Your Feet...Out on the Town

According to a survey in British newspaper The Telegraph, it only takes an average of 34 minutes for a woman wearing high heels to start feeling pain in their feet from high-heeled shoes. Four out of ten women surveyed stated that they carry a spare pair of pumps in case their first pair starts to rub throughout the night. More than fifty percent admitted to walking home barefoot after a night out on the town. The survey also showed that the average British woman owns 18 pairs of high heels.

The survey included 4,000 women between the ages of 18 and 65. Click here to read more.

Just remember that while your high heels may look fabulous, it's wise to listen to your feet when they hurt! Change into more comfortable shoes (not another pair of stilettos!) or take a seat and let your tootsies rest. And we don't recommend walking home barefoot - broken glass and rocks are just a few of the possible hazards you could stumble upon.

And if your feet keep hurting, please come see us - we can help! Visit our website or give us a call at (540) 904-1458 to have all your questions answered.

Diabetic Ulcers

Contributing Factors :

- Mechanical changes in conformation of the bony architecture of the foot

- Peripheral Neuropathy

- Peripheral Arterial Disease

- Glycosilation - Predisposes ligaments to stiffness

Diabetic Facts:

- 12-24% of individuals with ulceration require amputation

- Half of all non-traumatic amputations are the result of diabetic foot complications

- The 5-year risk of needing an amputation on the other extremity is 50%


Diabetic Peripheral Neuropathy results in:

- Loss of sensation in the foot

- Injuries and fractures

- Structural foot deformities

- Hammertoes

- Bunions

- Metatarsal Deformities

- Charcot Foot

- Tissue Breakdown


Peripheral Arterial Insufficiency Results In:

- Intermittent claudication

- Pain at rest

- Non-healing ulceration of the foot

- Ischemia of the foot - Inadequate blood supply

Examination:

Diabetic Ulcers tend to occur in the following areas:

- Heel

- Metatarsal Heads

- The tops and ends of hammertoes


Lab Studies:

- A complete blood count may signal an abscess or infection

- Non invasive vascular studies to assess circulation deficiencies

- Infection markers such as the sedimentation rate


Imaging (to evaluate the presence of osteomyelitis):

- Plain Radiographs

- CT

- MRI

- Bone Scans


Treatments:

- Treat infections with appropriate antibiotics

- Offloading the area of the ulcer

- Wound care

- Application of a Wound Vac - Negative pressure under an occlusive wound dressing for deep cavity wounds

- Surgical Debridement - Surgical management is indicated for debridement of non viable and infected tissue from the ulceration

- Debridement of infected bone

Rheumatoid Arthritis

Rheumatoid arthritis is a chronic systemic inflammatory disease of unknown cause that primarily affects the peripheral joints in a symmetric pattern.

RA causes joint destruction and thus often leads to considerable morbidity and mortality.

Why do people Get RA ?

- An infectious etiology has been speculated
- Associated with a number of autoimmune responses
- Whether autoimmunity is a secondary or primary event is still unknown
- RA has a significant genetic component

Frequency :

The worldwide incidence of RA is approximately 3 cases per 10,000 population

Mortality/Morbidity:

- Daily living activities are impaired in most patients
- Life expectancy for patients with RA is shortened by 5-10 years

Signs and Symptoms:

- Morning stiffness
- Arthritis of 3 or more joint areas
- Arthritis of hand joints - At least one swollen area
- Symmetric arthritis with simultaneous involvement
- Rheumatoid nodules

Progression of RA :

Stage 1 (early RA)

- No destructive changes observed on x-ray
- Radiographic evidence of osteoporosis possible

Stage II (moderate progression)

- Radiographic evidence of periarticular osteoporosis with or without slight subchondral bone destruction
- Slight cartilage destruction possible
- Joint mobility possibly limited; no joint deformities observed
- Adjacent muscle atrophy
- Extra-articular soft tissue lesions (eg, nodules, tenosynovitis)

Stage III (severe progression)

- Radiographic evidence of cartilage and bone destruction in addition to periarticular osteoporosis
- Joint deformity
- Extensive muscle atrophy

Stage IV (terminal progression)

- Criteria of stage III
- Fibrous or bony ankylosis - stiffness of a joint due to abnormal adhesion and rigidity of the bones of the joint

Remission:

Remission of RA - Five or more of the following conditions present for at least 2 consecutive months:

- Duration of morning stiffness not exceeding 15 minutes
- No fatigue
- No joint pan
- No joint tenderness or pain with motion
- No soft tissue swelling in joints or tendon sheaths
- ESR of less than 30 mm/h for a female or less than 20 mm/h for a male

Lab Studies:

No pathognomonic test is available to help confirm the diagnosis of RA. The diagnosis is made using clinical, laboratory, and imaging features. Clinicians will analyze the following:

- Markers of inflammation, such as ESR and CRP
- Synovial fluid analysis
- Rheumatoid factor - Present in approximately 60-80% of patients with RA over the course
- Antinuclear antibodies - These are present in approximately 40% of patients with RA

Treatments:

Disease-modifying antirheumatic drugs:
- Leflunomide (Arava)
- Methotrexate
- Sulfasalazine
- Etanercept (Enbrel)
- Infliximab (Remicade)

Nonsteroidal anti-inflammatory drugs

Analgesics

Glucocorticoids

Immunomodulators:

- Anakinra (Kineret)
- Abatacept (Orencia)

Shoe Advice from the APMA

A Shoe for Every Sport

Shoes, shoes, and more shoes. There seems to be a shoe designed for every sport out there. But there’s a method to the madness. Sport-specific shoes really can change your game. See the tips below to learn why the shoe you choose could make or break your day on the court or field.

Basketball — Whether you’re making the perfect pass or
finishing off the high-flying dunk, basketball shoes have
several features that will help you prevent injury.
• A thick, stiff sole gives support while running and landing
from jumps.
• High ankle construction supports the ankle during
quick changes in direction. A basketball shoe should
have the strongest support on either side of the ankle.

Racquetball/Tennis — On the surface, court shoes for tennis and
racquetball may look like any other athletic sneaker, but it’s
what’s on the inside that makes the difference.
• A court shoe supports both sides of the foot because of all
the quick lateral movements and weight shifts in court sports.
• It provides a flexible sole for fast changes of direction.
• It has less shock absorption than a running or basketball
shoe.

Running — The running shoe is perhaps the most personal and intricate of all athletic shoes. Every runner has different needs and there
are a multitude of choices out there.
• A running shoe must provide maximum shock absorption to help
runners avoid ailments such as shin splints and knee pain.
• The shoe should control the way your heel strikes the ground, so
the rest of your foot can fall correctly.
• Know your foot type (high, medium, low arch) so you can get the
shoe with the right support for your foot.

Free Foot Care for Poor and Homeless in Syracuse

Photo by David Lassman / The Post-Standard

This Wednesday in Syracuse, NY, over 50 poor and homeless patients left with happy feet from the annual foot care clinic by Amaus Health Services at the Cathedral of the Immaculate Conception.  This is the third year that this team of about 30 medical and nursing students offered free foot exams and cleaning to needy people in the area.  In addition to foot care, patients were also given socks, shoes, clothing, toiletries, and other items that were collected by students from surrounding universities.  “There are so many health issues that can result from exposure and the feet being injured and damaged," said Barbara Carranti, a LeMoyne nursing professor who organizes the foot care clinic.  "There are infections people would never know about unless they get a good foot inspection."

Your feet mirror your general health - everyone needs to take care of their feet, regardless of income level.

To read more about this past week's Amaus free foot care clinic, click here.

For more information about how we can help you take care of your feet, visit our website www.roanokefoot.com.

Give your feet a little TLC this fall

No matter how much you may hate it that the weather is moving into the lower temperatures, we need to always be sensible about taking care of our precious feet. Cold feet are not happy feet!

Here are a few tips to keep your feet warm and happy through the cold months:

1. Give your toes some shelter.

Open-toed shoes in cold weather may seem fun and rebellious, but your feet certainly won't appreciate the sentiment. Your feet tend to be one of the first areas of your body to lose heat in cold temperatures.

2. Keep your feet dry in inclement weather.

Wearing shoes with rubber, PVC, or Gore-Tex-treated components will help to keep the water out. Frostbite and trench foot are just a couple of dangerous conditions that can be caused by having wet feet for an extended period of time. However…

3. You need to keep your feet hydrated, too.

Lots of people suffer from dry skin in the cold months because of low humidity in and high winds. If your feet tend to dry out, use some moisturizer immediately after you shower, while your skin is still a little damp. You can also use a pumice stone to soften dry skin and calluses - just make sure to not use lots of pressure. Keep your feet warm by wearing clean cotton socks around the house; this will help them retain their moisture as well. And make sure to hydrate your whole body by drinking plenty of water!

For more info about taking care of your feet in cold climates, look at these articles:

http://preventdisease.com/home/weeklywellness143.shtml
http://beauty.about.com/od/skinflaws/a/skinsavers.htm
http://www.ehow.com/how_4689079_dry-feet-through-winter-months.html

New Blog Location!

We just wanted to let you know that we're in the midst of combining all of our blogs (Roanoke Foot Doctor, Blacksburg Foot Doctor, and Botetourt Foot Doctor) into a bigger, better one - if you'd like to keep following us and stay updated on all the fun foot facts and articles, please update your bookmarks to http://shenandoahpodiatry.blogspot.com.

Thanks for reading, commenting, and of course visiting our offices!

Dedicated to your happy feet,

Nancy Ann Ballhagen
Administrative Assistant, Blacksburg Office