Thursday, November 15, 2018

Tips for Proper Diabetic Footwear   


                                
(Borrowed from Dr. Comfort Shoe Company)

                    
Proper footwear is very important for preventing serious foot problems.  Athletic or walking shoes are good for daily wear.  They support your feet and allow them to "breathe".
                    
When buying shoes, make sure they're comfortable from the start and have enough room for your toes.  Don't buy shoes with pointed toes or high heels if you are diabetic.  They can put too much pressure on the toes.  If your doctor prescribes special diabetic shoes and inserts, be sure to get comfortable styles you'll enjoy wearing.  If you don't wear your shoes, you won't enjoy the health benefits your doctor intended.
                    
In addition to shoes, you may want to consider other footwear products to help protect your feet.  Good diabetic socks are specially designed to be seamless and wick moisture away from your feet.  This helps protect your feet against sores and infections.  Diabetic slippers are designed to give your feet the extra protection you need at home.

Diabetes and Smoking

                    
The risks inherent for diabetics are well documented.  Through no fault of there own, people with diabetes are at greater risk of blindness, kidney disease, neuropathy and vascular disease to name a few.  Unfortunately, they must endure a lifetime to adherence to blood sugar control and a healthy life style.  However, there are behaviors that people choose that directly increases the risks of diabetes.  Smoking is one preventable activity that preventable activity that puts diabetic patients at greater risk.
                    
One of smoking's most notable risks is that nicotine constricts blood vessels and decreases circulation to various parts of the body-particularly the feet.  Lack of circulation and oxygen being carried on red blood cells causes tissue death.  This also affects wound healing and slows healing from surgical procedures.
                    
For many reasons, diabetic patients should stop smoking.  For those that do quit, the benefits are immeasurable.  Although seldom easy, there are keys to quitting.  One must first be psychologically ready.  Those trying to quit need the support of family and friends.  Take advantage of medications to reduce the urge for nicotine.  Be patient with yourself and be willing to make changes to your routines and habits.  For more information, call;
American Lung Association 1-800 586-4877
American Cancer Society 1-800 227-2345
U.S. Department of Health and Human Services 1-877 448-7848
New Jersey Quitline  866 657-8677

Good luck
Evan Kelner, DPM   www.drkelner.com


Wednesday, October 24, 2018

Dry Skin of Feet

                    
As colder weather soon approaches, we must prepare for certain changes that can affect our bodies.  One of these changes is that our skin becomes more dry.  Cold air is a cause of dry skin.
                    
The feet in particular often become dry.  Rubbing and friction of the feet from improper foot structure or shoes can cause abnormal pressure on the skin causing skin damage, corns and callouses.  But there are other reasons that skin becomes dry.  Systemic diseases, medications, fungus infections and exposure to irritants and chemicals are some reasons skin becomes dry on feet.
                    
More than just dryness of the skin, patients experience tightness, itchiness, burning and pain of cracked heels.  Dry skin occurs when the skin becomes dehydrated.  Water in the layers of skin allow the skin to act as a protective barrier to outside elements.  Without this hydration, the skin cannot act effectively in this capacity.
                    
Treatment is directed to allowing for retention of water to the skin.  Several types of emollients, ointments, creams, moisturizers and topical steroids are commonly used.  People with dry skin should avoid soaking their feet in hot water as this draws moisture from the skin.  They should apply moisturizers to the bottom of feet and on shins after bathing.  Also "breathable" shoes made of leather or canvass should be worn.  Also socks should be worn with shoes or sneakers.
                    
Some of the more common skin products for dry skin are Eucerin, Bag Balm, Amlactin, Heel Balm, Urea creams, Carmol 40, Lubriderm and Sarna.

Thursday, August 16, 2018

Athletes Foot


                    
Athletes foot, or tinea pedis, is the most common skin condition seen in a podiatry office.  Although very common, tinea pedis can be easily misdiagnosed.  This is because tinea pedis can present in a number of different ways.
                    
The most common way athletes foot presents is between the toes, where the skin becomes moist, red or white, irritated, and often itchy.  Another presentation of athletes foot is the chronic type, where the skin becomes dry, scaly and cracked on the bottom of the foot.  Tinea pedis can also be acute or inflammatory, where the skin becomes rough and red.  Fluid filled vesicles also appear.  
                    
All the types of fungus, ( there are at least three ) thrive in moist, dark warm areas.  This type of environment along with a genetic predisposition, enables the fungus to infect the skin.  This is the reason that there is such a high rate of recurrence with tinea pedis.
                    

In preventing the fungus infection, the environment that allows the fungus to flourish must be eliminated.  The feet must be kept clean and dry, and allowed to "air out".  Shoes should also be allowed to air out for a least 24 hours.  Breathable cotton socks are preferable to nylon.  For those who suffer from excessive perspiration, medicated powder can be effective in controlling moisture.
                    
For the majority of cases, topical antifungal medications are sufficient.  The topical medications are typically used for at least 2-3 weeks.  For those conditions unresolved by topical medications, a course of oral medication may be necessary.
                    
Fungus infections of the feet are more than a cosmetic problem.  Untreated tinea pedis can spread to the toenails, or other parts of the body.  Fungus infections of the skin can lead to bacterial infections, cellulitis and wounds in diabetics.
                    
If you think you have athletes foot, seek the proper medical attention.

Referenced from Podiatry Today, July 2018, Myron Bodman,DPM

Sunday, July 29, 2018

Diabetes and Surgical Risks

                    
Elevated blood sugars increase the risks of adverse outcomes after surgery according to recent study cited in "Clinical Diabetes", summer 2018.  Special attention therefore must be paid to these patients both before and after surgery.  Compared to patients with normal blood sugar, patients with diabetes have an increased risk of mortality 6 months after surgery, and elevated risks of complications that require additional hospitalization.  Studies reveal that the higher the blood sugar, the higher the risk of adverse outcomes.  For those with diabetes in need of surgery, it is very important to consult with the physician controlling diabetes, to determine the best plan to keep the blood sugar control to prevent adverse outcomes.  Ways of decreasing blood sugar levels are losing weight and being physically active.  Losing weight can be achieved by eating smaller servings, try calorie-free drinks or water instead of regular soft drinks or juice,choose baked, grilled, and steamed foods instead of fried, eat more vegetables, whole grains, and fruit, and avoiding high fat toppings.  Walking whenever possible; walk every day for 30 minutes, 5 days a week or split the 30 minutes into two 15 minute or three 10 minute walks.  Try strength training by lifting light weights two to three times a week.  Talk with your health care team about ways to achieve your goals using meal planning, physical activity and medicine.

Below is a link for information related to surgery and diabetes.

Ways to Combat "White Coat Syndrome"


                     
Recently, I read an article the "Sentinel" newspaper written by Vashti Harris about a lecture given by two family practice physicians, Dr. Farrah Fong and Dr. Karen Lin about " White Coat Syndrome".
                     
White Coat Syndrome is an expression for fear of going to the doctor or feelings of anxiety when seeing a doctor.  Up to 20% of the population suffers from this fear.  Many develop this fear as children, who associate going to the doctor with getting vaccinations or other unpleasant things.  Later in life, some people carry over a dislike or distrust of doctors, medical treatments, or body examinations.  There is also fear of diagnosis of a serious illness, and guilt about unhealthy behaviors.  As a result, many people choose the internet over doctors.
                    
Because of the constraints of our healthcare system, doctors are compelled to see many patients in a limited amount of time.  This makes it difficult to build a trusting doctor-patient relationship.  News and internet stories, lawsuits and commercials report about medical errors, along with medication issues and recalls.  This has increased distrust toward the medical community as well.
                    
It is important, according to the doctors lecturing on the topic, to identify exactly what he or she is worried about.  Then one must confront these anxieties and deal with them rationally.  Patients can also find out how they can better control their condition to alleviate feelings of helplessness.  During an appointment, patients should make sure they have their worst concern addressed, and ask for clarification if the don't understand what the doctor is telling them. They should ask for written instructions or resources.  If a patient is afraid or uncomfortable with his or her doctor, they may consider seeking out a new doctor who they could better talk to.  Taking a family member or a close friend to an appointment can often provide support or comfort to the patient.






Low Back Pain

                    

If the foundation of a house is unsound, eventually the upper levels will collapse.  The same is true with the human body.  If one's foot structure is deficient, and there is insufficient support, muscles and tendons may strain to maintain the body in proper alignment.  Eventually, the muscles tire and the upper joints compensate; first the ankles, then the knees, hips and finally the lower back.
                    
Low back pain can be caused by tightness and inflexibility of the muscles of the back of the leg.  This may be a result of the strain from poor foot support.  Low back spasms may result from tight muscle groups.
                    

Exercises to strengthen the abdominal muscles and stretch the lower back muscles are important.  But the pain may not resolve completely if the cause has not been recognized and addressed.
                     
An orthotic or a high quality arch support should provide a good foundation to prevent muscle strain or upper joint pain.  This improved support may actually alleviate some types of low back pain.  If you suffer from low back pain, consider a good foot evaluation.

Evan Kelner, DPM