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About 25 million people have diabetes in the United States, according to the American Orthopaedic Foot & Ankle Society.
Diabetic foot care is important in preventing ulcers, amputations, strokes, and heart attacks. The research, published in the UK medical journal Heart this August, involved 13,000 patients with type 2 diabetes in England, and found that the loss of feeling in the feet is a good predictor of cardiovascular events such as heart attacks and strokes.
Scientists studied 407 deaths from any cause and 399 non-fatal cardiovascular disease events. Loss of sensation in the extremities does not just suggest nerve damage, but circulation problems as well. You may feel hopeless and wonder what can be done if you have already lost sensation in your feet. The Center For Podiatric Care & Sports Medicine treats diabetic patients who wish to lead active and fulfilling lives.
If you have any foot problems or pain, contact The Center for Podiatric Care and Sports Medicine. Dr. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising.
Diabetes is now recognized as a chronic, debilitating and costly disease, predicted to double to 366 million by 2030.
I am a firm believer the great maker, (whoever she was), was a podiatrist, or at least a friend of podiatry, for the longer we live the more we seem to rely on the services of others to tend to our feet. For my sins, I am a community based podiatrist with a demographic made up of seniors, who are often: sight challenged hypertensive, peripherally ischaemic, venous return compromised, obese with ankle oedema, on anticoagulants, and suffering all manner of arthritides. Aetiology of diabetic neuropathy is still poorly understood although glycation is probably a major factor. Currently there is no gold standard for chair side assessment of Diabetic Peripheral Neuropathy (DPN). From the 80s, Semmes-Weinstein monofilament examination (SWME) has been used in testing protective sensation. A modified Neuropathy Disability Score (NDS) has been shown to be the most reliable test for sensitivity and grading diabetic peripheral neuropathy. Motor weakness is unusual, although small muscle wasting in the feet and also the hands may also be seen in more advanced cases. Claudication can be a useful symptom, but peripheral arterial disease (PAD) is commonly asymptomatic.
A Foot Deformity Score helps identify high risk areas where repetitive trauma can cause breakdown, progressive ulceration, and infection.
Inadequate footwear makes a significant contributory factor in causation of diabetic ulcers i.e. There are several systems to categorize risk with the best known the University of Texas Diabetic Foot Risk System (with 7 categories). Early detection of the insensate limb is critical and improved Quality Adjusted Life Years is achieved through regular foot screening and foot care; in conjunction with intensive glycaemic control. An annual foot exam is recommended for all patients with diabetes to identify high-risk conditions and risk factors predictive of ulcers and amputations.
A multidisciplinary approach is recommended for patients with foot ulcers and high-risk feet, in particular, those with previous ulcer or amputation. Refer patients with the following to a foot care specialist: loss of protective sensation and structural abnormalities, history of prior lower-extremity complications. Include history for claudication and assessment of pedal pulses in initial peripheral arterial disease screenings; also consider obtaining ankle-brachial index (ABI). Refer positive ABI or significant claudication for further vascular assessment and consider exercise, medications, and surgical options.
Most diabetic wounds do not hurt and are first recognized by drainage on the sock or floor. Reusable Gel Dancer's Pads relieve forefoot pain by shifting weight away from the great toe joint and sesamoid bones. Natural Antifungal Lavender Tea Tree Foaming Soap is an antifungal and antibacterial soap in a pump dispenser.
The Reusable Gel U-Shaped Callus Pads are used to help off-load painful calluses and sore spots on the foot and ankle. Ultra Thin Ball of Foot Slip-on Straps offer comfort and protection for ball of foot pain and forefoot pain. Foot pain is the most common symptom experienced by those suffering from an Achilles tendon disorder. In more severe cases, other options, including physical therapy and surgery, may be required to completely heal the tendon.
Although it is not possible to prevent all injuries to your Achilles tendon, you can try following a few simple guidelines to minimize your risk. After adjusting for age, sex, ethnicity, systolic blood pressure, cholesterol, BMI, HbA1c, smoking status, and use of medication, peripheral neuropathy was associated with an increased risk of a cardiovascular event. Researchers concluded that testing for peripheral neuropathy annually is an easy clinical way to identify high-risk individuals who require more monitoring for cardiovascular health.
We offer state-of-the-art technology, such as Transcutaneous Electrical Nerve Stimulation and pulsed infrared light therapy, which improves the lives of diabetics suffering from severe pain in their feet.


Katherine Lai is Board Certified in Foot Surgery and has lectured extensively on The Diabetic Foot and Wound Care and on the Scope and Practice of Holistic Podiatry at an Integrative Medicine conference. Ryan Minara completed a 4 year Foot and Ankle residency from NY Hospital Queens where he was the Chief Resident. Rivera specializes in the aesthetic correction of foot deformities and has an expertise in wound management and is fully bilingual in Spanish and English.
Something like, 47% of diabetics have some peripheral neuropathy and at a conservative estimate, 7.5% are suffering symptoms at the time of diagnosis. All the more critical as the bludgeoning diabetic population becomes endemic among the 45 plus age group. High percentage are diabetic (and often not taking their medication), with chronic foot problems that limit mobility. Conventional wisdom supports symptoms alone have relatively poor diagnostic accuracy hence a combination of signs and symptoms approach is considered more appropriate. Palpation of foot pulses is however a good simple test to determine the presence of peripheral arterial disease. Screening includes signs such as: abnormal bony prominences, subluxation of the metatso-phalangeal joints, lesser toe deformities due to small muscle wasting, PesPlanus or PesValgus, previous amputation, and Charcot’s neuroarthropathy. In Australia the Enhanced Primary Care Plan gives greater access to clients who are potentially at risk.
To this end effective care involves clear communications between patients and other health care professionals.
If you begin to develop tiny injuries in the tendon, repetitive motions will cause these injuries to grow. Depending on the severity of your disorder, your podiatrist may recommend several different treatment options. Surgery, however, is typically recommended only after the individual has tried less drastic methods to heal the tendon.
With locations in Houston, The Woodlands, Bryan, and College Station we most likely have a location near you. Our NY podiatrists have long counseled patients with diabetes that foot health should be a top priority to avoid the development of nasty ulcers that can lead to amputation in some cases.
Cryosurgery is another treatment we offer patients who have been suffering from neuropathy pain for years. Geldwert is Board Certified in Foot and Ankle Surgery and is a recognized authority on the most advanced surgical techniques to correct bunions and hammertoes. Research confirms early detection of the insensate limb is critical, but difficult because diabetic peripheral neuropathy (DPN) is often asymptomatic.Despite clear and authoritative clinical guidelines research also supports first-line providers do not screen enough and their care quality suffers as a result.
Of course there are co-morbidities which collectively make toe nail clipping marginally safer than swimming blindfold slowly through a school of man eating sharks. Disruption to neuronal integrity and failure to regenerate results in progressive neuropathy characteristically presenting in a distal–proximal direction (stocking distribution).
Diabetic peripheral neuropathy manifests with a wide variety of sensory, motor, and autonomic symptoms.
Symptoms include weakness or atrophy of intrinsic foot muscles and associated foot deformities. The ankle-brachial pressure index (ABPI or ABI), using Doppler ultrasound is a useful adjunct to assess foot perfusion. Foot Health Education Programs promote daily self foot inspections with informed foot hygiene that minimize inadvertent self harm.
I hope this presentation will convince you to use podiatry services to improve the quality of care to our diabetic population. Diabetic wounds of the foot are a common problem that result from loss of sensation in the feet in poorly controlled cases of diabetes. Several conditions can impair the function of your Achilles tendon, including tendinitis, tensdinosis, tears and ruptures.
However, if the inflammation does not cease, you may develop a more serious type of tendon disorder known as tendinosis. Continued use of the foot prevents the body from repairing the small injuries that accumulate within the tendon. Resting the affected foot is a good way to start as you wait to see if the foot will heal on its own. Skilled surgeons may even be able to physically repair some of the nerve damage in your feet. The purpose of this short presentation is to highlight the podiatrist‘s role in screening the diabetic foot. Smaller fibres are often the first to be affected and with continued hyperglycemia, larger fibres follow. Results can however be falsely elevated in the presence of arterial calcification and in this event clinicians are using photoplethysmography the measure toe-brachial pressure index or toe pressures.
Morbidity rates for limb amputees are poor with a life expectance of approximate five-years.Dryness, tineapedis, cracks, onychomycoses, acute erythema and tenderness, and fluctuance under calluses. Poorly fitting shoes cause sheer which may lead to secondary skin changes.When shoes fail to support feet, high intermittent pressure result which puts the insensate foot at risk. Advice on appropriate foot gear and where to get it is combined with and open access in the case of emergency.


In severe cases, you may need to seek the aid of a podiatrist to ease your foot pain and heal your foot. Although Achilles tendon disorders are common among professional athletes, manual laborers may also suffer the same disorders. Our team of physical therapists, podiatrists, specialists, and podiatric surgeons will work alongside your primary care physician to find the best solutions to take care of your feet and decrease your risk of suffering an adverse cardiovascular event.
Delayed healing and propensity to infection mean small cuts and other abrasions have the potential to ulcerate. Best evidence supports the use of the 10g monofilament combined with the modified Neuropathy Disability Score (NDS) to chart protective sensation and identify those most likely to progress to ulcerative stage.
Proximal limb weakness include difficulty climbing up and down stairs, difficulty getting up from a seated or supine position, as well as falls due to the knees giving way. In the ‘toe’ examination, if the flow is deemed adequate patients are managed medically, surgically, and mechanically with the foci to heal and prevent severe recurrence. A significant number of people wear shoes that do not fit their feet and research continues to shown poorly fitting shoes are more prevalent in the demographic with diabetic foot wounds than in those without wounds with or without peripheral neuropathy. A greater understanding of diabetic wound care and advances in wound care technology have lead to significant advancements in the field.
Finally, some individuals may experience a rupture or significant tear in their Achilles tendon, resulting in increased foot pain. In addition, individuals who are not used to participating in challenging sports, such as basketball, may injure their Achilles tendon while playing these types of sports. Mariola Rivera DPM serving Westchester County, White Plains, Ardsley, Bronxville, Harrison NY, Larchmont, Mamaroneck, New Rochelle, Rye, Scarsdale, Rye Brook, Chappaqua, and the surrounding area. It is now recognized regular foot screening helps monitor and prevent serious complications in people coping with peripheral neuropathy and peripheral vascular disease.
NDS is a score based on vibration perception, pin-prick sensation, temperature perception, and ankle (Achilles) reflexes. Strength testing - Examine for distal intrinsic extremity muscle atrophy, since weakness of small foot muscles may develop.Autonomic neuropathy may involve the cardiovascular, gastrointestinal, and genitourinary systems and the sweat glands (sudomotor).
If the blood supply is determined to be inadequate, the patient is prioritised for revascularisation or ‘flow’. A routine foot assessment includes size, volume, suitability and wear marks of presenting footwear are reviewed and discussed with the patient. As tendons weaken with age, older individuals are also at a higher risk of these disorders. This will improve the overall flexibility of your Achilles tendon and reduce the possibility of injury. Research suggests people unable feel the monofilament have a 7.7-fold increase in ulceration risk.
Once an appropriate blood supply is established the patient is returned to ‘toe’ for preventive management. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.
Monofilaments have high inter and intra examiner reliability and are generally considered effective, inexpensive and simple screening for ‘at risk’ feet.The half -life of a Semmes-Weinstein monofilament is approximately 100 patients.
Bigger A-alpha (I) and A- beta (II) responsible for propioception (13 -20 mu), vibration and pressure (6 -12 mu).
Sudomotor neuropathy may produce heat intolerance, heavy head, neck, and trunk sweating with anhidrosis of lower trunk and extremities. Other treatment options your podiatrist may recommend include oral medications, such as ibuprofen. Filaments fatigue and bend too easily, giving false positives after testing about 10 patients. Signs might include warm dry skin (in the absence of peripheral vascular disease) and the presence of plantar callus under pressure-bearing areas. Vibration Perception threshold is tested using a 128Hz tuning fork or RydellSeiffer tuning fork. The “at-risk” foot for neuropathic ulceration might also have a high arch (pescavus) and clawing of the toes. The affected individual can also try to use ice on the foot to reduce any swelling and pain in feet. Vibration Perception thresholds have a strong co-relation with nerve conduction velocities and are a reliable indicator of “risk” for future ulceration across a wide range of ages and durations of diabetes.
However, it must be emphasized that all patients with DPN with or without obvious foot deformities must be considered as being at risk of neuropathic complications, such as Charcot’s neuroarthopathy or foot ulceration. Increased assessment frequency helps monitor rapidly-developing problems, such as ulcers, infections, gangrene, and Charcot’s neuroarthropathy.
This neurological deficit may only be discovered during a routine neurological foot examination. Until adequately assessed all Aboriginal and Torres Strait Islander people with diabetes are considered to be at high risk of developing foot complications and therefore will require foot checks at every clinical encounter and active follow-up.



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