For serious fractures, surgery may be necessary.

Depending on the degree of the injury, it may take several weeks to heal. Afterwards, be sure to let your podiatrist know if you continue to experience pain in the toe, since this might be a sign that the bone did not heal properly.

Blisters: Prevention and Treatment

2010-06-20T17:59:00.002-04:00

With the official start of summer on its way, people in Jacksonville and across the country will be starting their favorite outdoor activities. Whether you are a runner or play other sports, you should take steps to make sure your feet don't blister.

A blister is a fluid filled sac in the upper layer of skin. While they can be caused by chemicals or burns, our most common encounters with blisters are probably from those caused by friction. They are more common in warm conditions and when your skin is wet. Thus, blisters on the feet are preventable by doing the following:

Wear well-fitting shoes
Make sure they've been broken in
Don't walk long distances in dress shoes
Wear absorbent socks to keep your feet dry
Bandage or tape problem areas

Of course, when you do get blisters, take these steps:

Remove whatever is causing the irritation. This can be accomplished with bandages or better fitting shoes.
Blisters will heal on their own if left alone, so you probably will not need medical attention.
Don't pop your blister! This skin covering your blister is a natural barrier to infection.

If your blister is painful, you can find instructions on how to drain it here, courtesy of the Mayo Clinic.

Occasionally, a blister will become infected. Other times, infections will cause blisters. In either case, your podiatrist will have you on a course of antibiotics.

3 Causes of Joint Pain

2010-06-15T13:24:00.002-04:00

Almost all of us, at some point in our lives, will experience arthritis, or pain in the joints. It's practically unavoidable. And there's a very good chance that it's just the pain that comes with age. But before you start popping aspirins, consider some of the possible causes:

Osteoarthritis, also known as degenerative joint disease: 27 million people are living with this condition. If you are not already one of them, there is a very good chance you can add yourself to their numbers by the time you reach your 60s. Our joints are lubricated and cushioned by a tissue known as cartilage. Over the years, depending on your lifestyle, this cartilage wears away. When that happens, bone is rubbing against bone, causing small trauma. Your body responds by "filling the gaps" with tiny bits of its own bone, called osteophytes. These actually don't help, causing more pain.
Rheumatoid Arthritis: The symptoms are very similar to osteoarthritis, though people with rheumatoid arthritis are more likely to have warmness in the affected joints. This is because of a reaction against the joint capsule, a sack-like tissue which surrounds your joint and keeps fluid inside. Once again, the inflammation results in a loss of cartilage.
Gouty Arthritis, or plainly, Gout: The first two items on our list will cause pain in joints throughout the body. Gout, on the other hand, tends to start out at only one joint, and it's usually at the base of your big toe. You can distinguish gout from the others because the joint will be exquisitely tender, hot, and red. It might surprise you to find out that this is actually a disorder of the liver and kidneys. Normally, your kidneys will filter a waste molecule called urea into your bladder so it can be expelled. People with gout are unable to complete the biological process that produces urea, and so a chemical (uric acid) remains in the blood stream, where it is deposited somewhere. And usually that location is the joint of big toe, for some reason.

In general, arthritis is treated by warm baths, massage, stretching. Aspirin or Ibuprofen may also be useful. However, the causes of arthritis are far too many to cover in one blog entry. If you have joint pain your feet, consult with Dr. Reddy or a podiatrist in your area. This is particularly true if you have a fever as well.

What Are Orthotics?

2010-05-27T14:25:00.002-04:00

In past entries, we've mentioned orthotics as treatment options for foot conditions. Orthotics are just shoe inserts, right? Well, they're actually more than that. Shoe inserts will provide cushioning and feel comfortable, but that is the extent of what they're supposed to do. Orthotics are actually designed to correct the way you walk.

Many foot injuries arise simply because your foot isn't landing on the ground in the right way. With orthotics, your foot will be reset the bones of your foot in a neutral position so it can function naturally. They will distribute your weight more evenly over your foot, realign your knee and ankle, and generally improve the functionality of your foot. Here are some examples of people who would benefit from orthotics:

The patient with diabetes and loss of feeling in the foot
The runner who is prone to stress fractures
A victim of a stroke who needs to relearn how to walk
People with fallen arches or flat feet
Those suffering from heel pain and plantar fasciitis
People with bunions

In addition to these conditions, sufferers of low back pain and knee pain might benefit from orthotics. If your foot is not hitting the ground properly, the resulting misalignment will put your entire body out of balance. If you are experiencing pain in your back or foot, consider discussing orthotics with your podiatrist.

5 Steps to prevent Foot Ulcers

2010-05-25T00:03:00.002-04:00

When we think of ulcers, it is easiest to think of an ulcer of the stomach—a gradual wearing away of the stomach lining. However, people living with diabetes need to be watchful for ulcers on their feet. Simply put, an ulcer of the foot is a discontinuity in the skin. Many small causes add up to lead to ulcers, but the largest contributing factor is neuropathy. And unfortunately, according to the American Diabetes Association, up to one in four people with diabetes will develop an ulcer.

So what can you do to beat the odds?

Check your feet daily. Ulcers don't happen overnight, but instead are the result of lots of small traumas that happen over time to your feet. Look for calluses, ingrown toenails, and bunions because these are signs of excessive wear on your feet.
Take care of your skin. Look out for dry skin and cracks (fissures) in your skin.
Wear proper footwear. We're going to sound like a broken record, but proper footwear will save you from many foot injuries, including ulcers.
Quit smoking. We know, easier said than done. However, smoking delays the healing process, making ulcers all the more concerning.
Manage your blood sugar. Doing so will halt the progress of neuropathy, which in turn will lessen the likelihood of developing an ulcer.

Ulcers are the number one cause of diabetic foot amputations. Luckily, by maintaining a close relationship with your podiatrist, you will be able to save your foot and stay healthy.

4 Options for Plantar Fasciitis

2010-05-18T16:17:00.004-04:00

Do you have pain on the bottom of your foot? There is a very good chance that it is due to plantar fasciitis (fash-ee-AY-tus). The plantar fascia is a tissue sheath that protects the foot and maintains the arch. It attaches at the heel bone (calcaneus) and inserts into the bases of the toes. Unfortunately, it will become inflamed with overuse.

Plantar fasciitis is very common in runners and high-impact aerobics. Usually, you will feel pain in the morning or after sitting. It will go away after 5-10 minutes of activity and then come back after resting. However, you can prevent plantar fasciitis by wearing proper footwear.

Treatment options are expansive, ranging from stretch exercises to surgery. It's best to build your way up, trying things and seeing what works. Here are some other possibilities:

Night Splint: Wearing this will stretch out your foot while you are sleeping. You can also wear it while you are sitting and relaxing.
Aspirin/Ibuprofen: These will help reduce pain and inflammation.
Orthotics: Since plantar fasciitis is basically an overuse injury, these foot supports will correct the way you walk and minimize the injury.
Corticosteroid injections: By injecting these hormones, your doctor will give you GREAT relief. However, these are not for long-term use.

If you would like to try one of these options, contact Dr. Reddy or a podiatrist in your area.

A Shot of Sugar for Your Sprained Ankle

2010-05-10T18:40:00.002-04:00

With the summer months upon us, Jacksonville's athletes will be heading out to enjoy the Florida sun. And where there are runners, there will be running injuries. You should have no trouble finding information about sprained ankles. Instead of repeating all of that here, we present for you an emerging alternative treatment for a variety of musculoskeletal injuries, including sprained ankles: prolotherapy.

Your bones and muscles are all connected by special cords of tissue. Bones are connected to one another by ligaments, and muscles insert into bones with tendons. A sprain involves a torn ligament, and a strain involves a damaged tendon. Prolotherapy involves injections of dextrose, a sugar solution, to repair these kinds of injuries. The sugar acts as an irritant, promoting the healing process. You will need injections once every several weeks as the healing process continues.

Unfortunately, prolotherapy is not without its controversy. While many doctors support it, its effectiveness in clinical studies is inconclusive. For this reason, neither medicare nor most insurance companies will pay for this treatment. However, prolotherapy is considerably less invasive than surgery, which might be necessary in the case of severe ankle sprains. If you think prolotherapy can be beneficial to you, consult with Dr. Reddy or a podiatrist in your area.

Charcot Foot

2010-04-27T21:08:00.003-04:00

In weeks past, we've blogged about the prevalence of type 2 diabetes in Jacksonville, as well as some of the manifestations it will have on your feet. Over time, people with diabetes lose sensation in their feet, a condition known as peripheral neuropathy. While this is an undesireable outcome in itself, this loss of sensation may lead to Charcot Foot (pronounced shar-KO), a severely disabling condition. While we at On Your Feet want to maintain a positive tone at the blog, patient education is our goal, and thus any patient who has neuropathy needs to be aware of this stark condition.

When you lose sensation in your foot, you don't feel as much pain as you otherwise would. If you injure yourself, you won't notice. You'll just keep on going about as usual, on your injured foot. As you might imagine, this will only make a bad situation worse. These many repeated tiny injuries add up. Bones will break or dislocate, and the foot becomes deformed.

Prevention and early diagnosis are both key. If you are experiencing neuropathy, you won't be able to feel pain, so look for other signs of injury in your feet. Is one foot more swollen? Does it look red? If so, you may have an injury you are not aware of. Consult with Dr. Reddy or a podiatrist in your area to determine what the next course of action will be. However, you should expect to spend a good deal of time off that foot. With early diagnosis, you will prevent further damage and keep your foot as healthy as possible.

Loss of Sensation in Feet

2010-04-19T20:33:00.002-04:00

Your nerves are set up like telephone wires throughout your body, conveying information about the outside world to your brain, as well as carrying messages from the brain to parts of your body. When you lose sensation in your feet, it is because some of those telephone wires became damaged. This condition is known as neuropathy (new-ROP-a-thee).

While neuropathy is not unique to diabetes, half of all people with diabetes have some kind of nerve damage. When there is too much sugar circulating in the blood stream, it can damage the walls of the blood vessels that provide oxygen to nerves, especially those of the leg and feet. For this reason, people with diabetes need to pay careful attention to their feet to prevent or delay nerve damage and other complications.

If you are experiencing neuropathy in your feet, you will need to be extra kind to them. In particular, you will not be able to feel pain like you used to. This might seem like a good thing, but pain is your body's way of telling you that something is wrong. Many times, people with neuropathy will not be aware that they are hurting their feet with every step they take. Check your feet every day for signs of injury. This way, you will catch problems while they are still small and easy to solve. If you see a cut, bump, or red spot, take immediate action to protect the area. For additional guidance on managing your neuropathy, consult with Dr. Reddy or a podiatrist in your area.

5 Complications Every Diabetic Should Know of

2010-04-03T14:09:00.003-04:00

Type 2 Diabetes is one of the most common afflictions Americans suffer from. Furthermore, the incidence in Jacksonville is well above state and national averages, as reported here.
It affects your entire body, including your feet. Over the coming weeks, we at On Your Feet will be posting articles pertaining to Diabetes and the havoc it will wreak to your lower extremities. Before doing so, we'd like to share some general complications of diabetes. If you have Type 2 diabetes, or are at risk, a good place to start reading would be here. However, here is a quick rundown on body parts to watch:

Heart- Diabetics are many times more likely to be at risk of heart attack and stroke. High blood pressure is also very common.
Eyes- Diabetes will be damaging to the retinas of your eyes. These are the parts of your eye that pick up images from the world and send them to your brain. This leads to loss of vision and blindness.
Kidneys- Early on, diabetics will find themselves urinating more frequently and drinking more water. In later stages, there is a risk of kidney failure.
FEET! - As this is a podiatry blog, we would be remiss to neglect the impact of diabetes on your feet. Many complications arise when blood has a harder time circulating through your feet. Other complications come from loss of sensation. In forthcoming blog entries, we will delve deeper into what kinds of problems diabetics face. Which brings us to the fifth complication…
Amputation- It might be a toe, or it might be the whole foot. The loss of a body part is devastating, but it might be the only option to save a patient's life. Fortunately, your podiatrist will do everything to make sure that doesn't happen.

David Beckham’s Achilles Tendon Rupture

2010-03-23T17:11:00.002-04:00

By now, you've probably heard that David Beckham ruptured his Achilles tendon on March 14. So what does this mean for Mr. Beckham?

The Achilles tendon (or calcaneal tendon) is probably the most famous tendon in the body. It was named after the invincible Greek warrior from mythology whose only weak point was his heel. You will feel it behind your ankle. It's the thick, rope-like thing, and it is vital for pushing your foot down. A rupture in this tendon is the most severe traumatic muscular injury of the foot.

Without his Achilles, Mr. Beckham will be unable to walk on that leg without a boot. Furthermore, he received surgery to stitch together the two ends of his tendon. Fortunately for him, this injury is not career ending, but he will not be playing in the World Cup. He will also need to be careful, as one ruptured Achilles will make a repeat injury likely in his future.

If you think you've ruptured your Achilles tendon, you would have heard a loud "pop." A quick test for a ruptured Achilles is the Thompson test. If you squeeze the calf muscle of an uninjured leg, you should see your foot point downwards. However, if the Achilles is ruptured, it will continue pointing forward, and probably a little upwards. While your first course of action will be to seek emergency medical treatment, you should consult a podiatrist for surgery and/or follow up care.

How to Walk—things you don’t think about

2010-03-14T14:35:00.005-04:00

Unless you are under the age of 2, you probably already know how to walk. And if you are under 2, I am impressed with your level of reading comprehension! For the rest of the reading audience, however, walking is something that comes naturally and you never bother thinking about it. Until, that is, you spend a prolonged period not using one or both of your legs. When your muscles spend weeks or months on vacation, they become weak, and this in turn affects your gait cycle, the way your legs move when you walk.

For simplicity, we'll divide the muscles into 4 groups: hamstrings (back of the thigh), quads (front of the thigh), calf muscles, and shin muscles. Here's how they participate as your foot comes down (stance phase) and then up again (swing phase).

Heel strike. You touch down on the ground with your heel, and your shin muscles gradually lower the rest of your foot to the ground. If they have been weakened, your foot will just slap the ground.
Flat foot, also known as Forefoot loading. Your quads and calf muscles transfer weight over the arch of your foot while retaining stability.
Heel off. Your calf muscles carry your body mass and put you on your toes. If they are not at full strength, this will be difficult.
Toe off. You continue to transfer weight onto your other foot, as your quads stabilize your leg.
Swing Phase. Your quads and hamstrings steadily propel your foot forward and the cycle continues.

Of course, I haven't done justice to the roles of your hips and foot muscles in keeping your legs steady (especially during Toe off). However, these are the most noticeable actions, and if you are recovering from surgery or an injury, these are the muscles you will want to exercise in physical therapy. If you experience weakness during any of these steps, and you have not had an injury, that could be a sign of nerve damage, and you should consult with Dr. Reddy or a podiatrist in your area.

Photo credit: Queen's University