Diabetic Problems

Foot problems are a leading cause of hospitalization for the sixteen million persons in the United States who have diabetes (almost half of whom are unaware of their condition*). It is estimated that 15% of all diabetics will develop a serious foot condition at some time in their lives.

Common problems include infection, ulceration, and gangrene (too often leading to amputation of toe, foot or even leg).

Causes of diabetic foot problems:

• Ulceration, usually caused by excessive pressure, or trauma; pre-existing foot deformity greatly increases risk.

• Poor Circulation, restricting adequate delivery of oxygen and nutrients, in turn contributing to mobility reduction and the ability of wounds to heal properly.

• Neuropathy causes reduced sensation, leading to unnoticed symptoms and possible delays in treatment of infection, ulceration, and progressive foot deformities.

• Decreased resistance to infection due to white blood cell difficulties, especially problematic with the conditions listed above.

Foot Deformities:

Foot deformities such as hammer toes, bunions and metatarsal disorders have special significance in the diabetic population. A deformity places the foot at increased risk for developing corns, calluses, blisters and ulcerations. Neuropathy may render symptoms relatively painless.

Special deformities can occur in persons with neuropathy regardless of circulatory condition. A Charcot joint, resulting from trauma to the insensitive foot, causes the foot to collapse and widen. This destructive condition is often heralded by persistent swelling and redness, mild to moderate aching, and an inability to fit into shoes. If this occurs, it is important to stay off the foot and see a podiatric surgeon immediately.

*According to the American Diabetes Association

Early Detection Can Minimize Diabetic Foot Problems

If your feet constantly feel cold and you're experiencing reduced sensation or recurrent, persistent infections that are slow to heal, it could be an early indicator of diabetes. More than 16 million people in the U.S.have the disorder and almost half are unaware of their conditions.*

While there are other factors and signs of diabetes, including (but not limited to) unusual thirst, fatigue, irritability or frequent urination, experts say it's imperative that diabetic paitents seek help for chronic foot conditions to avoid long-term complications.

"The three major foot problems found in person with diabetes work in unfortunate unison, magnifying and escalating the impact of each other," says Dr. McCord, a podiatric surgeon in Everett, Washington. "Neuropathy, the diminished sensation of the nerves in the foot, makes patients unaware of pain, the primary warning signs of an ulceration or infection. Poor circulation or ischemia, coupled with a compromised immune system increases the risk of infection and the severity of the problem. The delivery of oxygen and other nutrients to the affected area is restricted," he said.

Treatment options for all these diabetes-related foot conditions are enhanced by early detection of the problems. For instance, a regular and thorough inspection of the feet, best conducted by both the patient at home and by a professional in a podiatric surgeon's office, greatly improves the chances of identifying a problem before it becomes severe. Local wound care, dressings and antibiotics can help accelerate the healing process. To relieve pressure on the affected area, your foot and ankle specialist may recommend wearing different shoes (even several different pairs during the course of the day). Healing sandals or custom orthoses may be required to protect the foot as it heals. In severe cases, the use of crutches, wheelchair, braces or casts is prescribed to remove pressure and aid proper healing.

When such foot deformities as hammertoes, bunions or metatarsal disorders threaten the diabetic patient's health and mobility, corrective surgery may be required. These deformities will worsen over time without intervention, as will conditions related to nerve, infection and circulatory problems. Podiatric surgery is usually an out-patient procedure performed under local anesthesia.

Maintaining foot health is critical to the overall health and well-being of diabetic patients. Each year more then 50,000 diabetics* must have a foot or a leg amputated due to diabetic complications. Dr. McCord stresses that many of these amputations may have been prevented with early detection and prompt treatment of conditions.

Dr. McCord is a member of the American College of Foot and Ankle Surgeons. His office is located at 3401 Rucker Avenue, Everett, Washington 98201. You may contact him at 425-259-3757.

*According to studies by the American Diabetes Association.

Sports Injuries

Exercise is good for you, but it also puts more demands on your body, especially your legs and feet. The repeated forward, up-and-down, and sideways motions common in sports put extra stress on your feet. Other factors contribute to injury, such as worn-out shoes and overused muscles. These stresses can lead to injuries that can happen suddenly or over a period of time.

With the help of good shoe support during sports your foot can withstand motion and pressure. The bones in your feet provide the frame on which your body balances. Soft tissue forms an intricate network with the bones. When properly aligned, this network provides a stable structure, allowing your foot to absorb, the stress of athletic activity. Muscles power movement. Tendons connect muscles to bones, allowing motion and giving support. And ligaments join bones to each other, preventing them from moving too far.

Forward Motion Injuries: With every step you take your foot flattens slightly. But repeated flattening during sports such as jogging, walking, cross-country skiing and biking can make you more vulnerable to injury. Inflammation of the plantar fascia and tendons are typical of these sports.

Plantar Fasciitis: Chronic inflammation of your plantar fascia can cause it to overstretch or tear.

Tendinitis: If connected to overused or weak muscles, your tendons may become inflamed.

Up-and-down motion injuries: Your feet can take a beating from the up-and-down motion of sports like aerobics. The ball of your foot is subjected to repeated pounding which stresses the weak parts of your foot. Basketball, gymnastics, volleyball and walking on stairs are also common activities that cause stress to your feet.

Repeated Pounding: With repeated up-and-down pounding, the pressure on your foot is concentrated on the ball of your foot. The foot's tendons and muscles aren't able to absorb the extra stress coming up through the bones, so fractures or tendon injuries in your foot, ankle and calf can occur more easily. Being overweight increases the pressure, as does jumping on hard surfaces, over training, or wearing stiff shoes or ones lacking support in the front.

Stress Fracture: Hairline cracks in bones are often caused by extra stress on the bones of your feet.

Shin Splints: Pain near your tibia may be from an inflamed tendon or muscle that is irritated along your bone.

Injuries from Sideways Motions: With sports like tennis, volleyball, basketball or racquetball your feet move side to side, with the direction changing countless times, often very quickly. Making these kind of moves can cause the joints to be twisted or jammed more easily, throwing your foot off balance. Because your joints are forced beyond their normal range of motion, ligaments and joints can be injured. Uneven surfaces are a known factor in this type of injury, as well as wearing shoes with loose ankle support. Other factors which contribute to injury are weak ankles, high arches and fatigue.

Ankle Sprain: An ankle sprain occurs when a ligament in your ankle over stretches or tears.

Turf Toe: When your big toe or second toe catch the turf, jamming a joint.

Podiatrist work hard to get you back to the activity you enjoy doing. Once you are there, you can take steps to help prevent future injuries. Be sure to wear the appropriate shoe gear for the particular sport you are participating in. Each pair of shoes is designed for specific type movement. Make sure you get the adequate nutrition to fuel and support your muscles. Start out slow and gradually increase your time and intensity in your sport.

This page is not intended as a substitute for professional medical care. Only your doctor can diagnose and treat a medical condition.

Foot Pain Among First Signs of Spring

Spring brings showers and May flowers, but according to Dr. McCord, an Everett Washington Podiatric surgeon, it also brings more foot pain.

Dr. McCord sees more patients with heel pain in the spring. In the spring, as people get more active, pain is typically the result of inflammation of the plantar fascia ligament that runs along the bottom of the foot.

He said weight can also play a role in heel pain. "People have a tendency to put on more weight in the winter. The greater the body weight, the greater the stress on the feet." he said.

Women who have been wearing higher-heeled shoes sometimes will experience heel pain when they begin walking in flatter shoes.

Dr. McCord, who is board certified and a member of the American College of Foot and Ankle Surgeons, says that most people with heel pain respond to conservative treatment such a stretching, switching to more supportive shoes and using over-the-counter shoe inserts.

For stretching he suggests rolling each foot over a rolling pin for 10-15 minutes in the evening. Ice should be applied to a sore area for 10-20 minutes after exercise. If there is pain, take over-the-counter anti-inflammatories like ibuprofen. If the pain persists see a doctor.

The right sport shoe also makes a difference, says Dr. McCord. He recommends the following guidelines in selecting sport shoes:

• It's best to have your feet measured, rather than going just by size.
• Shop for sports shoes at the end of a workout when your feet are largest.
• The shoe should fit the largest foot.
• Wear the sock you normally wear when working out when trying on shoes.

General Foot Care

For All Feet:

• Wash feet daily. Rinse off all soap and dry thoroughly, especially between toes.
• Trim nails straight across, and not too short. Don't cut or dig out corners.
• Do not trim, shave, or use over-the-counter medicines to dissolve corns or calluses.
• Wear Clean Socks or stockings, changed daily. Don't wear any that are too short or tight.
• Wear shoes that fit.

Some people's feet sweat more then others, and are more prone to athlete's foot. These tips may help:

• Wear shoes made of leather or canvas--not synthetics.
• Switch shoes from day to day.
• Use foot powder.
• See your doctor if severe problems persist.

For Diabetic Feet:

People with diabetes, or poor circulation, must take extra precautions. An infection could cost them their feet! Besides the general foot health things, follow these as well:

• Protect feet from injury by wearing adequate shoes.
• Look at and feel your feet daily to check for cuts, cracks, or redness. Sensation may be diminished, so you may not notice otherwise.
• Never wear constricting shoes, socks, or stockings.
• See your doctor immediately about anything other than a simple foot problem. Be sure to report any sign of infection or violet skin discoloration.

This page is not intended as a substitute for professional medical care. Only your doctor can diagnose and treat a medical condition.

Healthy New Year's Resolutions Should Include Foot Health

Dieting, exercising and generally leading a healthier lifestyle seem to top most New Year's resolution lists; but an often forgotten aspect of total health is the feet.

According to Dr. McCord, over 66% of the American population suffer from some level of foot pain but do little about it.

"Many people accept foot pain as a fact of life and do nothing about it" said Dr. McCord. "Feet are made to bear great loads over many miles. When functioning properly, your feet handle all of the demands you place upon them without discomfort."

Dr. McCord, who is board certified and a member of the American College of Foot and Ankle Surgeons, points out that high heels are improperly fitting shoes are to blame for 90 percent of foot deformities and ankle injuries suffered by American women.

"It's possible that many people are unaware of what a good fitting shoe is," he says. "Time needs to be invested in selecting a pair of shoes. The heels of the shoe should fit snugly, toes should have extra space in the shoe -- at least one-half the width of your thumb -- and shoes should be worn on hard floor before purchasing."

"We generally take our feet for granted, and we shouldn't" says Dr. McCord. "Feet are what get us to where we're going."

Podiatric Surgeon Provides Foot Health Tips To Seniors

American's senior citizens are more active than ever before, and the quality of life is better. They participate in walking, golf, biking, swimming, dancing or tennis, and their feet are at the center of their active lifestyles.

According to Dr. McCord, senior citizens are susceptible to foot problems. But with preventive maintenance and proper care, their feet will take them all the places they need to go.

Dr. McCord, who is board certified suggests the following foot care tips to seniors:

• Daily foot inspection is an important part of self care. A hand mirror can help while checking the feet.

• Remember to give the feet good preventive care, avoid injury, protect the skin, wear properly fitted shoes, do not attempt self treatment.

• When painful feet prevent wearing shoes or walking normally, see a board certified or qualified podiatric surgeon for examination and treatment.

• Diabetics should get regular foot exams since nerve damage diminishes feeling in the feet and foot problems could go unnoticed.

• As a part of the normal aging process it is not unusual for shoe size to change in length and shape. The shape of the shoe should conform to the shape of the foot.

• Shoes that are too tight are a contributing factor to foot problems. Select new shoes in the afternoon since feet tend to swell later in the day.

Good Shoes

The wrong shoes can cause or aggravate foot aliments. The right shoes can often prevent, but cannot correct problems. So wearing the right shoes is vital to foot health. Here are some things to look for when shopping for that new pair of shoes.

Construction

• Leather is best because it breathes.
• Soles should be strong and flexible with a good gripping surface
• Insoles should be cushioned to absorb the jolts of walking on hard surfaces.
• Arch supports distribute weight over a wider area. Rigid shanks also give added support.
• High heels are fun and look good, but they should not be worn too long at a stretch or for much walking. Besides cramping the toes, they change body posture, making backaches more likely.

Fit

• Only you can tell if shoes fit. If they aren't comfortable, don't buy them!
• Don't plan on shoes stretching with wear. If you already own shoes that are too tight, ask your shoe repair shop if they can be stretched.
• Because feet spread with age, have your feet measured every time you buy shoes. Both feet should be measured as they are often different sizes. Always buy shoes for the biggest foot.
• Go shoe shopping late in the afternoon. Feet swell to their largest then.
• Size depends on shoe make and style, too. Don't insist you always wear one size if the next feels better.
• The toe box should be roomy enough so you can wiggle all your toes.
• Your forefoot should NOT be wider than your shoe.
• The heel should fit snugly and the instep should not gape open.
• If you can't find shoes that fit, ask your doctor for advice.

Shoes for Children

• Shoes serve to protect children's feet from injury, so none are needed before a child walks.
• High-top, oxfords and tennis shoes are good choices
• Check often to be sure shoes aren't too small. Children's feet are flexible and they can be crammed into shoes two sizes too small without the child complaining.
• Do not have a child wear hand-me-down shoes. They are molded to the child that has worn them.

Romancing Your Feet

High Heels--High Fashion That Can Hurt Your Feet

Trying to decide what to wear on that special Valentine's Day date? When it comes to footwear, Dr. McCord, an Everett podiatric surgeon, advises women to use extra care in selecting and wearing high heels. The three- and four-inch heights or thin stiletto heel styles can lead to a variety of foot and ankle problems.

With higher shoes, your feet tend to slip forward, says Dr. McCord "This may amplify discomfort, especially if the shoes don't fit properly in the first place." He suggests women look for shoes with padding in the forefoot area, cushioning the toes and ball of the foot. And be sure there is sufficient shoe width to maintain comfort.

A stable heel is also important to the well-being of the foot and ankle, Dr. McCord says. Stability is maintained when the heel of your foot is firmly enclosed by the shoe, with the stiffest support being the best. He stresses that women should walk in the high heel shoes before they make a purchase. And walk on bare floors, not just the carpeted floor in the shoe display area of the store.

Common high heel-related injuries treated by Dr. McCord, who is board-certified and a member of the American College of Foot and Ankle Surgeons, include sesamoiditis (inflammation and swelling), neuromas (nerve damage), metatarsalgia (pain in the ball of the foot). Less frequent but all to common high heel-related injuries include ankle sprains and even bone fractures of the foot.

Such common maladies as bunions or hammertoes are accelerated by ill-fitting or excessively high heels. Walking in these shoes will change your gait pattern, which can affect your legs and back. Poor shock absorption of the shoes can also contribute to back pain. Such longer term conditions as arthritis in the toe and ankle joints can be exacerbated by excessive wearing of high heels.

Fashion editors point to high heels as enhancing the appearance of your legs as your calf muscles contract and adjust to the ankle of high heel shoes. Dr. McCord suggests women do some basic leg stretching exercises after wearing heels to avoid excessive tightening of these calf muscles and the achilles tendon. Wearing high heels on a regular basis over the years can cause these muscles and tendons to permanently contract, making walking in flat shoes or even bare feet more difficult.

Dr. McCord's high heel shopping tips include:

• Purchase shoes with heels only as high as you are comfortable with. Some women can tolerate higher heels better then others.
• Women with a higher arched foot have more tolerance for a higher heel.
• Also take into account the length of time you'll be wearing the shoes at a given stretch.