In 2002, according to the National Institute of Diabetes and Digestive and Kidney Disease, approximately 65% of those living with diabetes also had some degree of correlated neuropathy. In many cases, it is the symptoms of neuropathy that lead to the diagnosis of diabetes, because these symptoms indicate to the patient that there may be a larger disease process occurring.
Neuropathy, by definition, is disease or dysfunction of one or more peripheral nerves that typically causes numbness, weakness, or both. It is thought that a combination of factors can add to the incidence of neuropathy in diabetic patients, however it directly related to poor sugar control. Nerves are very sensitive to change and when blood sugars are high, the sugar molecules tend to glycosylate both the small blood vessels and the small nerves. This glycosylation compresses the nerve to some degree and results in the symptomatic representation of neuropathy.
Several categories of neuropathy affect the diabetic population, but the most common type is Peripheral Neuropathy. Peripheral Neuropathy is also known as distal symmetric neuropathy, meaning symptoms present first in the toes and fingers on both the right and left sides of the body. As the neuropathy progresses it continues along the foot and hand towards the arms and legs. The sensory changes are minimal and at first may go unnoticed, but as the neuropathy progresses symptoms become more discernable. The best way to prevent and control the progression of diabetic neuropathy is to keep your blood glucose levels within normal range, thus protecting your nerves from glycosylating.
Comprehensive foot examinations by your podiatrist can help diagnose peripheral neuropathies in the early stages and it is important to remember that if you are experiencing any changes in sensation to your toes or feet, you should see your doctor immediately. Your podiatrist will look for changes in light and sharp touch, vibration, reflexes and your ulceration risk. All of these components can hold clues to an early diagnosis of peripheral neuropathy.
If you have already been diagnosed with neuropathy it is still very important to follow-up with your Podiatrist for routine care, but more importantly to be doing your part at home. You must check your feet on a daily basis for any open areas, especially between the toes, and for any color changes that may indicate problems. The largest complication associated with having diabetic neuropathy is the patients’ inability to feel, thus injuries that would be painful in a non-diabetic go unnoticed in a diabetic and can lead to ulceration, infection, and loss of digits. If you notice something unusual or different from the previous day, you should immediately contact your podiatrist for an appointment.
Have questions about your foot care? Call us at (770) 771-6991 or (478) 475-9250 to schedule an appointment with your podiatrist today.
How to Take Care of Your Feet this Winter
With each changing season brings a new set of guidelines for keeping feet happy and healthy. Just as skincare needs change from summer to winter, so to do needs for foot health. For diabetic patients, proper care of the feet during winter months can be even more crucial. Read on to see some of our most important tips for winter foot care.
For runners or joggers looking to stay active through the winter months, be sure not to let icy roads alter your foot strike in a potentially damaging way. Ice on the ground can lead to slips and falls, so it’s best to simply shorten your stride on uncertain ground, rather than risk an injury with a longer, altered stride.
When dealing with snow or ice on the ground, it’s best to invest in a good pair of winter boots. Waterproofing is essential to protect your feet and keep them dry. To prevent any potential infection from wet, sweaty feet, consider foot powder inside boots to further reduce moisture.
A lot of us travel during winter months to see family and friends over the holidays. Always remember to wear comfortable, breathable shoes during travel, especially when flying. Feet can swell during long flights, and remember that you will need shoes that are easy to slip on and off during security checks. For these reasons, we recommend a set of comfortable loafers or other slip on shoes that can be worn with socks.
Another note on travel: Bring any orthotics that you already wear on a typical day. Vacations, especially trips that will include lots of walking and exploring new places, are not the time to try out a new pair of shoes. Make sure all footwear is broken in and to your comfort level.
Foot Care Items to Bring with You During Holiday Travels
- Pedicure tools like toenail clippers, files, and emery boards
- Blister pads to prevent blisters from forming and to protect existing ones
- Bandages in case of small cuts on the feet or ankles
- Foot lotions and creams to soothe tired feet at night, and to prevent over-drying in cold winter air
- Anti-fungal foot powder or treatment cream for athlete’s foot
- Antibiotic creams for blisters, minor damage, or skin irritations on the feet
- Sunscreen to protect any exposed skin
- Clean, dry socks – a new pair for each day
- All of your usual orthotics or inserts
We hope these simple foot care tips for winter weather will help your feet to stay happy and healthy this season! As always, if you have questions about your foot care or need to schedule an appointment with your podiatrist, you may call us at (770) 771-6991. We look forward to hearing from you!
If you’ve noticed new, small areas of growth on the sole of your child’s foot recently, there’s no need to panic. More than likely your child has been exposed to Human Papilloma Virus (HPV); a virus that can infect the skin leading to the development of plantar warts. Plantar warts are the most common infection of the skin caused by a virus and are typically seen in patients ranging in age from 12-16.
HPV is a virus that can infect several areas of the body, including the soles of the feet, and is spread via direct contact to the skin. Most often it comes in contact with the skin when patients go barefoot in public showers where the virus has been left behind by another individuals feet. It is important to keep in mind that the strain of HPV causing plantar warts cannot be spread to other areas of the body, such as the mouth or genitals.
The incubation period for HPV on the sole of the foot ranges anywhere from 1 to 20 months, thus it can be difficult to determine when and where the virus was picked-up by the patient. Once it does present itself it may go undetected, as many patients do not experience symptoms such as pain or do not notice a change in the skin on the sole of the foot. Infection is often disregarded as a callus in the early stages, due to increased thickness of the skin, overlying the area where the virus lives. One defining feature of plantar warts is the presence of small, black circular dots just visible underneath the skin. These “dots” are areas of blood, contained in capillaries that in a healthy foot are not seen, as capillaries typically do not extended into visible areas of the skin on the foot. However, as the HPV grows and comes up towards the surface of the foot, it stimulates blood supply to come with it, helping the virus thrive.
Warts can resolve on their own, as the body’s immune system attacks the virus and rids it from the body, but not all warts will resolve without treatment. Over the counter methods that can be tried include Salicylic Acid preparations (pads, liquid, gel, or ointment) and Vitamin A, in addition to keeping feet clean and dry to eliminate moisture and decrease the viruses chance to thrive. All of the above mentioned options are likely to work on new infections, but for warts that are long-standing, professional treatment from your Podiatrist is recommended.
Depending on the severity and length of infection time, there are many treatment options that can be utilized by your Podiatrist. Selection of a method will both be based on your Podiatrists opinion and evaluation of your child’s infection as well as discussion with you, the parent, to help determine which treatment methods can be tolerated by your child. Acids and ointments, similar to those available over the counter include Canthrone, Efudex and Salicylic Acids. If such treatments fail, cryotherapy (freezing of the wart with sodium nitrate) can be utilized causing the wart to turn black, and eventually fall off. This treatment is slightly more painful than some other options and often requires several applications for success. Debridement, or trimming and cutting out of the wart can also be successful. To ensure that enough of the wart is removed to prevent recurrence, a local anesthetic, injected with a needle, must be used.
Laser treatment is a relatively new method of treating warts and is generally clean, accurate, and effective in ridding your child of the infection. There is minimal to no pain associated with laser treatment, making it a good choice! Marigold therapy (the flower), even newer than laser treatment, has shown incredible success in treating HPV infections on the plantar surface of the foot, and is great for children as it is non-invasive and induces no pain. The only downfall with Marigold therapy is its limited availability in offices across the country.
If you think your child may have a plantar wart or require podiatric treatment as a result of contact with HPV, please don’t hesitate to contact us! Call (770)771-6691 to schedule your appointment today!
Foot Health Highlight: Pediatric Foot Injury and When to Be Concerned About Damage to Your Child’s Growth Plate
Whenever podiatrists hear of a child suffering from an injury, we automatically worry about possible damage to growth plates. It’s a legitimate concern that needs to be thoroughly evaluated upon presentation to the doctor. When dealing with lower extremity injuries the podiatrist will typically x-ray and clinically evaluate the injury to determine if the area in and around the growth plate is affected, or if the injury has directly disrupted the growth plate itself. The treatment plan changes from initial management to the possibility of surgical management and the choice of fixation (pins/screws etc) that can be utilized depending on the extent of growth plate involvement.
When understanding a pediatric injury versus the same injury in an adult, there are some important differences to consider. In kids, the bones are very malleable, meaning that the tendons and ligaments surrounding the bones are stronger than the actual bones themselves. Therefore, in a pediatric patient injury is likely to lead to bone injury — versus in an adult where ligament damage is more likely. Secondly, treating injuries or fractures in the pediatric patient is much more complicated because of the presence of the growth plate.
Growth plates in the lower extremity, when visualized on x-ray, indicate that growth of the individual is still possible. When evaluating bones on x-ray, there are specific “zones” that can be identified to signify growth, disruption of growth, and healthy bone. During infancy, the bones are very soft and malleable. They only harden (ossify) and change completely into solid bone in a child’s mid to late teens, sometimes not until their early twenties. What this means is that injury anywhere in the body, before ossification takes place, can affect growing bone with the possibility of disrupting growth, causing abnormal/irregular growth and even potentially halting growth altogether.
In an adult, the growth plate has closed, growth has ceased, and treatment of a fracture can be initiated without fear of interrupting growing bone. If pins, screws, or plates are needed for fixing the adult fracture, they can be applied without reservations or worries of disrupting growth. However, in pediatric patients certain types of fixation must be avoided and others used carefully and in specific ways so as to protect the growth plate and allow for normal growth to continue.
When the growth plate is unaffected, fracture management is still tricky, but can be more easily handled and the growth plate more easily avoided during treatment. When fracture across the growth plate is created by the initial injury, the goal of fracture management becomes more complicated as the growth plate cannot be avoided during treatment. It must be addressed with reduction and fixation bringing the edges of the fractured growth plate into close proximity with one another. Doing so decreases the risk of interrupted or halted growth in the affected bone with the hope that restoration of normal growth occurs.
Pediatric fractures can be complex, but they can be treated in such a way as to minimize disruption to normal growth patterns. It is important to seek treatment immediately if fracture is suspected, but refrain from pondering the worst-case scenario until your child has been evaluated!
Summer is here, and men and women alike are flocking to nail salons hoping to perfect their toenails for sandals and peep-toe heels! This week we’re taking the opportunity to remind you of some ‘salon smart’ tips that will help you select a salon that’s clean so you receive that pedicure you’ve been craving without putting yourself at risk for infection!
1. Assess the cleanliness of the salon: Look around when you enter a nail salon and check to see if they have bottles of cleaning products near their pedicure soaking tubs. Are they cleaning out the tubs after each client? Soaking tubs are the areas in a salon that carry the highest risk of infection, so use caution! Have they autoclaved their tools between each client? The only way to ensure that nail tools are completely sterilized is through the use of an Autoclave (those little “hot boxes” where tools are placed between each client). Without Autoclave sterilization the tools are only “clean,” and may have lingering organisms present.
2. Bring your own tools: Many salons provide clients the option of purchasing their own “nail tools,” for which you are the only client using those tools. Investing the extra few dollars on that first visit will provide you a decreased risk of infection and peace of mind, knowing that only those tools have touched your feet. You no longer need to worry about who’s toes were being worked on before yours, and what “bugs” may be passed from them on to you.
3. Ask the nail technician NOT to push back your cuticles: The nail cuticle is one your body’s protection mechanisms for keeping bacteria out. By pushing the cuticle back, you open up the possibility of infection, as bacteria can now enter underneath the cuticle. Interrupting the natural function of your cuticles combined with un-sterilized tools and dirty soaking tubs is a sure bet for infection!
4. Give your toenails a rest: Frequently taking off nail polish and allowing the nails to “breathe” helps prevent extra moisture from building up under the nail, subsequently decreasing your risk of infection by bacteria or fungus. In the winter months when sandals are infrequently worn, try to go without nail polish as much as possible. In the summer, when you know you won’t be on vacation or won’t need your nails looking “pretty in pink” for a certain event, take the polish off and give your toenails a break.
5. Diabetics should opt for medical pedicure instead: As mentioned above, dirty tools, soaking tubs, and interrupted cuticles all combine to create a high risk for infection. The risk of infection from a pedicure is the same for clients with and without diabetes, but in the diabetic, the healing potential can be significantly decreased. Due to the nature of diabetes and the course it takes within the body, blood supply to the toes may be decreased, and without adequate blood flow, the cells in your body that fight infection are less likely to reach the site. This can lead to an infection that, in severe cases, runs up the foot and leg and if not caught early and treated aggressively can lead to loss of toes! In addition, healing potential for diabetics is decreased and for the same reasons infection takes a greater toll; the cells in the blood needed for wound healing are less likely to reach the areas where they are needed. In short, if you’re diabetic, it’s wise to avoid pedicures at a salon. Instead, consider a medical pedicure with your podiatrist.
Hopefully these tips will pop into your head as you contemplate your next pedicure. It’s important for feet to look nice for the summer months eliminating embarrassment with sandals where toes are exposed, but it’s more important to avoid infection and its long-term complications!