The Best Treatment of Nerve Pain in Diabetic Patients

Diabetic neuropathy is a common complication experienced by most diabetics. It is a painful pins and needles sensation with a feeling of numbness. Diabetic neuropathy is a detrimental complication of diabetes, which is not easily treated. Patients with neuropathy are left with a loss of peripheral awareness causing ulcers and other complications that may lead to limb loss. Microangiopathy is the cause of diabetic neuropathy, which is due to excess blood sugar and high blood pressure.

 

Patient controlled blood pressure and sugar are the only real treatment of diabetic neuropathy; however, doctors most often treat the symptoms of diabetic neuropathy through topical and oral medications. Low average fasting blood sugars below 125mg/dl and low H1AC below 6% are the only proven treatment to stop and control diabetic neuropathy. Most other treatments are just band-aids to the problem. 

Capsaicin is a topical medication commonly prescribed to treat diabetic neuropathy. Capsaicin is derived from the active ingredient in chill power and works by interfering with pain impulses to the brain. It can be purchased over the counter, but a stronger dosage can be prescribed. Capsaicin is not effective in diabetics with blood sugars levels higher than 200 mg/dl. Other topical NSAID such as Voltaren gel and other topical anesthetics are used for diabetic neuropathy, however none of them treat the underlying cause just the symptoms.

 

Neurotin and Lyrica are common oral medications prescribed by doctors to treat diabetic neuropathy. There medications are GABA analogue that are used to treat epilsely but also used for diabetic neuropathy. These oral medication block pain impulse centrally. Neurotin and Lyrica oral are effective method of treating the symptoms of neuropathy but not the cause.

 

If you are experience numbness, tingling, and pain in your feet see a podiatrist.

The Pain of Peripheral Neuropathy

Peripheral neuropathy is a painful disorder that is a nerve condition and can result in pain, loss of sensation, and potentially an inability to control muscles. Peripheral neuropathy may be  present in the arms, hands, legs and feet, but neuropathy normally starts first in the feet. 

Even though the underlying causes of peripheral neuropathy are diverse, the overall symptoms and actions of the disorder are similar. Peripheral neuropathy is defined as a polyneuropathy. It is a disorder that occurs when many of the peripheral nerves malfunction at the same time ultimately resulting in loss of sensation and self-awareness.

Symptoms of peripheral neuropathy are:

• Tingling 

• Numbness 

• Loss of sensation in arms and legs

• Burning sensation 

• Pain 

• Sense of ants walking on arms and legs

Diabetes, alcoholism, nutrition deficiencies, trauma, AIDs, infections diseases and syndromes such as Rheumatoid arthritis and Guillain Barre can all cause neuropathy. Diabetic neuropathy is most common and chronic form of peripheral neuropathy resulting from poor control of blood sugar. Guillain-Barre syndrome is less common cause of peripheral neuropathy, but can be one of the more serious causes because it is an autoimmune disease that can lead to paralysis. 

Peripheral neuropathy is a determinate disease. Individuals with neuropathy lose their self-awareness. They are unable to sense temperature and pain. Commonly diabetics develop sores and ulcers from prolong pressure and suffer burn and other injuries from lack of body awareness. If you think you suffer from a peripheral neuropathy you should see your doctor. 

Finding the Right Back-to-School Shoes

Preparing for a new school year means back-to-school shopping for the usual supplies, clothes and shoes. Shoes should be one of the most important items on any back-to-school shopping list. While many youngsters many want to find the latest and greatest or coolest shoes, parents should consider some important factors on shopping for the right shoes. The American Podiatric Medical Association put together these tips on shoe shopping. 

1. Children’s feet change with age. Shoe and sock sizes may change every few months as a child’s feet grow.
2. Shoes that don’t fit properly can aggravate the feet. Always measure a child’s feet before buying shoes, and watch for signs of irritation.
3. Never hand down footwear. Just because a shoe size fits one child comfortably doesn’t mean it will fit another the same way. Also, sharing shoes can spread fungi like athlete’s foot and nail fungus.
4. Examine the heels. Children may wear through the heels of shoes quicker than outgrowing shoes themselves. Uneven heel wear can indicate a foot problem that should be checked by a podiatrist.
5. Take your child shoe shopping. Every shoe fits differently. Letting a child have a say in the shoe buying process promotes healthy foot habits down the road.
6. Always buy for the larger foot. Feet are seldom precisely the same size.
7. Buy shoes that do not need a “break-in” period. Shoes should be comfortable immediately. Also make sure to have your child try on shoes with socks or tights, if that’s how they’ll be worn.

Not only is finding the right shoe size important, the overall structure of a shoe is critical. A good shoe should have a stiff heel that cannot be easily squeezed or bent. The toe box of the shoe should bend flexibly when your child walks. And the shoe should have a solid midsole that should never twist in the middle. 


Properly fitting and structured shoes can help children avoid years of pain and future ailments. Click here for a list of children’s shoes that have been awarded APMA’s Seal of Acceptance. 

Dry Skin In feet

While dry skin is viewed as mostly bothersome and unattractive, chronic dry skin can lead to fissures and painful infections. Dry skin is caused by a variety of factors However, simple changes in lifestyle can solve most dry skin problems. 

Reason behind dry skin:

The water content in the epidermal layer, natural oils, and fatty substance are the major factors that determine dry skin or xerosis. The epidermal layer holds large amounts of water, which is key to keeping moisture in the skin. The skin also has a thin layer of natural oils and fatty substances that aid in skin hydration and protection from external drying forces. The absences of these factors lead to the common problems and symptoms of dry skin: scaling, redness, itchiness, and chapping.

Most common causes of dry skin:

1. Genetics: Some people are genetically predisposed to dry skin for some reason or another.
2. Soaps: The use of harsh soaps tends to strip away the protective oily fatty layer causing dry skin. Such as antibacterial and deodorant soaps.
3. Frequent, long, hot showers: Extend exposure to hot water strips the skin's protective layer and showers do not give skin an opportunity to re-hydrate.
4. Improper application of moisturizers: Moisturizers need to be applied when the skin is damp and not completely dry.
5. Medication and Drugs: Diuretics for high blood pressure and antihistamines for allergies can cause dry skin
6. Underlining medical conditions: Eczema, psoriasis, fungal infections, diabetes, hypothyroidism, and malnutrition can all lead to dry skin.  

Treatment:

Treatment of most dry skin is relatively simple. Small changes in a person’s daily habits and routines is all that is required to conquer dry skin.

• Do not shower excessively and take short showers in lukewarm water
• Occasionally take a bath in lukewarm water no longer than five minutes to re-hydrate the skin Use mild and fragrance free soaps
•  Use thick and greasy moisturizers. Stay away from oil based moisturizers and apply moisturizer when skin is still damp.

Dry skin can be prevented and is often easy to treat. However, people with chronic dry skin should consult a doctor.

Fungal nail infection

Many people suffer from discolored and distorted toenails. While all too common, there are many causes behind the changes to toenails; fungal or chronic bacteria infections, eczema, psoriasis, and even trauma to the toenail cause distortion of the nail.

Fungal infections are the most common cause of yellowed, thickened and/or deformed toenails and can affect one to all toenails, but cannot spread in the body via the blood stream. Fungal nail infections are slow developing infections that normally go unnoticed, but over time the infection can cause the nail to become distorted, thickened, and brittle in appearance. 

Fungal infections are the result of walking barefoot in public areas and showers with a moist environment that allows fungus to thrive. Sweaty and moist shoes that do not dry out can cause a person to contract an infection. Dermatophytes, the same organisms responsible for athlete’s foot, are can also infect toenails and skin. However, people with diabetes and immunocompromised individuals are more likely to contract these types of infections. 

Fungal infections are easy to diagnose, but can be difficult to treat. Early detection is key to lessening the length of treatment and can increase the chances of having a normal looking nail. Acute infections can be treated with over the counter medication; however, chronic infections can almost always be treated with prescription medications. Laser treatment is also an option in both types of infections. But, chronic infections normally allow little chance for a normal looking nail again even after clearing infection. If you noticed changes in your nail appearance see a podiatrist.

Tips on preventing fungal nail infections:

1.    Change socks frequently if your feet sweat a lot

2.    Bleach socks when washing

3.    Be cautious when walking barefoot, especially in public setting

Orthotics can solve lower back pain

Back pain can be a reoccurring problem. It is a nuisance that often jeopardizes a person’s quality of life and can be debilitating. While many people may suffer from lower back pain, they may not realize that the cause of their pain may be directly related to their feet and how they walk. Using an Orthotics in your shoes can alleviate back and foot pain as well as prevent future injuries.

What is an Orthotic?

Orthotics are custom prosthetic fabricated foot device. They are devices that are worn under the heel and arch of the foot. Orthotics are used to correct abnormal or irregular walking patterns. They improve foot function and reduce excessive stress and strain on the foot as well as other areas of the body. Orthotics provide stability, correct body and joint alignment, and allow for optimal foot biomechanics throughout a person’s walking or running pattern.

How does an Orthotic help with back pain?

Chronic back pain is typically due to a musculoskeletal weakness or bone misalignment. These abnormalities lead to improper compensation of body, which causes excessive stress and strain on the body. Some chronic pain is the end result of improper biomechanics. Most biomechanical abnormalities that are found in the knees, ankles, and back begin in the feet. The feet are the postural foundation of the body and need a device to absorb shock during ambulation. Having the proper support and function in the foot can solve back pain and symptoms such as radiculopathy.

How does an orthotic work?

Orthotics are devices, which are manufactured out of a variety of different material and function biomechanically with a person’s foot. While everyone’s foot is different, it is best to seek the advice and expertise of a podiatrist to determine whether or not an orthotic would be best to reduce lower back pain by absorbing shock.

Something so simple can solve back pain. For more information on orthotics and other foot related issues, please refer to out website.   

Toning Shoes: Are they worth the hype or do they need a caution label?

You may have seen the ads and have even been tempted to buy the latest advertised shoes, but heed our warning before opening your wallet. Several different companies, including Sketchers, Reebok and New Balance, have been marketing new type of fitness shoe that claims to tone or allow you to work out just by walking. Shoes that tone your body may sound great, but it may be too good to be true.

An article in today’s USAToday, A revolutionary sneaker, or overhyped gimmick? highlights the popularity of toning sneakers.

“The makers of ‘toning shoes’ say the shoes can help give wearers more shapely butts, legs and abs, often without the need for gym workouts. That's partly why toning shoes — which often have a rounded sole like a rocking chair, to stretch the wearer's leg muscles with each stride — represent the fastest-growing segment of the $17 billion-a-year athletic footwear industry.”

While the sneakers may be popular and promise an easy workout, they may have adverse effects and may end up causing more problems. Several podiatrists pointed out the shoes’ possible dangers.

"David Davidson, national president of the American Academy of Podiatric Sports Medicine, says the shoes basically make adults learn to walk, or run, all over again by changing their gait. That's a ‘scary’ prospect for someone with a "borderline problem" they might not know about.

Davidson says he's suspicious of any shoes that come with an instructional booklet and DVD.

‘Nothing about these shoes has any redeeming value to me,’ he says. ‘Sorry, I don't see it.’

Bryan Markinson, chief of podiatric medicine at Mount Sinai School of Medicine in New York, says some of his patients who are "not in the greatest of shape" have inflamed their Achilles tendons while wearing toning shoes. People thinking of buying them, he says, should begin an "active stretching program" or else risk injury.

Jonathan Deland, chief of foot and ankle service at the Hospital for Special Surgery in New York, warns the shoes can be ‘dangerous’ for people with balance problems."

Another blogger and certified pedorthist Janet Dixon also noted in a recent post the flaws and potential dangers of the shoes.

As always, consult with your podiatrist before trying any new shoe or workout routine. Everyone’s feet and walking style are different, so it is essential to work with your podiatrist to find out what is best for you. 

How to Battle Bad Foot Odor

Bad foot odor can be embarrassing and are often caused by a combination of sweat or moisture and normal bacteria found on feet. A little effort and minor lifestyle changes can solve foot odors issues easily.

Our feet are one of the sweatiest parts of our body. In fact, our feet can sweat up to a pint a day. When sweat and bacteria on our feet mix they produce isovaleric acid, which can cause unwanted foot odors. The medical term for smelly feet is bromhidrosis. The number one remedy and most effective cure for foot odor is simple. Keeping your feet dry and cleaning your feet daily is the most effective way to cure and prevent foot odors.

Ways to Keep feet dry:

• Wear socks that have proper ventilation
• Shoes that allow your feet to breath
• Deodorizing foot powder
• Ensuring feet are dry before putting on soaks and shoes
• Changing socks daily
• In addition, some people have smelly feet due to excessive sweating and unable to keep their feet dry. A small percent of the population suffer from hyperhidrosis, which can cause a person to sweat beyond their physical needs. Those individuals may have foot odors because they are unable to keep their feet dry.

Tips for battling excessively sweaty feet:

• Using antiperspirant deodorant spray
• Soak feet in salt solution. Mix a half a cup of kosher salt in a moderate filled basin of water. Soak feet for 5 to 10 minutes. Then do not rinse the salt off of your feet, but just pat them dry with a towel. The salt will soak up excess sweat.
• Reduce stress. Excessive stress can lead to excessive sweating.
• Changing socks more than once a day.

Additional tips to prevent bad foot odors:
Allowing shoe gear to adequately dry after every use
Spray shoe gear with Lysol or other antibacterial solutions
For more information on foot odors check out our website.

Principles of Good Running Shoes

Runners often pick running shoes based on the shoe brand. This may work sometimes, but good shoes should be chosen based on its structural elements and how it functions. Running is a high- impact activity that can be hard on a person’s joints and overall body, so finding the right shoe for running is essential.

The first thing a person should consider in a running shoe is the midsole, functional portion of the shoe. The midsole is the layer of the shoe, which is found between the outer sole and the upper portion of the shoe, absorbs shock, and controls excessive motion in a person’s running pattern. Knowing your foot type will determine what you should look for and consider in the midsole.

A good running shoe should also have a stiff supportive heel. A supportive heel is necessary because most runners have a heel to toe running pattern. The heel is an essential part of the shoe, because it is important source of stability. Also the heel can be a point of adjustment to increase comfort in some runner’s gait. That is why people can buy running shoes with difference in heel thickness. Some runners need a thicker heel to reduce the pull on the posterior elements in their legs such as their Achilles tendon, while other runners need a thinner heel. For all runners it is important to make sure the heel counter is comfortable for your foot and running pattern.

The outer sole of a running shoe is critical too. It is attached to the midsole and functions to resist wear, provide traction, and absorb shock. More importantly it is vital that the outer sole matches the terrain of the shoe’s intended use. The outer soles are made out of different materials and various rubber combinations. Be sure to select a shoe with an outer sole that matches your style of running.

It is also critical there is enough room in the toe box of the shoe. The toe box of the shoe should be flexible enough to allow adequate flexion in the big and second toes. A person should have a thumbnail distance between the end of the shoe and a person’s big toe. This will allow for adequate movement in the toes and reduce trauma to the toenails during runs.

Finding a quality running shoe is important. When evaluating shoes quality make sure it contains all of the necessary elements of a running shoe, and most importantly it works with your foot type. For more information on shoes check out our website.

A common cause of heel pain in children

Heel pain is as common in children as it is in adults, except the cause of heel pain for most children is due to inflammation of the growing bone of the heel. This inflammatory condition is known as Sever’s disease or Calcaneal Apophysitis.

Sever’s disease is characterized by pain in the heel caused by inflammation of the calcaneal physis or growing heel bone. The heel bone becomes inflamed in an area in which growth is still occurring called the physis. The physis becomes inflamed due to excessive pulling of the Achilles tendon.  Most physicians agree that the heel pain in Sever’s disease is due to micro-trauma in the growing heel bone due to over pulling of the Achilles tendon; however, the absolute cause of Sever’s disease is unknown.

Sever’s disease is considered to be an overuse-disease in children between the ages of 8 – 12 years old. Symptoms are most common in active or overweight children, especially in children who play soccer, participate in gymnastics, or any activities that requires excess running or jumping. Commonly, children who play soccer develop Sever’s disease because of their footwear or soccer cleats. Most soccer cleats have negative heels, which will increase stress in the region where the Achilles tendon inserts onto the heel.

Sever’s disease can occur in one or both heels. Clinically, children with Sever’s disease will have no swelling or redness, but instead will have extreme tenderness on the back of their heel, especially when squeezed and causes heel pain in children. It can be easily treated with simple heel lifts in a child’s shoe or with rest, ice, and pain medication. However, in extreme cases it is necessary to immobilize the whole foot in a cast for a week or two for proper healing of the inflamed bone. If you think your child has Sever’s disease see a podiatrist. For more information on heel pain and other foot related issues, please visit our website.

Knowing your foot type will help finding shoes

Buying new shoes can be a stressful process for many people especially with the millions of brands and styles. Knowing your arch type will help determine what kinds of shoes will best suit your feet.

Here is a simple process to determine your arch type:

1. Fill a shallow basin with water.
2. Step in the basin and then immediately transfer your foot to a paper grocery bag or piece of paper.
3. Next let the grocery bag or paper dry.
4. After the water has set on the grocery bag compare your foot imprint to the figure below.

O = High arch

1  = High arch

2  = Neutral arch

3  = Flat arch

High, flat, and neutral arches all function differently in which a person walks or is also referred to as gait. So, it is imperative that a person finds a shoe that properly supports their foot. If a person has a high arch, they will need to make sure to purchase a shoe that has more cushioning. People with high arches need more cushioning and less support because their foot under pronates and encounters more stress. A high arch foot is more rigid and rolls outward while running and walking. Because a high arch foot under pronates it leads to great impact on the foot during gait.

People with flat feet or low arches need a shoe that is more supportive. A person with a low arch needs a shoe that is more supportive because they have excess pronation in their gait. Which means when they walk or run they tend to roll their foot inward. This leads to less stability in their foot. So having a more structured or supportive shoe is important.

 A person with a neutral arch just needs a stable shoe. A stable shoe that adequate support and cushion. People with neutral arches have a happy functional medium between high and low foot types. Neutral arches will adequately pronate or roll their foot inward for proper ankle stability and proper shock absorption.

Having the proper amount of pronation in your gait is important, so it is important to find the right shoe that will function with a your foot type and will make finding shoes easier. For more information on shoes and foot types check our website.

Helpful links about shoes:

• Shoe Fitting Guide
• Things a good shoe should have
• APMA  approved shoes

Best way to protect yourself from a bad pedicure

With summer around the corner, there is nothing more lavish or important to some woman than a pedicure. However, you must heed caution because that relaxing footbath and pretty nail polish could be more trouble than what it is worth.  Proper precautions must be taken otherwise that foot massage could lead to a massive infection or worse.

There are several preventative measures that can be taken to prevent issues from a pedicure. One of the first steps to take is to make sure that you do not have any cuts or abrasions on your legs or feet. Getting a pedicure with open wounds drastically increases your chances of an infection. Also, do not get a pedicure the day of or after shaving your legs.

Ensure that the instruments that are being used on your feet have been properly sterilized. Most doctors recommend to people frequently receiving pedicures to buy their own set of instruments. Having your private set will ensure that the tools are sterile.

It is important to pay close attention to how the technician cuts your nails. Some technicians will either cut your nails too short or improperly, which can lead to possible infections and ingrown toenails. One major mistake nail technicians make are pushing back a person’s cuticles. Your cuticles serve as a seal and barrier for your toes. To have that barrier disrupted leaves your toes in vulnerable to all kinds of problems.

Lastly, make sure that the place you receive pedicures from have good habits of keeping their establishment clean, which includes: clean floors, washbasins, chairs, and other things of that nature. Furthermore, going to a nail salon where the nail technicians are certified can prevent major problems too. A certified nail technician means that they have been approved by OSHA (Occupational Safety and Health Administration) when it comes to sterilization of nail supplies.

Even though pedicure can be potentially hazardous, with the right precautions they can be relatively safe. If you receive a pedicure and notice any pain or swelling in your legs or feet see a podiatrist. For more information on pedicure visit our website.

Painful Ankle Sprains

A common injury that causes ankle pain is an ankle sprain. A sprained ankle occurs when the ankle rolls over or the foot inverts causing the ligaments around the ankle to be stretched or damaged. The most common ankle ligament that is damaged is the talo-fibula ligament. In more severe sprains the calcaneo-fibula ligament will be damaged too.

(courtesy of the National Institutes of Health)

The various signs of ankle sprains:

1. Pain on weight bearing
2. Pain on ankle rotation
3. Swelling around ankle
4. Ankle warm to touch

How an ankle heals is determined by how quickly treatment is commenced. The basic principle for treating all ankle sprains is based on the acronym R.I.C.E and anti-inflammatory medication. The acronym R.I.C.E. stands for:

R-rest (do not walk on it)

I-ice to reduce inflammation

C-Compressive bandages to immobilize the ankle

E- Elevate the ankle above the heart for 48 hours as much as possible

If the ankle does not improve after 48 hours then you should consult a medical professional, because the ankle could be fractured as well as sprained. If the ankle does improve after 48 hours there should be adequate physical therapy and a gradual return to physical activities.  There are a number of things that can be done to prevent ankle sprains through proper stretching and strengthening the muscle around the ankle and foot.

The severity of an ankle sprain is determined by the pain of the patient on weight bearing, number of ligaments damaged, and by the integrity of the joint structures. For some people sprains are due to bad luck. However, there are some people who are pre-disposed to ankle sprains. Those pre-disposing factors are:

1. Poor rehabilitation of a previous sprained ankle
2. Certain foot types are prone to ankle sprains due their foot and ankle relationship
3. Weak muscle around the ankle that are not strong enough to protect the ankle from rolling over the foot

When an ankle sprain is not properly treated it can lead to future strains and chronic ankle pain. So the next time you have an ankle sprain make sure it is adequately treated. If you have chronic ankle pain or have an ankle sprain that last longer than 48 hours see your local podiatrist. For more information on ankle sprains check out of website.

Myth: All babies have flat feet

There is nothing more important for parents than the health of their child. While visits to the pediatrician are common, the wellness of those tiny feet and toes are often overlooked.

When a young child starts to first walk at about the age of 9-15 months of age, the foot has a fat or chubby appearance where there is a less bony architecture apparent in the foot. At this point in the development of the foot, it is very difficult to evaluate whether the child will have future problems with a flatfoot deformity.

At the ages of two and three, the child's foot starts to show more of its characteristic shape since the foot is less fat and the bones are more prominent. If the child has flat feet at the ages of two to three, then it is wise to have the foot examined by a foot specialist such as a podiatrist. Early detection of foot ailments can eliminate a lifetime of pain.

Children with flat feet are known to have foot pain and if left untreated, the pain may lead to future foot ailments and possible joint pain. Children typically do not grow out of having a flat foot, but if detected early children’s flat feet can be corrected simply through special braces, shoes, or with insoles. Treating a child’s flat foot not only aids in the prevention of future foot pain. Early detection can allow for permanent correction of foot deformities.

Things to watch for:

Since flat feet deformities causes instability of the foot while walking, children with flat feet may complain about discomfort in the foot arch, heel, or ankle pain. The discomfort is often aggravated with increased standing, walking, or running activities. However, since the excessive rolling inward of the arches may also make the leg and knee more turned inwards, children with flat feet may also complain of pain in the low back, hip, knee, or leg due to the abnormal mechanics of the foot which is created by the flat foot deformity.

If you think your child may have flat feet see a podiatrist.  Some thing that seems so trivial can potential save your child from years of grief. To learn more about flat foot deformities check out our link foot deformities. 

The Woes of Foot Pain

For some the most painful part of waking up in the morning is getting out of bed. A number of people spend their days suffering in agony with morning heel pain that comes and goes throughout the day. A common cause of heel pain is plantar fasciitis. Plantar fasciitis is an inflammation of a thick, fibrous fascia in the arch of the foot called the plantar fascia. The plantar fascia attaches into the heel and fans out toward the ball of the foot, attaching into the base of the toes. If this fascia is stretched excessively it will become inflamed and begin to cause pain.  In severe cases, the pain can be constant and awaken people from sleep. Plantar fasciitis can be described as stabbing pain that occurs in the morning. However, after the foot has been adequately stretched the pain normally subsides and returns after long periods of standing or getting up from a seated position.

Plantar fasciitis is common in:

• Athletes 
• Overweight individuals 
• Pregnant women  
• Individuals who wear shoe gear with inadequate support

Plantar fasciitis can be treated through:

• Simple Calf muscle stretches
• Orthotics
• Cortisone injections
• Wearing shoes with better support 

The main emphasis of treatment for plantar fasciitis is to reduce the forces that are causing the plantar fascia to stretch excessively. If you are struggling with similar foot pain, see a doctor. Something so painful can often be resolved with a short visit to your podiatrist.