Author Archive for steve

Edema, swollen feet and footwear

Published by steve on November 29, 2007 in Uncategorized. 0 Comments

There are several conditions that can lead to swelling in the foot.

 

Lymphedema also known as Milroy’s Disease if it is hereditary, is an accumulation of lymphatic fluid in the interstitial tissue that causes swelling most often in the arms and /or legs. Primary lymphedema occurs when lymphatic vessels are missing or impaired and affects a million people in the US. Secondary lymphedema occurs when lymph vessels are damaged or removed and affects 2 million people in the U.S. 

  

Edema results from venous insufficiency when the lymphatic fluid can not be transported out and an abnormal amount of protein rich fluid collects in the tissues of the affected area.

 

Sesamoiditis is the inflammation and swelling causing pain and tenderness in the sesamoid bones of the first metatarsophalangeal (MTP) joint. This typically occurs when excess pressure is exerted to the ball of the foot when landing heavily on the ball of the foot.

 

When considering appropriate footwear, thought should be given to how easy the shoe can be adjusted to accommodate any swelling that may occur over the course of the day. With a touch or as it is commonly called Velrco™ closure the strap can be easily adjusted as volume increase. Shoes with vamps or uppers made of stretch materials like neoprene, will accommodate the swelling and provide a mild compression to help reduce swelling in the foot. Combined with compression hosiery, some relief from pain can be accomplished. 

 

Peripheral Neuropathy and Footwear

Published by steve on November 29, 2007 in Uncategorized. 0 Comments

Neuropathy is the disturbance of function or pathological change in a nerve.

 

Charcot- Marie-Tooth (CMT) disease, named for three physicians who first identified the disease in 1886, is usually inherited as a dominant trait and is the most common disease within a group of conditions called Hereditary Motor and Sensory Neuropathies (HMSN).

CMT affects approximately 125,000 individuals in the U.S. At present there is no known cure for CMT.

 

There are thought to be at least five genetic causes of CMT that lead to two distinct types of  nerve disease. HMSN Type 1 where there is damage to the nerve fiber insulation and HMSN Type 2 where there is damage to the nerve itself.

 

The disease is marked by a slow progressive muscle weakness in the feet lower legs, hands and forearms and a mild loss of sensation in the toes, feet and fingers.

 

Diabetics with advanced neuropathy are unable to detect when too much pressure is being placed on a bony prominence of the foot. As a result there is a break or hole in the skin, known as an ulcer, and the diabetic can not feel this pain. The most common ulcerations occur on the sole or plantar surface of the foot and the metatarsal heads and hallux. Of the 15% of diabetics that will experience diabetic foot ulcers, as many as 20% of these diabetics will suffer from lower extremity amputation.

 

Accommodative, seamless, soft, stretch footwear with a hook and loop closure, together with a removable insole for custom inserts are often recommended by footwear professionals.

 

Corns, Calluses and Footwear

Published by steve on November 29, 2007 in Uncategorized. 0 Comments

Corns and calluses are the most common foot problem with prevalence increasing with age, especially with women.

 

Corns are an accumulation of the skins epidermis and are often caused by an ill fitting shoe or a digital joint that is out of alignment, corns are created by the body to protect the underlying bones of the foot from pressure by building up layers of skin. Ironically, it is this very protection that can cause discomfort if the pressure persists.

 

Calluses are discrete hard areas on the skin at the sole of the foot. Calluses are often caused again by an ill fitting shoe, a prominent underlying metatarsal bone or a mechanical dysfunction of the foot where here is increased pressure at a specific area of the foot. As the body creates skin to protect the area, again with the build up of skin on the sole of the foot it is compacted by the body weight and unless the affected area is relieved of pressure will cause pain.

 

As with other forefoot and midfoot  deformities such as curly toe, lobster foot, claw foot, cleft foot, conjoined toes, cysts, extra toes,  hallux limitus, hallux valgus, bunions, hammer toes, ingrown toe nails, saddle bone deformity, metatarsalgia, morton’s neuroma, onychomycosis, plantar fibromatosis, sesmoiditis, tailors bunion, bunionette, the key for treating the complaint is to relieve pressure.

 

This can only be achieved with accommodative footwear that is fitted correctly to the foot.  Depth shoes with removable insoles for custom inserts, depth shoes with a deep toe box, shoes with soft uppers, shoes with stretch uppers or stretch lateral or medial panels in the case of bunions or corns, footwear with an adjustable closure such as a hook and loop closure or touch closure, can provide a solution for pressure relief.

  

Diabetes and Footwear Considerations

Published by steve on November 29, 2007 in Uncategorized. 0 Comments

Diabetes is a serious chronic condition of metabolism resulting in high blood glucose.

The inability to secrete insulin or the inability for the insulin to act, or a combination of both, results in high blood glucose. High blood glucose may lead to blindness, heart attacks, strokes, kidney failure, and amputations.

 Type 1 Diabetes  

This type of diabetes accounts for 10% of the diabetic population. The body does not produce any insulin and daily insulin shots must be taken to stay alive.

 Type 2 Diabetes also known as Adult Onset Diabetes. This type of diabetes is very common accounting for the remaining 90% and is determined by diet rather than genetics and occurs as a result of the body’s insulin resistance.For reasons yet unknown, the body’s cells partially shut down their insulin recognition systems. Although insulin is present which should opens the cellular gates to absorb glucose, this does not happen, the gates remain “closed” and glucose levels build up. The pancreas then detects the build up of glucose and starts to produce even more insulin.  The excess insulin then acts as a toxin for the rest of the body. The effects of excess insulin can include  vascular disease, hypertension, abdominal obesity as the excess glucose is converted to fat, and  adverse blood chemistry changes including increased cholesterol, triglycerides, uric acid, and high density lipoprotein (HDL).  

More than 20% of hospital admissions related to diabetes are due to foot disease. 15% of diabetic patients will develop a foot ulcer during their lifetime. Typically, ulcers are most often associated with peripheral neuropathy leading to an insensate foot whereby the patient might not feel or detect pain. This loss of protective sensation combined with foot deformity and peripheral arterial disease could lead to ulceration, infection, gangrene and ultimately amputation.

 

In trying to determine appropriate footwear consideration should be made for the following:

  

1. Most importantly, shoes should fit correctly, not only in length but also in width.      Ideally the upper part of the shoe known as the vamp should be designed to minimize the number of seams in the shoe that could cause abrasion or rubbing, ideally the upper should be seamless. The materials also need to be soft, and if possible adaptive so that they can accommodate any changes in the volume of the foot during the course of the day.

 

     2. Look for a depth shoe with a removable insole so that there is plenty of room for     diabetic insert should one be required. The insert should offer plenty of cushioning and  be of a materials that can mold to the  foot for total contact to ensure equal weight distribution and minimize shear forces in the shoe. A depth shoe also allows for modifications that will help alleviate pressure points that may be at risk for ulceration.

  

3. The way a shoe is attached to the foot is also important. Look for a padded tongue where laces are used or consider a hook and loop closure commonly called a Velcro™ closure or touch closure. This type of closure can help in getting the shoe on and off where often tying laces can be a problem for some diabetics.

 

4. Shoes should be designed so that they can easily modified should the need arise.       

    Modifications could include medial and lateral stabilizers, sole and heel flares,        scaphoid pads,  metatarsal bars, rocker soles, full steel shanks, carbon fiber plates, along with a range of other improvised modifications dependent on the need of any given foot.

Arthritis and Footwear Considerations

Published by steve on November 29, 2007 in Uncategorized. 0 Comments

There are numerous conditions that can cause Arthritis, which is a term that refers to many different diseases that may inflame the joints of the foot and ankle.

 

Some of the most common diseases causing arthritis in the foot and ankle include:

 

  • Synovial inflammatory disease; including rheumatoid arthritis, psoriatic arthritis, and Reiters Syndrome.

 

  • Degenerative joint disease most commonly known as Osteoarthritis.

 

  • Crystal deposition disease; including Gout and Pseudogout.

 

  • Connective tissue disease including; systemic lupus erythematosus and scleroderma.

 

  • Infection where septic arthritis prevails.

 

  • Neuropathic disease indicative of Charcot Foot.

   

Each of the different causes of arthritis affect the foot and ankle in different ways but in generally result in pain as a result of inflammation, swelling, stiffness, tenderness, redness and warmth at the affected joint, and sometimes numbness and skin color change.

  

In trying to determine appropriate footwear consideration should be made for the following:

 

  1. Most importantly, shoes should fit correctly, not only in length but also in width. Ideally the upper part of the shoe known as the vamp should be of a material that can mold to the foot. Soft fine leathers such as deerskin or other accommodative materials like neoprene, that can stretch to accommodate swelling over the course of the day, can provide relief from pain.

 

  1. Look for a depth shoe with a removable insole so that there is plenty of room for an orthosis should one be required. If an orthosis is not required, the insert should offer plenty of cushioning and of a material so that the foot can mold to the insert to equally distribute weight and minimize shear forces in the shoe.

  

  1. The way a shoe is attached to the foot is also important. Look for a padded tongue where laces are used or consider a hook and loop closure commonly called a Velcro™ closure or touch closure. This type of closure can be adjusted easily to accommodate swelling as it increase throughout the day. This type of closure can help patients with arthritis in their hands where tying and untying laces can be difficult or often painful.

  

  1. Shoes should be designed so that they can easily modified should the need arise.       

      Modifications could include medial and lateral stabilizers, sole and heel flares,   

     metatarsal bars, rocker soles, toe crests or  SACH heels, along with a range of   

other improvised modifications dependent on the need of any given foot.

AL Gore for President- what are the bookies thinking?

Published by steve on November 7, 2007 in Uncategorized. 0 Comments

It was on a plane from Atlanta to London in mid February 2007 that I first watched Al Gore’s “An Inconvenient Truth.”  Up until that point, like most right leaning ex-Republicans, I was somewhat skeptical about the empirical evidence behind the global warming theories being bandied about by pseudo-scientists.  My final destination was Spain to watch my home town team Liverpool beat Barcelona in the Champions League, soccer’s most prestigious club completion in Europe.  En route to the game I decided with a couple of friends to visit the Val D’Aran in the Spanish Pyrenees for a spot of skiing. It had been 20 years since I was last there and the difference was amazing. It was not the mass development in that the region that surprised me the most, it was the lack of snow in what was the peak of the season. A local told me that the snow had receded up the valley each year and there had not been skiing at Tuca my favorite resort for about 15 years. It got me thinking about Al Gore’s movie. I was slowly becoming convinced that he might be on to something.

When I returned Stateside I read an article that predicted that Al Gore would win an Oscar for his documentary and had been nominated for the Nobel Peace Prize to boot!!  It was at that point that I became convinced-Al Gore was going to be the next President of the United States. I went online to my favorite site oddschecker.com to see what his chances were-the English bookies are always right about political outcomes, especially with regards to US politics-and there he was.

 A great big 14/1 against him being the next US President and 7/1 against him being the Democratic nominee.

As the Democrats were, and still are, odds on to beat the Republicans, I took the 14/1 and placed my bet.  All my friends think I’m nuts.  But the bookies don’t. Since February, Al went on to win the Oscar ( and joked about running in front of about 1.5 billion people) and then went on to win the Nobel Peace Prize. His odds of being the next Democratic Nominee tumbled to 4/1 in October and 6/1 to be the next President. My thinking here for the apparent inconsistency with the book is that the bookies believe there’s a chance Al might run for the Presidency but not as a Democrat. Interestingly, some bookies will take a bet on Al being the Democratic nominee but not as the next President.

There are a couple of bookies that will still take a bet on Al being the next US president and  London book maker Victor Chandler has him drifting in the market and today you can get 16/1 against. More interestingly for me is those bookies that were offering odds Corals, Ladbrookes, Hills are no longer doing so.

As I watch Al being asked  every day if he intends to run  and watch as opinion polls confirm that he is the only person capable of beating Hillary, he seems more Statesman-like in his demeanor and more and more like the next U.S. President- for real this time.

So what are the bookies thinking? I think that they think he will run, possibly as an Independent, and if he does run that he will win the Presidency. In the meantime they are quite happy to take any money they can get on any other candidate including Hillary. The bookies are as they say “never wrong”.

 I think I need to call Victor Chandler……

  

The choices we make in life.

Published by steve on November 5, 2007 in Uncategorized. 0 Comments

It’s often the small decisions we make in life that someties have enormous life-altering consequences. If you are a diabetic and have peripheral neuropathy,  choosing a pair of shoes can be such an occasion. That is why it is so important for a diabetic to be fitted for their shoes by a qualified professional such as a Certified Pedorthist. If you’re looking for a Pedorthist in your area go to www.pedorthics.org  A Pedorthist will fit take into consideration a wide range of criteria before selecting the correct shoe for your feet. As diabetics are considered most at risk for amputation, this could mean the difference in salvaging your limb. You will find your Pedorthist has a wealth of knowledge about footwear and what is available for your specific needs. Ill- fitting or poorly designed shoes can often lead to a number of ailments that can impact your daily standard of wellness. Take the time, make the extra effort and investment in your foot care and you will be rewarded enormously.

And then sometimes it’s the big decisions that you make in life that can lead to massive consequences. I don’t know if he thought it through at the time but when Imam Samudra the convicted bomber of the 2002 Bali nightclub blasts decided to be a part of the indiscriminate killing I wonder if he considered not only the havoc he wreaked on those families who lost their loved ones, but what his two young daughters must now be going through as they said goodbye to their father before he was to be executed. As they are both less than 8 years old they would not understand his political ideaologies or his reasoning that fateful day he made that decision, but for them they will miss their father for the rest of their lives.

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Diabetics-Taking Care of Your Feet.

Published by steve on October 30, 2007 in Uncategorized. 0 Comments

If you are diabetic, taking care of your feet is critical. By taking just a minute or two every day to check your feet can make the difference in saving a foot from amputation. For diabetics the loss of sensation in the foot which occurs in about 7 of every 10 diabetics often means that the body cannot detect if there is, for example, a stone or a pebble in the shoe that can lead to a wound which if left untreated can lead to an ulceration and ultimately an amputation. Another common cause of trauma is poorly fitted or non friendly diabetic footwear that may have internal seams that can cause rubbing or an abrasion. Full contact molded diabetic insoles minimize sheer and abrasion on the plantar surface of the foot and can also help minimize the risk of trauma.

Daily self exams are the best way to minimize the incidence of damage and take only a couple of minutes.

“Of all diabetes-related complications, a serious foot ulcer and subsequent amputation might be the most preventable with proper care and vigilance in checking the feet at least once a day for small cuts and other abrasions,” said Troy J. Boffeli, DPM, FACFAS, a Minneapolis-based foot and ankle surgeon speaking for the American College of Foot and Ankle Surgeons. “Even those with good control of their blood sugar can experience foot ulcers, especially if neuropathy, a frequent diabetes complication, has caused decreased feeling on the bottom of their feet.”Foot problems are not an inevitable consequence of diabetes. The risk can be lessened significantly by following a few simple precautions:

  • Keep your blood sugar under control to help minimize cardiovascular and blood circulation problems
  • Lose weight, don’t smoke and adhere to prescribed dietary, medication and exercise regimens
  • At least once a day, examine your feet for cuts and other small wounds you may not feel
  • Never walk barefoot, outdoors and indoors
  • Cut nails carefully - straight across and not too short; never trim corns and calluses yourself
  • Wash your feet every day in lukewarm water; dry carefully
  • Choose comfortable shoes with adequate room for the toes
  • Wear clean, dry, non-bulky socks; change daily
  • Shake pebbles or bits of gravel out of your shoes before wearing
  • Seek treatment from a foot and ankle surgeon if minor cuts and sore spots don’t seem to be healing

  

My First Blog

Published by steve on October 26, 2007 in Uncategorized. 0 Comments

I’m a novice at this I have to admit. I’m all set up and ready to go. My focus will be on all things orthopedic. Mainly relating to the foot and footwear- shoes, inserts, socks, what is good and what is not and how to best look after your feet in general.

                    

The foot has in my opinion always got a bit of a bad rap. “Stinky feet”  “sweaty feet”  “ smelly feet” ““cold feet”   “barking dogs” as well as all the other numerous and even racist derogatory terms associated with feet.

 Well, I’m blogging from this day forward to say stop the madness!!  The foot is one of man-kinds wonders of design and evolution. The foot is the most under-appreciated parts of the body and one of the most important to your overall well being.

 Feet are, you see, fantastic.  An engineering marvel with 26 bones and 33 joints - a biomechanical work of art. Multi-faceted, the foot can perform in many guises in any environment. Demands on the foot to get you where you need to be, are daily.

 Walking and mobility is a critical component of a healthy life-plan. Once you stop moving it’s pretty much a matter of time before your quality of life decreases dramatically.

 So I’m here to say how important it is to look after your precious feet. Look after them and they in turn will look after you.

 

So to end my first blog I want to recommend as series of simple exercises I found in an article I read recently in the LA Times by Janet Cromley. They can be done at home and without any fancy equipment.

 • The towel curl: This is one of the safest exercises, says podiatrist Dr. Douglas Richie. While sitting with feet flat on the floor, try to grip a small towel by curling the toes over the towel. Even if you are not able to actually grip the towel, the attempt is still good exercise. To exercise the individual toes, try this with marbles or tissues. This exercise strengthens toes and arches.

• The calf raise: In a standing position, raise and lower the heels off the floor while rolling up onto the balls of the feet. Do this while bending the toes into the floor as if standing on tiptoe. A more ambitious variation of the drill is to do it one foot at a time. This exercise strengthens the arch, toes and Achilles tendon. Do not do this if you have a strained arch, as you could strain the arch further.

• The tennis-ball roll: While seated or standing, roll the foot gently over a small ball, such as a tennis ball. This is good for maintaining the arch.

• The toe massage: While sitting with one foot on the opposite knee, massage the ball of the foot, in between each metatarsal. Repeat with the other foot.