Please briefly explain diabetes.

Dr’s. RESPONSE:  Diabetes is a disease of carbohydrate metabolism.  It basically occurs when the body is unable to process excess sugar in the bloodstream.  It is detectable using a simple blood sugar test.  The patient should test their blood sugar every morning before eating to ascertain their level.  Ideally, a level below 125 mg/dl is optimal.  Another test that a physician can perform is called a hemoglobin A1c level.  This is done by taking a small vial of blood which is tested in the lab.  The number that comes back should be less than 6.  If the number is higher, it means that your blood sugar levels over the past 90 days have been high.  This test is excellent because it tells the physician how compliant a patient is or has been.

There are two main types of diabetes.  A type I diabetic is also known as juvenile onset and they are often less than 30 years of age.  This type accounts for just less than 10% of all diabetics.  Their diabetic disease is due to the fact that their pancreas cannot make sufficient quantities of insulin, a chemical needed to take sugar out of the bloodstream and store it for future use.  These individuals usually discover their diabetes very rapidly and usually in the first decade of life.  Treatment is lifelong insulin injections. 

A type II diabetic is much more common, approximately 90% of the diabetic population.  This type usually presents during adulthood, hence the name adult onset diabetes.  This type usually occurs in those individuals over 40 years of age and is often slow in onset and progression.  In fact, millions of Americans have type II diabetes right now and are unaware and undiagnosed.  In this type, the body produces insulin in the pancreas correctly, but the body is unable to use this insulin or an improper response to the insulin occurs.  This type is controlled at first with lifestyle change, but often progresses to oral medicines.  These persons are often overweight and are prone to poor diet and fatigue. 

Another type of diabetes is called gestational diabetes.  This is quite rare and only occurs to women who are pregnant.  About 3% of pregnant women have this type and it quite oftenly disappears at the end of a pregnancy, to the tune of 97%.  This is much more prone to those women who are moderately to severely overweight before their pregnancy. 

Central Florida  Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.flfootandankle.com

Diabetics are losing feeling in their feet! Why?

According to the American Diabetes Association, about 15.7 million people (5.9 percent of the United States population) have diabetes. Nervous system damage (also called neuropathy) affects about 60 to 70 percent of people with diabetes and is a major complication that may cause diabetics to lose feeling in their feet or hands.  Foot problems are a big risk in diabetics. Diabetics must constantly monitor their feet or face severe consequences, including amputation.

Dr’s. RESPONSE: 

Diabetics lose feeling in their feet.  This is called diabetic sensory neuropathy.  Grossly simplified, the nerves do not conduct sensations as well as they can.  This is due to a variety of factors, but commonly a higher level of sugar in the blood stream diminishes the nerve action potential.  Direct metabolic damage then occurs to the nerves, which results in neuropathy.  There are three types of neuropathies a diabetic can have.  Sensory, motor, and autonomic neuropathies are all possible. 

Sensory neuropathy, the most common type, usually presents as the first type before motor neuropathy.  It is classically described as a sock and glove distribution.  This means than the loss of sensation occurs in the same distribution as a sock.  That is, all feeling is lost or diminished below a certain level just above the ankle joint, in the same area where a sock would be around the lower leg.  A diabetic will not be able to detect sensation or will have difficulty detecting two points of discrimination.  A person can also have an absent protective threshold.  In other words, a diabetic may not be able to feel hot water when checking drawn bath water, whereas a non-diabetic would jump, pull their hand back reflexively, and say “ow!”  This example also clearly illustrates the lack of temperature discrimination.  Another sequella is diminished vibration sensation. 

Lastly, proprioception can also be affected.  Proprioception is the ability of the body to know where a limb is in space or what movement is being performed.  For example, when you close your eyes while walking over a curb, your bodys’ own sensing system takes over.  It knows just how much height is required to lift the foot over the curb.  It also knows when to expect your foot to land onto the ground above the curb and at what force should be expected.  We are able to perform this complex task because of small receptors that line our joints and detect tiny movements made by us.  These movements are interpreted by our brains like movement in space. 

Motor neuropathy is a deficit of motor coordination affecting the intrinsic muscles of the foot leading to biomechanical and structural changes of the foot.  These changes predispose the diabetics feet to ulcers and subsequent infections. 

 Another type of neuropathy that can occur is autonomic neuropathy.  The autonomic nervous system is responsible for regulating body temperature among other things.  It does this by creating sweat and directing blood flow to or away from an extremity.  Poor control would lead to reduced blood flow, lack of sweating, and other conditions.  It also is responsible for hair follicles reacting to reduce heat or gather warmth. 

Morton’s Neuroma

A neuroma is a benign growth in the tissue surrounding a nerve.  In the foot, this most frequently happens in the space between the third and fourth metatarsals (the bones that connect your toes to the rest of your foot).  When this nerve becomes inflamed, it is called Morton’s Neuroma. 

Morton’s Neuroma can be quite painful.  It is often described as feeling like stepping on a rock or a marble, right in the ball of the foot between the third and fourth toes.  This can lead to a stinging, tingling, or burning, sharp pain.  Morton’s Neuroma develops from compression of the nerve over an extended period of time.  Activities that often lead to Morton’s Neuroma include running and racquet sports, which produce a lot of tension in the ball of the foot.  They can also develop from wearing shoes that cram all the toes into a tight toe box, or put pressure on the ball of the foot, such as high heels.  In fact, women are almost ten times as likely to develop Morton’s Neuroma as men.

Diagnosis of Morton’s Neuroma is a fairly simple, clinical evaluation of the effected foot.  The podiatric physician will generally inspect the foot for areas of callus, indicating a repeated and prolonged exposure to irritation.  The ball of the foot may be squeezed in the area of the neuroma, which will reproduce the pain.  This is generally enough information to confirm the Morton’s Neuroma diagnosis, but an x-ray may be taken to rule out any other possible conditions.

Morton’s Neuroma may be treated in a variety of ways, with the least invasive method usually being the preferred method.  A change in shoes, orthotics, or taping and padding the foot to relieve some of the pressure may be sufficient to allow the nerve to become less inflamed.  A change in activity is usually required, at least temporarily, to take some of the pressure off of the swollen nerve.  If the less invasive methods don’t work, or the problem persists, your podiatric physician may decide that surgical intervention is the best way to relieve the pain.  There are several methods of surgery, which your doctor can discuss with you.  

Central Florida 
Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.flfootandankle.com

Podiatry will have a new face this fall!

Podiatry will have a new face this fall, as Western University of Health Sciences in Pomona, California opens up the ninth podiatric medical college in the country.  The Southern California School already boasts a wide range of programs, including osteopathic medicine, physician assistant, nursing, pharmacy, and physical therapy curriculum.  This August, the school will add podiatry, dentistry, optometry, and biomedical sciences to that list.

The College of Podiatric Medicine at Western University appointed Lawrence B. Harkless, DPM as the founding dean of the school.  Dr. Harkless formerly worked as a professor in the department of orthopedics at the University of Texas Health Sciences Center in San Antonio, as well as the Louis T. Bogy Professor of Podiatric Medicine and Surgery.  Recently, Dr. Harkless received the 2008 Distinguished Achievement Award in Diabetic Limb Salvage, a great honor for anyone in the medical community.

The curriculum at the school will follow the “two-and-two” format, meaning that the first two years of education will focus on the basic biomedical sciences, with an emphasis on classroom learning.  The final two years will be based on clinical experience.  This is the typical curriculum of a podiatric medical school, as well as osteopathic and allopathic medical curriculum.  Western University of Health Sciences will also take advantage of having many different programs under the same university by placing an emphasis on interprofessional health care teams. 

The College of Podiatric Medicine at Western University of Health Sciences is currently in the process of getting its accreditation, through the Council on Podiatric Medical Education (CPME).  There is space in the newly founded program for approximately fifty students.  More information on the school, including how to apply, can be found at their website.

The Bureau of Labor Statistics anticipates a 9% increase in the employment of podiatric physicians between the years 2006 and 2016.  It is in accordance to this statistic that the American Association of Colleges of Podiatric Medicine plans on opening up more schools soon.  In 2007, Midwestern University in Arizona also opened up a college of podiatric medicine, with their inaugural class set to graduate in 2011.  The new College of Podiatric Medicine at Western University of Health Sciences in Pomona will graduate its first class in 2013.  

Central Florida 
Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.flfootandankle.com