What is Deep Vein Thrombosis?

Deep Vein Thrombosis, commonly abbreviated DVT, is a condition of blood clotting in the veins that lie deep within the body. A blood clot forms when the blood thickens and clumps together. A DVT can occur anywhere in the body, but most commonly forms in the deep veins of the leg.

When a blood clot forms in the deep veins, it can break off from the sides of the veins, forming what is known as an embolism. The embolus can then travel through the body, and get lodged into the small veins of the lung. When this occurs, it is known as pulmonary embolism (PE). Pulmonary embolism can cause shortness of breath and difficulty breathing, and can sometimes progress to a more serious condition, which can even cause death.

Blood clots can also form in the superficial veins of the body, or the veins closer to the skin surface. This is often seen in varicose veins. Blood clots in the superficial veins, however, are not a risk factor for pulmonary embolism.

When a clot forms in the deep veins, it may completely block off blood return to the heart through that vein. This can cause pain, redness, and swelling, typically seen in the leg around the calf.

Risk factors for deep vein thrombosis include increased age, obesity, heart disease, infections, use of oral contraceptives, and pregnancy. The major risk factor for DVT, though, is immobilization. Any situation that limits walking and movement for a prolonged period of time is a potential risk factor for deep vein thrombosis. They are common in post-operative settings, as well as in hospitalized patients.

Special care is taken to make sure that clots are prevented from forming during a hospital stay. If deep vein thrombosis does form in the hospital, they can be managed before they turn into a more serious condition such as pulmonary embolism.

Treatment of deep vein thrombosis centers around medicines that help prevent the growth of a clot, as well as break down the clot once it has formed. Blood thinners like Heparin and Coumadin are used to prevent the clot from getting any bigger, and different medications may be used to dissolve a clot that is already formed.

The most important part of treating deep vein thrombosis and pulmonary embolism is the early recognition of the condition. Doctors, nurses, and other hospital workers are all trained to recognize the symptoms, and treat deep vein thrombosis before it becomes a more serious issue.

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

Vaccinations for Pregnant Women

For pregnant women, getting a flu shot will be extremely important this year. This message comes from the Centers for Disease Control and Prevention, with particular regard for the H1N1 vaccine. The H1N1 virus, known throughout the media as swine flu, can cause premature labor in pregnant women, and can keep them in the hospital for weeks. Pregnant women are at a high risk for mortality from the virus – they make up about six percent of the H1N1-confirmed deaths in the country, though they only account for about one percent of the population.

Even with all of the information available on the importance of pregnant women getting vaccinated against the flu, only about 1 in 7 will go through with it. This discrepancy may be the result of women who are hesitant to take medications while pregnant, however, the CDC stresses that the vaccination is not harmful to the mother or the fetus. In fact, it is highly beneficial to both.

The antibodies that the mother makes after receiving the flu vaccine can easily cross the placenta and be delivered to the fetus. This gives the infant protection against the virus after birth, until the child is old enough to get a flu vaccine themselves. Babies are not vaccinated until they are six months old.

Interestingly, most obstetricians do not currently vaccinate their patients against either H1N1 influenza or administer the seasonal flu vaccine. This can make it difficult for a pregnant woman to obtain the vaccination, as many are reluctant to go to drugstore or grocery store immunization spots.

Compounding this problem is the reluctance of vaccine providers, mainly pharmacists, to fill a doctor’s prescription for a flu vaccine. There have been several accounts of pharmacists refusing to fill the prescription, though the American Pharmacists Association is urging its members to follow the CDC’s guidelines.

It is the hope of the CDC and the American College of Obstetricians and Gynecologists (ACOG) to increase the number of pregnant women to get not only the H1N1 vaccine, but the seasonal flu vaccine as well. Any kind of flu can be a serious detriment to the mother. Surveys conducted by ACOG suggest that more obstetricians will be delivering vaccines to their patients this year.

Drugstores hoping to gain rights to distribute H1N1 vaccinations are jumping on board as well. Walgreen’s, if they are to receive the vaccinations, will have signs up next to pregnancy tests, as well as written reminders for women buying prenatal supplements.

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

Varicose Veins

What are Varicose Veins?

In the legs there are deep veins found buried under layers of muscle, superficial veins that are closer to the skin, and perforating veins which connect the deep and superficial veins. Normally, valves in the perforating veins allow blood to flow in a one-way direction from superficial to deep. This allows all of the blood to be shunted into the deep veins, and then brought back to the heart to be re-circulated through the body.

When someone has varicose veins, there is a problem with the valves in the perforating veins. This causes blood to pool and remain in the superficial veins, which increases the pressure within the veins. The veins are capable of stretching, which makes them visible through the skin. When you’re looking at someone’s varicose veins (maybe your own!) you are viewing the blood within the superficial veins.

How are they treated?

The main goal of treatment of varicose veins is to bring the pooling blood out of the lower extremity. This may include elastic stockings or other compression device to help the veins gather enough pressure to return the blood back to the heart.

Surgical treatment includes stripping the veins, which may or may not include laser therapy. This eliminates the veins, so that the blood is forced to return to the heart through a different vein. This can eliminate a varicose vein that has already formed, but does not prevent new ones from forming.

What are the symptoms? Are they painful?

Varicose veins are usually not painful, especially in minor cases. However, the pressure of blood remaining in the superficial veins can cause discomfort. For this reason, as well as aesthetic reason, many people opt for surgical intervention to remove the affected veins.

Are Varicose Veins dangerous?

Generally, varicose veins are not a dangerous condition. Primary varicose veins are caused simply by faulty valves in the perforating veins. You may be predisposed to varicose veins based on heredity or an occupation that requires you to stand all day. Women are three times as likely as men to develop varicose veins, and they can be brought on by pregnancy as well.

Varicose veins may also be indicative of a more serious condition, known as deep vein thrombosis, or DVT. These are secondary varicose veins that are caused by a blockage within the veins. It is important to show your doctor any new varicose veins, as they should be able to diagnose a more serious underlying condition.

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

Back to School Shoes

Stocking up on back-to-school items? You’ll need pencils, paper, notebooks, a new backpack, and other school supplies, but don’t forget a new pair of shoes!

Children’s footwear plays an essential role in the foot health and overall health of your child. They will be exposed to all sorts of different terrain, from the classroom to the playground, and everywhere in between. The right pair of shoes will keep them active and comfortable. Here are a few things to look for in a new pair of shoes for your kids:

· Grab the back heel of the shoe, and press down on both sides. A supportive shoe will not collapse easily.

· Take the shoe and try to flex it at the toes. A good shoe will allow for the toes to flex, but will not bend too easily. A shoe that is too stiff will not allow for the toes to function properly.

· Hold the shoe in the front with one hand and at the back of the shoe with the other hand. Try to twist the shoe. If the shoe twists easily in the middle, it is not supportive enough.

· Bring your kids with you. If you let your children have a say in their footwear, it will help promote a healthy lifestyle in the future.

· After your child has been wearing the shoes for a while, check the bottoms of the shoes. Uneven wear patterns, especially in the heel, can indicate a biomechanical problem, which should be evaluated by a podiatrist.

· Bring a pair of socks when you go shopping. Sure, you can use the socks that they have in the store, but they may not be the socks that your child wears. Different socks can have different thicknesses, which may alter the fit of the shoe.

· Look for the APMA seal of acceptance. This seal is awarded by the American Podiatric Medical Association for shoes that fit the guidelines for acceptable footwear. You can look at a complete list of these shoes here.

Keep in mind that the right shoes for your children will allow them to participate in a number of activities in school. If they are playing sports after school, it is also important that they wear sport-specific footwear. Cleats are for soccer or baseball, and running shoes are absolutely necessary for running. Taking care of your children’s feet and having them take care of themselves is the first step towards a long, healthy lifestyle.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

Heart Rate Monitors

Looking to take your training to the next level? You may want to consider a heart rate monitor as a way to enhance your training. Heart rate monitors are becoming increasingly more popular in the running and cycling communities. They are generally composed of a watch that keeps track of and displays the heart rate, and a chest strap that reads the pulse while you work out.

When looking for a heart rate monitor, there are a few things to keep in mind. You’ll want to find a chest strap that fits snugly around your chest. This can sometimes pose a problem for women, as many of the chest straps are designed to fit a man’s chest. To combat this problem, many companies have developed sports bras that actually have a separate pocket for the heart rate monitor to fit into. Some of these models include the Heart Bra, made by Polar, as well as a sports bra designed by Numetrex. These items range in price from $35-50.

Another thing to look for in a heart rate monitor is the watch. Does it have a nice, big, easy-to-read display? What about the buttons – are they easy to find a press while running? If you’ll be cycling with it, is the display large enough to read when mounted to the handlebars? These are some things you’ll want to consider when investing in a heart rate monitor.

There is a wide range of features that can be added to a heart rate monitor watch. Some of the more basic models will simply tell the heart rate and the time, and will be fairly easy to use. Models like the Omron HR-100C, Oregon Scientific SE100, and Polar FS1 all get good reviews, are easy to use, and range in price from $30-50.

At the other end of the spectrum, there are models that have built in GPS units, and can track with great precision your exact location, speed, and distance ran/biked. These models are usually upwards of $400, such as the Suunto t6c, Polar RS800sd, or the Garmin Forerunner 405. In addition to tracking speed and distance, these watches are more like mini computers. They are able to log training programs, and the information on the watch can then be uploaded to a computer.

Heart rate monitors are often sold at sporting goods stores, specialty running shops, or online at websites such as amazon.com. Websites that sell this equipment will generally have lots of user reviews, which can be useful in deciding which heart rate monitor to get.

The most important aspect of purchasing an item like this is to decide what you would like to get out of the heart rate monitor. If you simply want to know what your pulse rate is, then a simpler model may be right for you. If you’re generally into electronics and gadgets, you may want to spring for the higher priced models that will offer lots of functions and training tools.

A heart rate monitor is a great way to keep track of your health and your training goals. They also make good gifts for the runner in your life, or just a nice treat for yourself!

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

New Study Compares Prescription Orthotics to Over-the-Counter shoe inserts

A new study is under way to investigate the efficacy of prescription orthotics, a device that podiatrists use in practice often. The study will compare over-the-counter shoe inserts with prescription orthotics, or orthoses as they are known as in the medical community.

The ongoing three-year study, which is being funded by the American Podiatric Medical Association (APMA), will look at the success rate of the prescription orthotics in treating plantar fasciitis, a common cause of heel pain. Podiatrists have been able to successfully treat plantar fasciitis with foot orthotics for a long time as a form of non-surgical, conservative treatment – this study will serve to quantify and qualify that information.

The research is being conducted at the Scholl College of Podiatric Medicine, through the Center for Lower Extremity Ambulatory Research (CLEAR). The interim director of the research program, Dr. James Wrobel, seeks to compare the results of prescription orthotics as a treatment for heel pain with the results of over-the-counter shoe inserts. The study will also look at the overall efficacy of the prescription orthotics at treating the heel pain. In other words, did the pain go away when using the orthotics?

Prescription orthotics are generally more durable than over-the-counter shoe inserts, needing replacement only after several years. They are prescribed by a podiatrist, and are usually done fairly quickly in an appointment. The doctor will take either make a plaster casting of the foot, or a digital image using computer software.

Prescription orthotics are typically used for three different reasons. There are orthotics designed to change the function of the foot, orthotics that are designed to protect the foot from outside forces, and orthotics that are designed to be both protective and serve to alter function of the foot. Different materials are often used when manufacturing the orthotics, depending on the purpose that they will serve.

As doctors across the country focus more and more on evidence based medicine, it will be studies like this one that will back up the use of treatments such as prescription orthotics. Many remedies in the medical world are not confirmed as being any better than others, but through research like this, a fair comparison can be made.

If you have any questions about prescription orthotics, talk to your podiatrist about different options. If you are experiencing heel pain, share this with your doctor. Conservative treatments, such as orthotics, are generally used before more invasive, surgical procedures.

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

Blisters? That socks.

Blisters – they can drive a person crazy. Athletes, particularly runners, will often think of blisters as a common problem, something that just comes with the territory. You may have seen runners covering their feet with Band-Aids or duct tape to prevent them from forming, or you may have gone to these measures yourself. Generally people will get blisters from a poorly fitting pair of shoes, or perhaps from another source; their socks.

That’s right – your socks may be giving you blisters. When we wear cotton socks to run in, or to walk around in all day, we are trapping a layer of moisture right up against our feet. Think about getting out of the shower and grabbing a cotton towel to pull all the water off of you. This is exactly what your socks are doing, only they hold that sweat right up against your feet. This increases the friction between the sock and the skin on your foot, which will increase the friction between the layers of skin on your foot. Over a period of time, a blister will form.

So how do we combat this problem? One way to prevent blisters from forming is by switching from a cotton sock to a sock made of moisture-wicking fibers. Many brands make socks specific to running or other activities. These socks are made to fit tight, and often have extra layers of padding in areas that are most sensitive to blister formation, like the heel and ball of the foot. The materials used may be synthetic materials, such as nylon, polypropelene, or acrylic, as well as natural fibers like merino wool. All of these non-cotton fibers have the ability to spread moisture out over a greater surface area. The greater the surface area, the easier the moisture can evaporate.

When it comes to moisture-wicking socks, there are lots of options. For natural fibers, brands such as SmartWool and Bridgedale use merino wool. A variety of synthetic materials are used by brands such as WrightSock, Under Armor, and Balega. DryMax socks use a double layer sock, transferring the friction normally seen between the foot and the sock to this layer. Many brands that make running shoes also make moisture-wicking socks, such as Nike, Brooks, Asics, Adidas, and Mizuno. When it comes to choosing moisture-wicking socks, the options are about as plentiful as the options of shoes! You can purchase these types of socks directily from out online store by clicking here!

So, if you have a problem with blisters, try changing your socks. With so many options, you can try a few different brands to see which ones will be your favorite. Ask around – maybe someone you know has a favorite brand of their own. But be careful, once you start wearing moisture-wicking socks, you may not ever go back to cotton!

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

Ahh! My Legs! Restless Legs Syndrome – Part 1

What is it?

Restless Legs Syndrome (RLS) also known as Wittmaack-Ekbom’s syndrome is a neurological condition that is characterized by burning, itching, gnawing or creeping sensations inside the legs. Some people have even described the feeling as insects crawling up and down the insides of their legs!

Who is affected?

What are signs and symptoms of Restless Legs Syndrome?

            Paresthesias which are irregular sensations and dysesthesias which are unpleasant irregular sensations are indications of RLS. These abnormal feelings usually occur in the leg – between the knee and ankle, deep inside the body. RLS may also occur in the torso, arms, hands, thighs, and feet! This condition usually occurs bilaterally (on both sides of the body), but in some cases only one side of the body may be affected.

            The way to relieve the sensations is by continued movement – so people with RLS usually keep their legs in constant

            It is thought that 12 million Americans may be plagued with this condition! Although both males and females are affected, it occurs slightly more frequently in women. The disorder can occur at any age – from infants to the elderly. The majority of those affected with RLS lie in the middle-age to older category. Unfortunately, the intensity of syndrome increases with age. Older individuals experience longer episodes of symptoms more often.

What are some characteristics of this condition?

The most unusual and distinguishing feature of this disorder is that relaxing or lying down will trigger the symptoms of this condition! If left undiagnosed and untreated, this syndrome will cause sleep deprivation which can lead to exhaustion and fatigue during the day as well as the lack of concentration, reduced memory, and the inability to accomplish daily activities.

motion to prevent the uncomfortable feelings from arising. A person with RLS will pace around, toss and turn in bed, and shift their legs continuously while seated.

            Individuals with RLS usually find that the symptoms of the syndrome are less obvious during the day and more definite in the evening hours. This condition may be brought about by stillness, immobility, or inactivity such as sitting in a theater, airplane, or car seat for extended periods of time.          

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

Ahh! My Legs! Restless Legs Syndrome – Part 2

Restless Legs Syndrome is a condition where the affected person has the uncontrollable and compelling impulse to keep their body in motion in order to prevent unpleasant and uncomfortable sensations. Body movement relieves the RLS-affected individual’s symptoms.

What are some causes of Restless Legs Syndrome?

            There are several associated factors/conditions that may lead to this neurological disorder.

-          A family history of RLS has been noticed, suggesting that this syndrome has a genetic component.

-          Individuals with iron-deficiency anemia or other vitamin deficiencies may be at risk of developing RLS.

-          Individuals with unremitting diseases such as peripheral neuropathy, diabetes, kidney failure, and Parkinson’s have a connection with RLS (RLS symptoms may diminish by treating the underlying disease)

-          In some instances, child-bearing women may feel symptoms of RLS. The abnormal neurological sensations usually occur in the last trimester. In most cases, RLS symptoms fade away around1 month after delivery.

-          Medications such as anti-nausea drugs, anti-psychotic drugs, anti-seizure drugs, anti-depressant drugs and allergy/cold drugs (Benadryl) may increase RLS symptoms!

-          Caffeine (found in coffee, teas, soft drinks, and chocolate), alcohol and tobacco may contribute to the increased intensity of symptoms of RLS.

-          A very recent publication in the journal Neurology has shown there is an association between belly fat and Restless Legs Syndrome. This new study found that individuals with a body mass index (BMI) of 30 or greater were 42% likely to have symptoms of this neurological disorder than persons with normal BMI (23).

Unfortunately, a majority of RLS cases have no known cause.

How is this disorder treated?

            RLS may be caused by several different factors. As such, several different treatment methods are employed to handle the syndrome.

-          Iron, magnesium, and folate supplements

-          Decreased use of caffeine, alcohol and tobacco

-          Normalizing sleep patterns (may be achieved by moderate exercise or hot showers)

-          Hot baths or leg massages

-          Change in medications (talk to your doctor)

These remedies may play a role in reducing RLS symptoms and bring about relief, but do not expect them to completely eliminate the abnormal sensations.

If you feel unpleasant tingling, creeping, “pins-and-needles” or tugging sensations on or in your body, especially in the leg area – you should consult your local podiatrist. When discussing your condition, be sure to inform them of all the medications, supplements, and herbal remedies you may be taking as well as your smoking and drinking habits. They will prescribe the right treatment/medications to help reduce and may be eliminate Restless Legs Syndrome! 

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

Who do you call when you find a footprint at a crime scene? A Forensic Podiatrist, of course!

A small but growing trend in the realm of criminal justice and scientific crossover is forensic podiatry.  Forensic podiatry deals with the evidence found at a crime scene that is related to the foot.  This may include things like footprints found at the scene or the wear pattern of the sock liner of the shoe. 

One of the most prominent forensic podiatrists is Dr. Michael Nirenberg.  An article written by Dr. Nirenberg in 1989 stresses the importance of forensic podiatry.  In “Forensic Methods and the Podiatric Physician”, Dr. Nirenberg compares forensic podiatry to the fields of forensic odontology (the handling and evaluation of forensic dental evidence) and forensic anthropology (the handling and evaluation of forensic bone evidence).

Following the publication of Dr. Nirenberg’s journal, the American Society of Forensic Podiatry was formed.  This group serves to organize podiatric physicians who are involved in forensic podiatry, and promote the use of podiatric forensics in legal cases.  The group also serves as a means of communication between forensic podiatrists to share information and research. 

Some of the information that a forensic podiatrist may gather as evidence in a case includes the podiatry records of people involved, footprints, shoe gear that may be left at the scene of a crime, and in some cases, even a gait analysis from a security camera can be used!  However, the most valuable and easily administered evidence in past criminal cases that forensic podiatrists have contributed to comes from a comparison of the wear patterns of the inside of shoes.  The way that a person wears a shoe down, especially on the inside of the shoe in the sock liner, is unique to the individual.  Furthermore, this wear pattern is seen in most shoes that a person will wear.

Forensic podiatry is a fascinating field that is slowly but surely gaining attention.  Some predict that one day forensic podiatry will be as common as any other form of forensics, and the information collected from forensic podiatrists will be ubiquitous in the world of criminal justice.

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

IT Band Syndrome

If you are a runner, chances are good that you’ve suffered from an injury at some point in your running career.  It may have been hip, knee, lower back, or foot pain that brought you to a stop.  In any case, the experience was likely unpleasant.  Some of the most common running-related injuries are also the most preventable.  One of the most common running-related injuries is iliotibial band syndrome (IT Band Syndrome).

The iliotibial band is a sheet of tissue that runs from the hip to the knee.  At the hip, it connects to a muscle called the tensor fascia latae.  This muscle works in abducting the thigh (pulling it away from the midline of your body) and rotating the thigh medially while walking or running.  At the knee, the IT band attaches to the tibia, or shin bone, at a point known as Gerdy’s Tubercle.  This point is located on the tibia just below the knee, on the outside of the leg. 

Pain from iliotibial band syndrome can be quite debilitating, and will certainly bring your running to a temporary halt.  The pain is generally diffuse, and is located at one of the attachments of the band of tissue.  Most people complain of pain at the knee, specifically at Gerdy’s Tubercle, but the pain may also be referred to the hip. 

If you have a tight iliotibial band, there may be some relief from stretching out the tissue:

Stretch #1:  From a standing position, cross the injured leg behind the uninjured leg.  Next, lean towards the uninjured side, with your hands on your hips for balance.

Stretch #2:  While sitting on the ground, extend your uninjured leg straight out in front of your body.  Next, cross the injured leg over the uninjured leg, and pull the injured leg as close to your chest as possible. 

            Try each of these stretches, holding the position for 30 seconds each.  These should be done everyday, especially after running.  If the pain persists, you may want to go to a doctor to rule out any other causes of hip or knee pain. 

            If you’re just beginning to run, don’t let IT band syndrome discourage you.  It’s something that is easily fixed, and can often be attributed to a pair of poorly fitting shoes. 

            Remember that pain is not normal.  It is the body’s way of warning itself that something is wrong.  If pain persists, it may something more serious and should be evaluated by your doctor.

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

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

Benefits of Below Knee Cast

A recent study in The Lancet shows that treatment of severe ankle sprains with a below the knee cast is more effective than a compression bandage. A total of 584 participants with severe ankle sprains from eight emergency departments were included in a study to evaluate different treatment methods. Patients were placed in a below-knee cast, an Aircast brace, a Bledsoe boot (walking boot) or a tubular compression bandage. Patients were evaluated at three months and nine months.

Those who received a below-knee cast had significant improvement in pain, symptoms and the quality of ankle function compared with the tubular compression bandage. Those placed in an Aircast brace experienced an improvement in the quality of ankle function, but had no difference in pain or symptoms in comparison to the compression bandage. Those placed in the Bledsoe boot had no benefit over the tubular compression bandage at three months. When the patients were evaluated again at nine months, there were no significant differences between the tubular compression bandage and other treatments (1).

DR'S RESPONSE:  This might seem obvious, but any kind of conservative treatment that limits or prohibits motion in an area of injury would be the best treatment option.  The important point to decipher is that regardless of treatment, at 9 month follow-up, there were no significant statistical differences noted.  Thus, one must measure cost with effectiveness when treating injuries.

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

Running in the Dark

  Well yesterday I was running in the dark on my street. As I was merging into my friend's front lawn, he has this little bump on the perimeter of his lawn, you can’t even really consider it a curb since it is barely seen and black. Anyways, I did not see it running onto the grass and landed on my ankle incorrectly after somewhat tripping over this bump.

 I went to sleep with what was a mild ankle pain at the time. I could normally walk, but with some discomfort. Now as I just woke up, there is no swelling in the ankle, maybe some minor inflammation. BUT, I can barely walk, I mean it really hurts to put pressure on that foot.

 This is my first injury of this type, should I seek professional care or just do the standard home treatment (Ice it, and rest)

 I would get it checked out by a doctor, even if it is just a sprain it's better to get it looked at by a professional. If it's just a sprain take Advil to bring down the swelling in the joint (there's swelling even if you can't see it) and ice it for periods of 10 minutes on and then 10 minutes off.

DOCTOR'S RESPONSE:  Any kind of tripping, twisting, or sprains normally doesn’t require a visit to the doctor.  However, any time you are “barely able to walk” after an injury should ring alarm bells that something is possibly amiss.  There could be a variety of injuries.  I recommend that you make an appointment with your local podiatrist, a physician with specialized training for problems in the foot and ankle. 

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