I am asked frequently by patients as to which medications are the best for peripheral neuropathy. There are many different type and they all work in various manners. I am going to give a brief list of the more common medications commonly used for peripheral neuropathy.

Antidepressants

Amitryptiline and nortryptiline are tricyclic antidepressant medications originally used to treat depression. However, these medications have also been shown to interfere with the processes that cause you to feel pain. Cymbalta is a much newer medication that has been shown to be effective for nerve pain in patients with diabetes. Normal side effects of anti-depressants include nausea, drowsiness, dizziness, constipation, and poor appetite.

Anti-seizure Medications

Gabapentin (Neurontin), pregabalin (Lyrica), Topamax, and carbamzepine (Tegretol) are medications that not only prevent seizures caused from epilepsy, but also prevent nerve pain. Lyrica is a newer and commonly prescribed medication for peripheral neuropathy.

Pain Relievers

Pain medication is commonly used for mild peripheral neuropathy. Severe caution must be used when prescribing these medication in order to prevent dependence, sedation and constipation.

Lidocaine Patch

This patch contains a topical anesthetic which causes mild to moderate numbness of the superifical layers of the skin and improve pain symptoms.

Transcutaneous Electrical Nerve Stimulation

A “TENS” unit is a machine in which electrodes send a mild electric through the painful limb. This treatment must be done frequently to have the greatest potential for success.

If you have peripheral neuropathy, please come see Dr. Williams or Dr. Silvers at Advanced Foot & Ankle Center and we can help relieve your symptoms.

It is finally summer and it is hot outside. People will have a nice golden tan and some people will burn and blister. If you are an avid wearer of flip-flops or sandals, you must remember to put sunscreen on your feet.

Why are the feet so commonly forgotten? It is important to remember that your feet and legs are made of the same skin as your face, shoulders and arms.  Burns can occur on the feet and are not just reserved for those crazy people who walk on hot coals.

Constant exposure to ultraviolet radiation will cause mutations of the skin. Exposure to UV-A and UV-B along with certain genetic factors could lead to skin cancer if not careful.

You must wear sunscreen that protects from both UV-A and UV-B rays.

UV-A rays are associated with aging and UV-B rays are associated with burning. However, UV-A is the one associated with long term damage.

There are 2  compounds sunscreen available that will protect against both UV-A rays and UV-B rays.

1. Mexoryl SX by L’Oreal

2. Helioplex by Neutrogena

The products that you can buy that have these compounds are listed below:

1. Anthelios SX Daily Moisturizer by LaRoche-Posay  (has Mexoryl SX)

2. Neutrogena Ultimate Sport Sunblock Spray,  SPF 100 by Neutrogena (has Helioplex)

It is recommended to apply the sunscreen 15-30 minutes prior to sun exposure.

Be safe and sunburn free!

Best Running Shoe for Summer 2010

Here is a simple guide to help new runners get started.

1. How do I get started running?

I personally believe that a person should start walking for a period of time such as 20-30 minutes. Once a person feels comfortable with walking for 30 minutes, then begin adding a 1-2 minute running episode into the walking session. As time goes on, increase the running episodes a little more until you are running for 30 minutes continuously.

2. Is it normal to feel foot and leg pain while running?

Some foot and leg pain is completely normal as you continue to add intensity and distance to your workout. Severe pain is not normal. If you are running with a limp, then you have an issue. Stop running immediately and take some time off. If you are not sure about the pain, then try walking for a couple of minutes and see if the pain disappears.

3.  Are running shoes required?

Although running doesn’t require much in the terms of equipment, you must have a good pair of running shoes on your feet. Running shoes are designed to place your foot in the proper position and  help with shock absorption. The shoes should also fit rather snug in order to prevent movement in the shoe and blister formation.

4. Is there a difference between running on a treadmill and running outside?

A treadmill will pull the ground underneath the runner and also there is no resistance from the wind. This can make running indoors easier. However, treadmills are sometimes padded and can absorb shock which is good if you are prone to injury or overweight. To simulate running outside you may incline the treadmill slightly.

5. What are good locations for running?

The ideal running routes are those which are well-populated, free of traffic, well lit, and scenic. You must think of running as a way of exploring. Ask other runners about the best routes to take.

6. Why am I out of breath every time I run?

You are trying to run too fast. Slow down and relax. Concentrate on deep breaths. If needed, take a walking break. No need to torture yourself.

7. Why does my side always start hurting when I am running?

Stomach pain is common in new runners because the belly is not accustomed to the “jostling” that running causes. More frequent running makes the stomach pain go away. Also, do not eat solid meals at least an hour before you run. When you get a side cramp, focus on pushing all the air out of your belly. This will stretch the diaphragm muscle where the cramp is usually located.

8. Should I breath through my mouth or nose?

It is completely normal to breath through both. Relax your jaw and keep your mouth slightly open.

Running is fun and a great form of exercise.

If you are a new runner and are having foot or ankle issues, please come Dr. Kory Williams or Dr. Eric Silvers at Advanced Foot and Ankle Center in McKinney and Prosper, TX  for all your needs.

Sweaty Feet

Smelly Feet

Peripheral Neuropathy

Nail Fungus

The foot is an incredible structure made of 26 bones, 33 joints, 107 ligaments, 31 tendons, and tons of blood vessels and nerves. All together, the feet hold 25% of all the bones in the body.

The average person takes 10,000 steps each day. This equals to 115,000 in a lifetime. This is enough steps to go around the planet more than 4 times.

The feet of an average person weighing 130 lbs absorbs almost 500 lbs of pressure with every step. This can reach 5 million lbs of pressure each day.

It has been noted that 66% of Americans states their feet hurt on a regular basis and the top self treatment is changing shoes or taking shoes off. 18% of the patient stated they do nothing and deal with the pain. Only 7% sought care from a doctor.

Women generally walk 10 miles per day while men walk an average of 7 miles per day.

The feet are thought to be a reflection of an individual’s health. Arthritis and blood vessel disease often reveal their initial symptoms in the lower extremities.

The foot is a marvel of architecture. Hope you enjoyed these fun facts.

Over 1/3 of people with diabetes will have evidence of organ or tissue damage.

Diabetic foot ulcers are a huge concern for patients. High blood glucose can lead to vascular complications, slow wound healing and could increase the risk of sepsis.

If a diabetic patient has an amputation of the foot or leg, the risk of death in 5 years is 50-80%.

A study in Norway analyzed the following:

• 1,339 diabetic patients with history of foot ulcers

• 155 diabetic patients without a history of foot ulcers

• 63,632 patients without diabetes

The 10 year death rate for patients with diabetes and a history of foot ulcers was 49% in comparison to 35.2% of diabetics without a history of foot ulcers and 10% for non-diabetics.

Overall, their findings showed there is a 38% increased risk of death if you are diabetic with a history of foot ulceration.

If a patient has an ulceration that heals less than 50% in the first 4 weeks of treatment, it has been shown the wound will not be healed at 12 weeks.

Tight blood sugar control is mandated!

Please understand that diabetes is very serious and can be prevented.

95% of all diabetics gets the disease from obesity and sedentary lifestyles.

Please be responsible about your health and well-being.

If you have diabetes or a diabetic foot ulceration, it is extremely important that you have a podiatrist in your “team” of doctors.

Please allow Dr. Kory Williams and Dr. Eric Silvers the opportunity to help prevent you from foot complications from diabetes.

They are located at Advanced Foot and Ankle Center in McKinney, TX and Prosper, TX. Call 972-542-2155 for an appointment.

Flexible flatfoot usually begins in childhood and progresses through adulthood. It often occurs in both feet and worsens with age. As the deformity progresses with age, the tendons and ligaments that hold up the arch with stretch and tear and become inflamed.

A flexible flatfoot means that your arch flat only with standing, but the arch returns with sitting.

Diagnosis of a flatfoot is made with clinical evaluation by Dr. Kory Williams or Dr. Eric Silvers. X-rays are normally ordered to see the bones and joints.

Conservative Treatment

1. Shoe modifications – wear supportive athletic shoes and avoid flip-flops and other shoes that have no arch support.

2. Activity Modifications – avoid situations in which you stand or walk for a prolonged time. Give your arches a rest.

3. Weight loss – if you are obese, try to lose some weight. Too much weight can aggravate your symptoms.

4. Orthotics – Custom orthotic devices (that go into your shoes) are the best conservative treatment available.

5. Immobilization – sometimes a walking cast or going keeping weight off the limb is the best option.

6. Medications – Anti-inflammatories

7. Physical Therapy – this can provide temporary relief.

When conservative therapy has been exhausted and every non-surgical attempt has been tried, then surgery can be performed.

Traditionally, flatfoot surgery is not performed in kids less than 12-13 years old. The type of flatfoot surgery varies from patient to patient. The type of flatfoot surgery depends on:

1. The amount of deformity present

2. The type of deformity present

3. Other health problems

4. Patient’s ability to responsible after the surgery

Dr. Kory Williams and Dr. Silvers are well versed and trained in the area of flatfoot surgery. If you or your child has a flatfoot deformity, please make an appointment at Advanced Foot & Ankle Center in McKinney, TX and Prosper, TX. Call 972-542-2155.

However, recent studies have been shown that Metformin can actually lower the levels of Vitamin B12 in the body and in turn, cause nerve pain or neuropathy.

The nerve pain symptoms can include:

1. Numbness and tingling in the fingers and toes

2. A poor sense of balance

3. Depression

4. Dementia

Obviously, as podiatrists, we are most concerned about the manifestation in the legs and feet.

These symptoms can be controlled and the low Vitamin B12 can be reversed with help from a medicine called Metanx.

Metanx is a prescription medical food for the dietary management nerve symptoms.

You may read more information at the following website:

Metanx Information

If you have take Metformin and are having nerve sympt0ms, please come see Dr. Kory Williams or Dr. Eric Silvers at Advanced Foot & Ankle Center in McKinney, TX and Prosper, TX for treatment.

Thank you,

~Dr. Williams

Finally, the days of summer are upon us. At last we can kick off our shoes and winter boots and slide into some sandals or flip flops.

A podiatrist in Louisiana studies the effects of flip flops in 100 people. He found that by using the toes to grip and keep the flip flop in place, people work the muscles in their shins much more than when they are barefoot. He said that short walking strides while wearing flip flops can also strain the lower legs.  He felt that flip-flops with deepened heel cups and defined arches can remove some of the stress from the legs and feet, but a sneaker is preferred when performing extensive walking or activities.

Another podiatrist felt flip-flops do not provide shock absorbing qualities. She also felt that flip-flops shorten the stride, making muscles work harder in the legs and feet which ultimately leads to compensation by the knees, hips and back. This compensation could lead to injuries. She recommends finding a sandal with a back strap and deep heel cups.

How to Avoid a Flip-Flop Fiasco

The APMA has a complete list of flip-flops given the “Seal of Acceptance”.

Click below for the list:

List of Flip-Flops Approved by the American Podiatric Medical Association