Diabetics are plagued with multiple complications secondary to uncontrolled, high levels of blood glucose. In my practice, I see diabetics who suffer from kidney disease, failing eye sight, and cardiovascular issues. The most noted complication is peripheral neuropathy. This is a progressive disease of the nerves in your feet and possibly the hands. Many treatments for neuropathy have been very unpromising, but new developments in surgical procedures may give patients hope.
It is believed that the some nerves in diabetic patients swell and increase in size secondary to increase water content. The nerves in your feet travel from your spinal cord all the way down to the feet. They curve around boney structures and dive through muscles and fat and run along course with arteries and veins. As the nerve enlarges it takes up more space and potentially gets compressed.
Much like carpel tunnel, a compressed nerve can cause numbness, burning, and pain. This pain is very similar to the pain experience by diabetics in peripheral neuropathy. A number of doctors have suggested that some diabetics have compressed nerves rather than permanently damaged nerves as previously perceived. Much of the research done on this concept is still very immature. Yet, many diabetics are undergoing surgery and experiencing a reduction in pain and an increase in sensation.
It is important to note that not all diabetics with peripheral neuropathy will have a successful procedure. It is very difficult to prove the pain or numbness is secondary to compressed nerves. Since it is a surgical procedure and there is always risk when undergoing anesthesia, not all diabetics will be recommended to undergo such surgical procedures.
There are also very few surgeons across the country you have been formally trained to perform nerve decompressive surgery for diabetic compressive neuropathy. The procedure has not been widely accepted at all institutions since the concept is so new. There has been a significant amount of research done on the surgical procedure, but the studies failed to established enough evidence to be widely accepted by the medical community.
F
or some patients, such surgical procedures may be acceptable and necessary to achieve relief. Unfortunately, these procedures are not indicated for all diabetics who suffer from peripheral neuropathy. It is important you understand the potential risks and benefits in considering such surgery. Not all patients find relief and some complication to surgery are increase of pain, decrease in sensations, infection and poor wound healing.
There has yet to be an accepted cure for diabetic neuropathy. The best treatment is to tightly control your diabetes and prevent the disease from progressing. Patients often find it necessary to be on one or several medication to help decrease the symptoms. Vitamin supplements and physical therapy modalities have also been suggested for treatment protocols.
Showing posts with label diabetic neuropathy. Show all posts
Showing posts with label diabetic neuropathy. Show all posts
Wednesday, November 3, 2010
Thursday, March 19, 2009
Sock It To You!
The Perfect Sock
We use them almost every day. They come in all different forms and sizes and some even come with bells and bows. What am I talking about? Your socks! Do you ever wonder if your socks are feet friendly? Believe it or not but socks made out of the wrong fabric or that are poorly made may worsen some common foot conditions.
The American Podiatric Medical Association (APMA) recommends the following when shopping for socks:
Purchase a sock made of a polysynthetic blend. This material will best wick away moisture from the foot, which can prevent blister formation and irritation.
Avoid socks with large seams at the toe or in other areas. Those with diabetes or decreased circulation, who have an increased chance of developing irritation and blistering of the foot skin, should seek out seamless socks whenever possible.
Choose thickness of sock material based on personal preference and comfort.
Evaluate each sock’s fit, making sure that there is no loose fabric around toes or heels.
Conversely, socks that are too tight can decrease circulation and comfort.
If you suffer from sweaty feet also known as hyperhydrosis, it is especially important to buy the correct socks. You may think 100% cotton is the best way to go but a blend of cotton with other natural materials will do a better job of wicking away moisture. Choosing the right sock will keep your feet dryer and less stinky. Maybe you will think again when buying your husband’s socks!
Noticing the importance of choosing the right socks, the APMA recently recognized and gave the seal of acceptance to two new sock products. Injinji Footwear Performance Series Tetratsok has a patented anatomical, five toe-design that separates toes with an anti-friction seamless membrane. The sock is made out of a combination of coolmax wicking fiber, and a durable shell cover of nylon and lycra. This helps protect the foot from slipping and sliding in your shoe.
The Takeda Legwear Big Toe R x L socks are designed specifically for the right and left feet. This allows for a snug and comfortable fit. BigToe R x L socks is also made from Coolmax fabric to keep moisture away from your skin.
They next time you buy socks, take a closer look at the materials. Slip them on and see how they fit. Are they snug? Can you feel the seams? Are there any knobs of fabric that are rubbing against your feet? Just as importantly are your shoes. If your shoes are too tight, it will exacerbate the effects of poor quality socks. Make sure your shoes are the right size and gives you room to wiggle your toes.
We use them almost every day. They come in all different forms and sizes and some even come with bells and bows. What am I talking about? Your socks! Do you ever wonder if your socks are feet friendly? Believe it or not but socks made out of the wrong fabric or that are poorly made may worsen some common foot conditions.
The American Podiatric Medical Association (APMA) recommends the following when shopping for socks:
Purchase a sock made of a polysynthetic blend. This material will best wick away moisture from the foot, which can prevent blister formation and irritation.
Avoid socks with large seams at the toe or in other areas. Those with diabetes or decreased circulation, who have an increased chance of developing irritation and blistering of the foot skin, should seek out seamless socks whenever possible.
Choose thickness of sock material based on personal preference and comfort.
Evaluate each sock’s fit, making sure that there is no loose fabric around toes or heels.
Conversely, socks that are too tight can decrease circulation and comfort.
If you suffer from sweaty feet also known as hyperhydrosis, it is especially important to buy the correct socks. You may think 100% cotton is the best way to go but a blend of cotton with other natural materials will do a better job of wicking away moisture. Choosing the right sock will keep your feet dryer and less stinky. Maybe you will think again when buying your husband’s socks!
Noticing the importance of choosing the right socks, the APMA recently recognized and gave the seal of acceptance to two new sock products. Injinji Footwear Performance Series Tetratsok has a patented anatomical, five toe-design that separates toes with an anti-friction seamless membrane. The sock is made out of a combination of coolmax wicking fiber, and a durable shell cover of nylon and lycra. This helps protect the foot from slipping and sliding in your shoe.
The Takeda Legwear Big Toe R x L socks are designed specifically for the right and left feet. This allows for a snug and comfortable fit. BigToe R x L socks is also made from Coolmax fabric to keep moisture away from your skin.
They next time you buy socks, take a closer look at the materials. Slip them on and see how they fit. Are they snug? Can you feel the seams? Are there any knobs of fabric that are rubbing against your feet? Just as importantly are your shoes. If your shoes are too tight, it will exacerbate the effects of poor quality socks. Make sure your shoes are the right size and gives you room to wiggle your toes.
Wednesday, February 11, 2009
Diabetes and Foot Ulcers
There are over 23 million American with diabetes, and another 57 million with pre-diabetes. Many argue that diabetes is becoming an epidemic. As technology continues to advance the efficiency of our world, it also takes away the need for physical exertion. In order to get the exercise necessary to stay healthy, we have to “go work out.” Most of us are dropping the ball on this; and thus, America is gaining weight. This combined with fast food and fat filled diets are causing diabetes to be on a continual rise. Unfortunately, many underestimate the severity of the disease. Diabetes is a very serious condition that has many complications which includes blindness, cardiovascular disease, kidney failure, and foot ulcerations. These complications are acquired over time and greatly increase mortality rates. A person diagnosed with diabetes before the age of 40 will lose 15-20 years of their life!
Out of all of the complications linked to diabetes, the complication that causes the most hospitalizations is foot ulceration. Many of these ulcers may lead to amputations and this greatly increases the mortality rate. A person has a better chance of survival with colon or breast cancer than they do having a diabetic amputation. There are several reasons why diabetes has such strong effects on the feet; all of these complications combine into a formula for disaster if one does take proper measures to protect their feet and their health.
Causes foot ulcers 1o1
1) Macrovascular/Microvascular complications. Diabetes is the inability of the body to control blood glucose levels. The rise in blood glucose, or hyperglycemia, is when there is excess sugar in your blood stream. This can facilitate clot formation and increase your chance of heart attack and stroke, but more commonly leads to micro vascular complication that decreases your blood flow in small vessels and in your extremities. A decrease in blood supply in an area, such as the foot, makes it difficult for your body to keep those tissues healthy.
2) Foot deformities. The excess sugar in circulation can deposit in tissues and joints and lead to foot deformation. Diabetics may see changes in their foot structure or feel pain with motion. In very serious cases, the foot develops Charcot’s foot. In this instance, the bones in the foot are actually being destroyed. The deformity is often described as the foot becoming a” bag of bones.” These deformations change how forces are applied across the foot. Normally, when walking, weight is nearly evenly distributed across your foot, deformations cause increases in pressure at certain areas. This facilitates tissue break down
3) Peripheral Neuropathy. Neuropathy is the loss of nerve function. The nerves most commonly affected are sensory nerves. Over time, diabetics experience nerve damage due to the increased levels of sugar. Initially, this damage presents as tingling and burning but eventually leads to loss of feeling. Thus, diabetics lose the ability to feel pain, the body’s natural warning sign. It is very dangerous for diabetics to be unable to perceive a problem in the foot. For an example: If one steps on a piece of glass, they would be unaware and walk around on the glass all day.
Preventing Ulcers 101?
1) Controlling your blood sugar levels with diet and exercise is the best way to prevent all diabetic complications. When diet and exercise is not enough, there are medications that can assist your body in maintaining appropriate amounts of sugar in your blood.
2) Inspect your feet regularly. Look in-between your toes under and all around. Watch your feet for any changes in appearance, temperature, and feeling. Before or when changes are noted, contact a podiatric physician. A podiatric physician can help prevent and accommodate changes in your feet due to diabetes.
3) Avoid walking around barefoot, in sandals, or any other open shoes. This leaves your feet vulnerable to getting cuts, bruises, bumps, and infections.
Diabetes is a multisystem disease that can cause many complications. Foot ulcers are highly prevalent, but also highly preventable. It is important to consult your physician to help you control your blood sugar levels. Podiatric Physicians are foot specialist that have extensive training in diabetic feet and wound care. They will provide you with the best care to prevent foot ulcers and amputations, the leading cause of diabetic hospitalizations.
Out of all of the complications linked to diabetes, the complication that causes the most hospitalizations is foot ulceration. Many of these ulcers may lead to amputations and this greatly increases the mortality rate. A person has a better chance of survival with colon or breast cancer than they do having a diabetic amputation. There are several reasons why diabetes has such strong effects on the feet; all of these complications combine into a formula for disaster if one does take proper measures to protect their feet and their health.
Causes foot ulcers 1o1
1) Macrovascular/Microvascular complications. Diabetes is the inability of the body to control blood glucose levels. The rise in blood glucose, or hyperglycemia, is when there is excess sugar in your blood stream. This can facilitate clot formation and increase your chance of heart attack and stroke, but more commonly leads to micro vascular complication that decreases your blood flow in small vessels and in your extremities. A decrease in blood supply in an area, such as the foot, makes it difficult for your body to keep those tissues healthy.
2) Foot deformities. The excess sugar in circulation can deposit in tissues and joints and lead to foot deformation. Diabetics may see changes in their foot structure or feel pain with motion. In very serious cases, the foot develops Charcot’s foot. In this instance, the bones in the foot are actually being destroyed. The deformity is often described as the foot becoming a” bag of bones.” These deformations change how forces are applied across the foot. Normally, when walking, weight is nearly evenly distributed across your foot, deformations cause increases in pressure at certain areas. This facilitates tissue break down
3) Peripheral Neuropathy. Neuropathy is the loss of nerve function. The nerves most commonly affected are sensory nerves. Over time, diabetics experience nerve damage due to the increased levels of sugar. Initially, this damage presents as tingling and burning but eventually leads to loss of feeling. Thus, diabetics lose the ability to feel pain, the body’s natural warning sign. It is very dangerous for diabetics to be unable to perceive a problem in the foot. For an example: If one steps on a piece of glass, they would be unaware and walk around on the glass all day.
Preventing Ulcers 101?
1) Controlling your blood sugar levels with diet and exercise is the best way to prevent all diabetic complications. When diet and exercise is not enough, there are medications that can assist your body in maintaining appropriate amounts of sugar in your blood.
2) Inspect your feet regularly. Look in-between your toes under and all around. Watch your feet for any changes in appearance, temperature, and feeling. Before or when changes are noted, contact a podiatric physician. A podiatric physician can help prevent and accommodate changes in your feet due to diabetes.
3) Avoid walking around barefoot, in sandals, or any other open shoes. This leaves your feet vulnerable to getting cuts, bruises, bumps, and infections.
Diabetes is a multisystem disease that can cause many complications. Foot ulcers are highly prevalent, but also highly preventable. It is important to consult your physician to help you control your blood sugar levels. Podiatric Physicians are foot specialist that have extensive training in diabetic feet and wound care. They will provide you with the best care to prevent foot ulcers and amputations, the leading cause of diabetic hospitalizations.
Wednesday, December 10, 2008
The Risk Associated with the Diabetic Foot
Diabetes, a disease where the body does not produce its own insulin (Type I) or where the body improperly uses its own insulin (Type II), results in increased blood sugar levels. Seven percent of Americans or 20.8 million people in this country are living with diabetes. This is a life-long disease that can severely affect the body’s major organ systems, particularly the feet and ankles.
Oftentimes, symptoms of diabetes such as numbness and tingling first appear in the feet. This is due to decreased sensation called neuropathy. Poor circulation and increased infection rates are common among diabetics and this combined with neuropathy is a recipe for disaster in the lower extremities. A diabetic ulcer usually comes from a simple corn, callus or blister. This occurs due to increased friction on a bony prominence such as a hammertoe or bunion. Ulcers and infections can also result from unknowingly stepping on a sharp object such as a piece of glass or needle while walking barefoot. One may only discover this occurrence after noticing blood or pus draining from their feet. Ulcerations can lead to a raging infection and ultimately loss of a toe or toes, part of the foot or even the leg or legs.
Another complication of diabetes is Charcot Joint, which is found in diabetics with neuropathy. Charcot causes a complete collapse of the joints in the foot most commonly in the mid-foot area leading to a permanent foot deformity known as rocker-bottom. Those with Charcot are also prone to ulcerations and amputations from this deformity.
Early detection and prevention are key factors in effectively dealing with the diabetic foot. A simple comprehensive foot exam by a local podiatrist at least once or twice a year can identify problems early and dramatically decrease the amputation rate. A podiatrist is frequently the first physician to identify the initial signs and symptoms of diabetes.
Management and prevention of diabetic complications is a team effort of physicians and a compliant patient. It is important for diabetics to check their feet every day, never walk barefoot, wear comfortable shoes that are not too tight and check shoes for any foreign objects. Feet, ankles and lower legs should be well moisturized. The skin on the bottom of the feet and especially heels are prone to dryness and cracking. A thick cream with at least a 10-20% urea moisturizing agent instead of plain lotion is best for this area as the skin is tougher and thicker on the soles of the feet. However, the area in between the toes should be kept dry. Fungus like warm, moist environments and fungal infections can occur with increased moisture in between the toes. Sock selection is also important. Seamless socks help prevent friction and skin irritation. White socks are preferred as any drainage or blood spots can become clearly visible immediately. Synthetic socks are also better at wicking away moisture keeping the area in between the toes dry. Those with thick fungal nails should have a podiatrist cut their toenails to prevent cuts and bruises that can ultimately lead to ulcers and amputations.
If you are diabetic and notice any changes in your feet or ankles such as bleeding, a callus, or ulcer, it is imperative that you seek treatment from your local podiatrist immediately to avoid a serious infection and possible amputation.
Oftentimes, symptoms of diabetes such as numbness and tingling first appear in the feet. This is due to decreased sensation called neuropathy. Poor circulation and increased infection rates are common among diabetics and this combined with neuropathy is a recipe for disaster in the lower extremities. A diabetic ulcer usually comes from a simple corn, callus or blister. This occurs due to increased friction on a bony prominence such as a hammertoe or bunion. Ulcers and infections can also result from unknowingly stepping on a sharp object such as a piece of glass or needle while walking barefoot. One may only discover this occurrence after noticing blood or pus draining from their feet. Ulcerations can lead to a raging infection and ultimately loss of a toe or toes, part of the foot or even the leg or legs.
Another complication of diabetes is Charcot Joint, which is found in diabetics with neuropathy. Charcot causes a complete collapse of the joints in the foot most commonly in the mid-foot area leading to a permanent foot deformity known as rocker-bottom. Those with Charcot are also prone to ulcerations and amputations from this deformity.
Early detection and prevention are key factors in effectively dealing with the diabetic foot. A simple comprehensive foot exam by a local podiatrist at least once or twice a year can identify problems early and dramatically decrease the amputation rate. A podiatrist is frequently the first physician to identify the initial signs and symptoms of diabetes.
Management and prevention of diabetic complications is a team effort of physicians and a compliant patient. It is important for diabetics to check their feet every day, never walk barefoot, wear comfortable shoes that are not too tight and check shoes for any foreign objects. Feet, ankles and lower legs should be well moisturized. The skin on the bottom of the feet and especially heels are prone to dryness and cracking. A thick cream with at least a 10-20% urea moisturizing agent instead of plain lotion is best for this area as the skin is tougher and thicker on the soles of the feet. However, the area in between the toes should be kept dry. Fungus like warm, moist environments and fungal infections can occur with increased moisture in between the toes. Sock selection is also important. Seamless socks help prevent friction and skin irritation. White socks are preferred as any drainage or blood spots can become clearly visible immediately. Synthetic socks are also better at wicking away moisture keeping the area in between the toes dry. Those with thick fungal nails should have a podiatrist cut their toenails to prevent cuts and bruises that can ultimately lead to ulcers and amputations.
If you are diabetic and notice any changes in your feet or ankles such as bleeding, a callus, or ulcer, it is imperative that you seek treatment from your local podiatrist immediately to avoid a serious infection and possible amputation.
Diabetic Neuorpathy
Burning, tingling, and numbness in your toes and feet may be the first signs of diabetes. Peripheral neuropathy is a dysfunction of nerves and is commonly seen in the hands and feet. There are two types of nerves that may be affected: small nerve fibers, and large nerve fibers. Small nerve fiber damage will cause abnormal sensation and large nerve fiber damage leads to decreasing sensory perception and coordination. Damage to these nerves can be caused for several reasons, but the most common is diabetes. The progression of the neuropathy is highly dependent on the glucose levels in the blood, though the exact mechanism of damage is still unknown.
In uncontrolled or undetected diabetes, there are abnormally high levels of glucose or “sugar” in the blood. The abnormal levels of glucose causes multiple problems in your body including, eye, kidney, and cardiovascular damage. Often, the first problem noticed is the atypical sensations in the feet caused by peripheral neuropathy or nerve dysfunction. The symptoms are progressive and start at your toes and move up like a sock. Diabetic patients often complain of tingling, burning, numbness sensations, similar to the sensations a person feels when their foot “falls asleep.” Over time, the damage will lead to complete loss in sensation. This is the leading cause for diabetic foot ulcerations. A person with lost foot sensation still has motor (muscle) function and can continue to walk, but they are unable to detect sores or pain. Unknown sores on the feet combined with other diabetic complications leads to ulcers (open sores) and sometimes amputations.
To assess your peripheral nerve function, a podiatric physician can do several basic screening tests. While the patient’s eyes are closed, the podiatric physician uses several tools to test the small and large fiber nerves in the foot. Such tools consist of a Semmes Weinstein Monofilament (similar to fishing line), tuning fork, and a Q-tip. It is such a simple screen and takes only five minutes to perform, so, there is no excuse for diabetics or pre-diabetics not to get tested. Early detection of neuropathy can greatly decrease its progression and protect the feet from ulcers, infections, and even amputations.
Diabetes is one of the leading causes of death in the United States and the complications associated with the disease can greatly impede on a person’s quality of life. It is important to prevent and detect diabetes early to avoid and slow down the debilitating damage of the high glucose levels in the blood. Diabetes has a great effect on a person’s feet and often shows some of the first signs of diabetic complications. Thus, one with diabetes or diabetic risk factors should pay close attention to their feet and contact their podiatric physician.
In uncontrolled or undetected diabetes, there are abnormally high levels of glucose or “sugar” in the blood. The abnormal levels of glucose causes multiple problems in your body including, eye, kidney, and cardiovascular damage. Often, the first problem noticed is the atypical sensations in the feet caused by peripheral neuropathy or nerve dysfunction. The symptoms are progressive and start at your toes and move up like a sock. Diabetic patients often complain of tingling, burning, numbness sensations, similar to the sensations a person feels when their foot “falls asleep.” Over time, the damage will lead to complete loss in sensation. This is the leading cause for diabetic foot ulcerations. A person with lost foot sensation still has motor (muscle) function and can continue to walk, but they are unable to detect sores or pain. Unknown sores on the feet combined with other diabetic complications leads to ulcers (open sores) and sometimes amputations.
To assess your peripheral nerve function, a podiatric physician can do several basic screening tests. While the patient’s eyes are closed, the podiatric physician uses several tools to test the small and large fiber nerves in the foot. Such tools consist of a Semmes Weinstein Monofilament (similar to fishing line), tuning fork, and a Q-tip. It is such a simple screen and takes only five minutes to perform, so, there is no excuse for diabetics or pre-diabetics not to get tested. Early detection of neuropathy can greatly decrease its progression and protect the feet from ulcers, infections, and even amputations.
Diabetes is one of the leading causes of death in the United States and the complications associated with the disease can greatly impede on a person’s quality of life. It is important to prevent and detect diabetes early to avoid and slow down the debilitating damage of the high glucose levels in the blood. Diabetes has a great effect on a person’s feet and often shows some of the first signs of diabetic complications. Thus, one with diabetes or diabetic risk factors should pay close attention to their feet and contact their podiatric physician.