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Monday, April 18, 2011

Special foot care is required for people with diabetes

According to the Canadian Diabetes Association, researchers predict that about 2.5 million people will have diabetes in Canada by the year 2016. Damage to the nervous system (neuropathy) affects over 50% percent of people with diabetes and can lead to the loss of sensation in your feet. Just try for a minute to imagine what it would be like to have no feeling in your feet. Foot problems can be a big risk for diabetics. Diabetics must constantly monitor their feet or face severe consequences, including a possible amputation.

In a diabetic patient a cut as small as a blister can cause a lot of damage. Diabetes decreases blood flow which makes injuries slow to heal and predisposes one to infection.
Persons with diabetes should inspect their feet every day. Look for small puncture wounds from slivers of glass, wood hair and other objects, bruises, redness, warmth, blisters, ulcers, scratches, cuts and nail problems. Get someone to help you, or use a mirror if you cannot see your own feet.

Below is some good advice for taking care of your feet especially if you are diabetic:
1.      Examine your feet daily and also after any trauma, no matter how minor, to your feet.
2.      Use a water-based moisturizer every day (but not between your toes) to prevent dry skin and cracking.
3.      Wear cotton or wool socks (or diabetic socks – white is the best colour). Avoid elastic socks and hosiery because they may impair circulation.
4.      Move or remove any items you are likely to trip over or bump your feet on. Keep clutter on the floor picked up. Light the pathways used at night - indoors and outdoors.
5.      Always cut your nails with a safety clipper, never a scissors. Cut them straight across and leave plenty of room out from the nail bed or quick. If you have difficulty with your vision or using your hands, let your chiropodist do it for you or train a family member how to do it safely.
6.      Wear sturdy, comfortable shoes whenever feasible to protect your feet. To be sure your shoes fit properly, see your chiropodist for fitting recommendations or shop at shoe stores specializing in fitting people with diabetes. If you have flat feet, bunions, or hammertoes, you may need prescription shoes or shoe inserts.
7.      Regular exercise will improve bone and joint health in your feet and legs, improve circulation to your legs, and will also help to stabilize your blood sugar levels. Consult your physician prior to beginning any exercise program.
8.      If you smoke any form of tobacco, seriously consider quitting. Smoking accelerates damage to blood vessels, especially small blood vessels leading to poor circulation, which is a major risk factor for foot infections and ultimately amputations.
9.      Following a reasonable diet, taking your medications, checking your blood sugar regularly, exercising regularly, and maintaining good communication with your physician are essential in keeping your diabetes under control.
10.  See your chiropodist or podiatrist on a regular basis
Additional Information
Prevention of diabetic foot problems involves a combination of factors.
1.      Good diabetes control
2.      Regular leg and foot self-examinations
3.      Knowledge on how to recognize problems
4.      Choosing proper footwear
5.      Regular exercise, if able
6.      Avoiding injury by keeping footpaths clear
7.      Visit your chiropodist on a regular basis

Wednesday, April 6, 2011

Take Care of YOUR feet!

Basic Foot Care Guidelines
Foot pain is not normal. If you experience any type of persistent pain in the foot or ankle, please contact your local foot specialist of family doctor.
1.    Inspect your feet regularly. Pay attention to changes in color and temperature. Look for any changes in your toenails, cracks or cuts in the skin, peeling skin or blistering on the soles of feet or any growth on the foot
2.    Wash your feet regularly, especially between the toes, and be sure to dry them completely.
3.    Trim toenails straight across, but not too short. Be careful not to cut nails in corners or on the sides; this can lead to ingrown toenails. Persons with diabetes, poor circulation, or heart problems should NOT treat their own feet, because they are more prone to infection.
4.    Make sure that your shoes fit properly. Purchase new shoes later in the day when feet tend to be at their largest, and replace worn out shoes as soon as possible.
5.    Select and wear the right shoe for each sport or activity that you are engaged in (e.g., running shoes for running).
6.    Alternate shoes—don't wear the same pair of shoes every day.
7.    Avoid walking in barefeet. Your feet will be more prone to injury and infection. At the beach or when wearing sandals always use sunblock on your feet.
8.    Be cautious when using home remedies for foot ailments. Self-treatment may turn a minor problem into a major one.
9.    If you are a diabetic, please contact your local foot specialist of family doctor  and schedule a regular check-up.

What's inside YOUR Foot?

Foot Anatomy
The foot is made up of 26 bones, 33 joints, 107 ligaments, 19 muscles, and numerous tendons.  All these parts are kept in the right position and moving together by a complex, individual system of biomechanics. Given this complexity, it is not surprising that most people experience some problem with their feet at some time in their lives.
Within each foot you have:

·         Seven short tarsal bones which make up the heel and back of the instep
·         Five metatarsal bones spread from the back of the foot toward front and make up the structure for the ball of the foot. Each metatarsal is associated with one of the toes
·         Fourteen phalanges, small bones, form the toe structure
·         Tarsal and metatarsal bones provide the structure for the arch of the foot
·         Bands of ligaments connect and hold all the bones in place
·         A thick layer of fatty tissue under the sole helps absorb the pressure and shock that comes from walking and everyday movements
·         A vast array of neurovascular bundles travel through the foot to support all these structures 

Monday, April 4, 2011

Diabetes and Your Feet

One of the key functions of the hormone insulin is to help transport sugar into the body’s cells. Diabetes Mellitus is a disorder defined by impaired insulin secretion and variable degrees of peripheral insulin resistance which can lead to hyperglycemia (too much glucose in the blood).

There are two main kinds of diabetes, Type 1 (insulin dependent) where there is no insulin secretion at all, and Type 2 (non-insulin dependent) where there is insufficient or ineffective insulin management in the body.

Early symptoms of this disease are; frequent thirst, frequent hunger, and frequent urination.

Possible latter stage complications of this disorder are vascular disease, peripheral neuropathy (nerve damage) and a predisposition to infection. If you lose feeling in your feet, it is hard to detect when you may have a problem. Cracks, cuts, or ulcers may develop before you are aware they are happening and your ability to fight off infection may also be impaired.

Managing your blood glucose levels through medication and diet; quitting smoking and getting regular exercise is the key to staying healthy. See your family physician if you have any of these symptoms or have a family history of diabetes.

During Foot Health month (May) in Ontario the Ontario Society of Chiropodists wants us all to be aware of the following facts regarding diabetes:

·         2.3 million Canadians live with Diabetes today
·         345 000 Canadians will develop a Diabetic foot ulcer in their lifetime
·         Every 30 seconds, somewhere in the world, a limb is lost as a consequence of diabetes
·         After an amputation, 50% of patients will have their other limb amputated within 2 years
·         More than half of amputations may have been prevented by a Chiropodist’s treatment
·         More than 4000 Canadians with Diabetes had a limb amputated in 2006
·         The average cost of treating an infected Diabetic wound is $17 000
·         The estimated cost to treat chronic leg ulcers in Ontario is $15,564,000 (2005)
·         A North American child born in 2000 stands a 1 in 3 chance of developing Diabetes in his/her lifetime
·         3 out of 4 people will develop foot problems throughout their life
·         The average person will walk further than the circumference of the earth in their lifetime

The evidence is clear that Diabetic foot ulcers and wounds that result in amputation may be prevented by early detection, prevention measures such as regular foot checks, stopping tobacco use and effective wound care.

Thursday, February 10, 2011

Dermatology I - Winter Skin Problems

Your skin is the largest organ of your body weighing an average of 4 kg and covering an area of 2 square meters. It is either glabrous (smooth and without hair) or hairy. Our skin functions as a barrier against physical objects, light and pathogens (germs). It is involved in our temperature regulation, sensation, grasp, insulation and also a calorie reservoir. There are two main layers and several sub-layers. The two main layers are the epidermis and the dermis. There are appendages such as hair and nails and under the dermis lies the sub-cutaneous fat.

In the winter, the combination of low atmospheric moisture, indoor heating and also our age can give way to extreme dryness, itching and skin cracking – especially around the finger nails and heels. Not only are any breaks in our skin painful, but also allow pathogens (germs) in. In the case of someone who is immuno-compromised such as a person with diabetes, this can be a big deal.

So what can we do? First of all, moisturizing daily with a good non-soap cleanser is a must. Also apply a moisturizer after getting out of the shower or bath. Do not put moisturizer or creams between your toes. All moisturizers are not the same - ask your foot specialist, family doctor or dermatologist which one is right for you. Some creams contain ammonium lactate which is good for debriding (removing) rough skin. Others may contain urea which is good for keeping moisture in.

If you have a skin condition which you are concerned about, please see your health care professional right away.

More about skin…

The Epidermis consists of the following 5 layers;         
Stratum Germinativum (bottom layer)
Stratum Spinosum
Stratum Granulosum
Stratum Lucidum( only on palms and soles)
Stratum Corneum (top layer)

And includes the following cell types;
 Keratinocytes (produce keratin)
 Melanocytes (synthesize pigment – skin colour)
 Langerhan’s cells (immunoreaction – protects us from germs)
 Merkel’s cells (mechanoreceptors – allows us to sense pressure)

The basement layer separates the dermis and epidermis layers

The Dermis (also called the Corium) consists of the following 2 layers

Papillary layer – uppermost part
Reticular layer - below the papillary layer

Within these layers are the dermal matrix consisting of collagen, elastin and ground substance
(proteoglycans), appendages, nerves and blood vessels.

Below the dermis lies the subcutaneous fat which insulates us and separates the dermis from
the fascia. 


1.        The Michener Institute, 2008
2.        Dockery, GL & Crawford, ME 1997, Cutaneous Disorders of the Lower Extremity, WB Saunders, Philadelphia

Saturday, January 15, 2011

Injury Prevention Principles for Runners

No matter where you are on the athletic continuum, newbie, weekend warrior or professional athlete - injury prevention will be important to you. The following presentation gives you an overview of things you need to consider in order to continue to enjoy your sport....

Don't practice until you get it right. Practice until you can't get it wrong.

Foundation Chiropody