Facts about Diabetes Mellitus
This article contains statistics taken from numerous journal articles regarding the effect of diabetes and the problems that it can cause.
Incidence of Diabetes Mellitus
- 15% of the population of developed nations
- 16 million people in U.S have diabetes mellitus
- 15% of patients with diabetes will develop foot ulcers
- There are currently 2.4 million people with diabetic foot ulcers
- Foot and leg amputations are 15 times more likely in patients with diabetes
- 15% of people with foot ulcers will require amputations
Morbidity and Mortality
- Half of the non-traumatic foot amputations in the United States are the result of diabetes
- The 3 year survival rate after a leg or foot amputation is 50% in diabetic patients
- 50% of diabetic amputees will develop ulcers on the opposite limb
- 50% of those diabetic patients will lose the other limb in 3 years or die
Cost
- Total cost for diabetic care in 1997 = $98,000,000,000.00
- Diabetic foot care in 1997 = $6,000,000,000.00
- Non-operative care of a single foot ulcer = $7,000.00
- Average cost of care for an infected foot ulcer = $17,000.00
- Average cost of amputation and rehab = $45,000.00
Misconceptions
- 68% of patients with diabetic foot ulcers have neuropathy
- 32% of patients with diabetic foot ulcers have normal sensation
How effective are orthotics?
- Re-ulceration rate at one year = 58% if return to street shoes, 28% if return to therapeutic shoes with in soles
If you are a diabetic with a foot sore or ulceration, please come see us at Advanced Foot & Ankle Center for evaluation and immediate treatment. It is also advised that you seek foot and ankle evaluation if you are a diabetic and are not aware of any current foot or ankle issues. Dr. Eric Silvers has treated many diabetics with all types of foot and ankle problems for over 15 years. Please call 972-542-2155 to set up an appointment now.
The 5 Basic Types of Shoes for Running
The five basic types of running shoes are as follows:
1. Motion control running shoes
2. Stability running shoes
3. Cushioned running shoes
4. Trail running shoes
5. Racing running shoes
The motion control, stability and cushioned running shoes are fitted according to the runner’s foot type; which is either pronated, overpronated or supinated. The trail and racing shoes are fitted according to the type of race or terrain the runner will be running on.
Motion Control Shoes
These shoes are designed primarily for runners who have low arches, who are moderate to severe over pronators, and runners who are heavier and need extra support.
These shoes are manufactured to prevent a runner’s foot from rolling inward too much (over-pronating). These shoes tend to be more rigid, heavier, have a wider outsole and have a high density sole (medial post) on the medial aspect of the shoe where the arch lies.
The medial post is a wedge of high density EVA material that is inserted into the sole of the shoe on the medial side. The EVA material resists compression which ultimately reduces the amount the foot rolls inward with each running stride.
Stability Shoes
These shoes are best for runners who have medium arches and for those who are mild to moderate pronators.
Stability shoes offer features found in both motion control and cushioning shoes, but to a lesser degree. The primary function of these shoes is to support the foot without interfering the foot’s natural pronation. These shoes have excellent arch support and midsole cushioning. These shoes are not as restrictive as motion control shoes. These shoes have tendency to be curved inward slightly. This shoe is the best for most runners.
Cushioned Shoes
These shoes are best for runners who have high arches and for those runners who are supinators or under-pronators.
These shoes are designed to provide shock absorption and extra cushioning for people with high arches. These shoes are slightly curved in order to encourage pronation. These shoes are more flexible, have softer midsoles, and less medal support.
Trail Shoes
These shoes are best for off-road running, extra traction, durability, and for runners who need thicker more durable soles of the shoe.
These shoes are tough enough to withstand bad weather and rough terrain.
Racing Shoes
These shoes are best for runners who have no motion control problems and for those runners who need shoes for fast paced training or racing.
These shoes offer very little in terms of stability, cushioning or durability features. They are very lightweight. These shoes have a low heel and flexible forefoot. They are not recommended for runners with injures or pronating problems.
This information was excerpted from the Shoe Wearer’s Handbook by Clare Barron and Kent Basson, pages 46-49.
Syndactyly
Syndactyly is a condition in which the toes do not completely separate at birth. It occurs every 1 in 2,500 births. Syndactyly is synonymous with “webbed toes”. There is various types of syndactyly. The toes can be partially webbed or completely webbed.
This condition is usually not painful. Cosmetic issues are typically the problem that most people have. Some people are self conscious about their toes and this blog is to inform those people of their options regarding correction of the toe deformity.
Syndactyly typically does not affect the ability to walk or run. However, webbed toes can limit flip-flop use.
Surgery can be performed to separate the toes. This surgery is meticulous and intricate. Surgery entails separation of the toes and the usage of rotational skin flap or use of skin grafts to replace the areas void of skin. Often times, the blood vessels and nerves in between the fused digits are shared, therefore, numbness or tingling can occur between toes after separation and healing can be slow if the blood flow to one of the digits is disrupted. Scarring can be complication of this procedure. However, the surgery is very successful. Further details can be explained in our office.
If you have webbed toes, schedule an appointment to discuss your options with Dr. Eric Silvers at Advanced Foot & Ankle Center with offices in both McKinney, TX and Prosper, TX.
Call 972-542-2155 for an appointment today.
Hallux Malleus
Hallux malleus is a deformity of the great toe. This deformity can be very stiff or flexible. The joint in the great toe becomes contracted in a flexed or downward position. This deformity usually occurs due to an imbalance of the tendons that insert on the top and the bottom of the great toe. When the tendon on the bottom of the toe (the tendon that causes the toe to flex down) over powers the tendon that causes the toe to bend up, this deformity occurs.
Oftentimes, patients will develop a callus and even an ulcer on the tip of the great toe. This deformity is often seen in conjunction with hammertoes. High arched feet are typically the most affected by this deformity.
At Advanced Foot & Ankle Center, this deformity is treated initially with padding techniques to prevent sores from developing at the tip of the toe. Custom, soft, accommodative orthoses are sometimes prescribed for the patient to provide cushioning and also to prevent worsening of the deformity.
If conservative treatment fails, surgery is indicated. Surgery usually consists of performing a bone fusion of the two bones in the great toe. This can be done with screws, staples, or wire fixation.
If you have a hallux malleus deformity, please come see Dr. Eric Silvers at Advanced Foot and Ankle Center in McKinney, TX and Prosper, TX.
Call today to schedule an appointment with our team - 972-542-2155.
Psoriasis
Psoriasis is an systemic inflammatory disease that is caused by abnormalities in the immune system. In our practice, psoriasis commonly affects the bottom of the patient’s feet and manifests as a reddened-type rash with silvery scales or flakes of skin. The skin lesions are usually symmetrical. Psoriasis is commonly painful, itchy, inflamed, and can crack or fissure.
Psoriasis can also cause metabolic syndrome which causes patients to be more susceptible to diabetes, high blood pressure, high cholesterol and obesity. Psoriasis patients are more prone to having heart attacks and depression as well.
Psoriasis is commonly misdiagnosed as chronic athlete’s foot. Patient are commonly prescribed antifungal creams medications that do not end up working.
Psoriasis affects the toenails. The toenails will sometimes have little pits or divots. Sometimes the nails with be rough like sandpaper instead of smooth. The nails can have a tendency to come off. The nails can also have a dirty, brown appearance as if the nail was dipped in crude oil. The nails are often misdiagnosed as having fungus.
The patient will often have psoriasis in other places such as the knees, elbows, scalp and along creases in the skin folds such on the bottom or under the breasts. Oftentimes, the hands will manifest identically to the feet.
To diagnose psoriasis, a punch biopsy of the skin is most definitive. Once diagnosed, treatment can be started.
Treatments
Topicals
1. Topical corticosteroids – some topical steroids are very strong and some are not. Some stronger topical steroids are betamethasone, halobetasol, and clobetasol. These meds are typically only used for 1-2 weeks at the most. If they are used for a prolonged time period, it may cause the skin to become thin, develop stretch marks, and cause the skin healing to slow down. The lower dose topical steroids can be used for longer time frames.
2. Vitamin D Analogs – these medicines decrease inflammation and lessen the prominence of the skin lesions. Medications such as Dovonex and calcitriol are used twice daily. Taclonex is a combination of steroid with a vitamin D analog.
3. Topical calcineurin inhibitors – an ointment called Tacrolimus is usually combined with salicylic acid. This ointment locally affects the immune system to slow down the progression of the psoriatic lesions.
4. Keratolytics – skin creams with lactic acid, salicylic acid and urea are often used to decrease the amount of scaling and soften the hard skin.
5. Moisturizers – there is a large quantity of OTC and prescription moisturizers that can be used immediately after bathing to prevent recurrence of skin lesions and keep them at bay.
6. Topical retinoids – a medication called Tazarotene can be used once daily to decrease inflammation and decrease the amount of skin cell development at the site of the psoriatic lesions.
7. Coal tar – can decrease inflammation and itching. The downside to this product is that it has an odor, can stain the clothes and can cause sensitivity to sunshine.
8. Anthralin – research does not yet know how this product works
If you have psoriasis and desire treatment, please come see Dr. Silvers at Advanced Foot & Ankle Center in both McKinney, TX and Prosper, TX.
Call 972-542-2155 for an appointment today.
Toe Ulcer Caused By a Bone Spur
A patient presented to my office complaining of painful “sore” on the right great toe. The patient stated the he had this painful sore in the past and was healed successfully with local wound care. Upon examination of the x-rays taken in my office, it was noticed that the patient had a large bony spur at the direct spot where the ulcer was present.
Therefore, the ulcer was due to a large bony spur. The skin could no longer withstand the pressure between the bone spur and the ground and started breaking down and ultimately developed an ulcer.
This patient was advised that the most definitive treatment would include removal of the bone spur that is causing the ulceration. Patient is currently undergoing local wound care treatment. Updates will be provided in the future.
~Dr. Williams
