Blog List
Diabetes
- Description
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Diabetes is a disease that affects every part of the body, even when the diabetes is under control. Diabetics, because of the nature of their disease, have fewer defenses against everyday wear and tear, especially where the feet are concerned. Increased blood sugar affects the feet in the following ways:
The sugar affects the nerves of the feet, causing peripheral neuropathy. Peripheral neuropathy is a disease which can produce anything from strange feelings in the feet (burning, tingling, numbness, etc.), to a complete loss of feeling in the feet. The lack of proper feeling makes the diabetic more likely to injure their feet without knowing it. This makes the diabetic more susceptible to infections; fractures which are not felt, and do not heal properly; and severe bone and joint disease which changes the contour of the foot. See Charcot Foot for more information.
Sugar also affects the smaller blood vessels in the feet causing peripheral vascular disease (P.V.D.). P.V.D. decreases the amount of blood, nutrients, and oxygen that are brought to the skin, fat, muscles, joints, and bones of the feet. This causes: tissues to be absorbed, an inability to properly heal everything from small cuts to broken bones, and just plain fatigue and weakness of the feet.
Absorption of the natural protective fatty pad on the bottom of the feet. This is due to P.V.D. and/or the natural aging process. When the fat pad becomes thinned or completely absorbed, it cannot protect the skin properly from normal bone pressure. This puts tremendous stress on the skin which underlies these bones, and can cause inflammation, calluses, and eventually skin ulcers which may become infected. These problems may become worse without the diabetic knowing it, if peripheral neuropathy is present.
Calluses
The formation of calluses is caused by an accumulation of dead skin cells that harden and thicken over an area of the foot. This callus formation is the body’s defense mechanism to protect the foot against excessive pressure and friction. Calluses are normally found on the ball-of-the-foot, the heel, and/or the inside of the big toe. |
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Bunions
What are bunions?
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The common bunion is a localized area of enlargement of the inner portion of the joint at the base of the big toe. The enlargement actually represents additional bone formation, often in combination with a misalignment of the big toe. The misalignment causes the big toe to move outward (medically termed hallux valgus deformity). The normal position of the big toe (straight forward) becomes outward directed toward the smaller toes. The enlarged joint at the base of the big toe (the first metatarsophalangeal joint, or MTP joint) can become inflamed with redness, tenderness, and pain. A small fluid-filled sac (bursa) adjacent to the joint can also become inflamed (bursitis), leading to additional swelling, redness, and pain. A less common bunion is located at the joint at the base of the smallest (fifth) toe. This bunion is sometimes referred to as a tailor’s bunion. |
Arch Pain
The arch functions as a shock absorber for our entire body. Each time we step down, we place up to 5 times our body weight on the foot, depending on whether we are walking, running, or jumping. If there were no shock absorber in the foot, the force of each step would fracture or dislocate the bones of the foot, leg, and lower back. When pain occurs in the arch, it is telling us it is “sick” and cannot function properly. If left untreated, it can cause constant pain throughout the entire foot, and eventually the knee, hip, and lower back.
Achilles Tendonitis
DESCRIPTION & CAUSES
Achilles Tendonitis is an inflammation of the Achilles Tendon. This tendon attaches the muscles in the calf of the leg to the back of our heels. The Achilles Tendon is a long and thick tendon, which moves our foot down, so that the toes point to the ground (plantar flexion). This tendon can become inflamed due to the following causes:
Over utilizing it, such as too much running, especially up or down hill.
Trauma, such as a kick to the tendon.
Shoe or boot pressure, especially at its attachment to the heel, or just above it.
There are over 250,000 injuries to the Achilles Tendon annually. In fact, more Than 10% of all running injuries are to the Achilles tendon.
Tendonitis may be classified as either acute or chronic
Acute Achilles Tendonitis comes on quickly, usually after a specific activity or event. It is characterized by an overstretching or tearing of some of the small fibers of the tendon, and causes pain or tenderness when walking or running. It can occur at the insertion (near the attachment to the heel bone, or further up the leg, about 4 or 5 inches above the heel. Acute tendonitis can also follow a specific injury, such as a kick to the tendon while playing soccer.
Chronic Achilles Tendonitis develops gradually over time. Many times, you can feel an obvious thickening of the tendon that may be tender when squeezed, due to long standing scarring of the tendon. Pain is also present when walking or during other forms of activity, and feels better at rest.
Tailor’s Bunion
What are Tailor’s Bunion?
The terms doctors use to describe a bunion that forms by the little toe are Tailor’s Bunion and Bunionette. This type of bunion is similar to the bunion that forms by the big toe joint, except it forms on the joint just below the fifth toe. It is called a Tailor’s Bunion because years ago tailors would sit on the floor with their legs crossed and sew for hours. This constant and abnormal pressure on the fifth toe, and the bone below it (the fifth metatarsal head) would cause an inflamed and painful bump to form that resembled bunions that formed on the big toe side of the foot. |
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A Tailor’s Bunion is a complex deformity that involves the following foot pathology:
A bump that develops on the outer side of the foot, in the area where the little toe and the bone it connects to (the fifth metatarsal) meet. The joint where these two bones meet is called the fifth metatarsophalangeal joint.
The turning inward of the little toe, so that it presses against the fourth toe (the little toe is no longer straight).
Tailor’s Bunions are a progressive deformity, and if left untreated the bump will become larger, and the little toe will eventually lie over or underneath the fourth toe.
- Causes
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The normal foot is made up of bones and joints that are held tightly together, in a precise relationship. In order for a Tailor’s Bunion to form, the ligaments and tendons that hold the bones and joints together must be more flexible (lax) than normal. This abnormal laxity allows the fifth metatarsal to gradually drift towards the outside of the foot, and the little toe to turn in, toward the fourth toe. The result is a prominent bump on the outside of the fifth metatarsal, at the metatarsophalangeal joint. If pressure is applied to this bump (like pressure from a shoe), the bump and its surrounding soft tissues enlarge, causing pain, swelling, and eventually a Tailor’s Bunion.A Tailors type deformity can also be a simple bump on the dorsal lateral side of the fifth metatarsal head and associated soft tissue. This type is very localized and is generally caused by shoe pressure or pressure from other outside sources.
The most common causes of lax (flexible) foot ligaments are:
The genes we inherit from our parents
Flat feet
The weakening of muscles and ligaments caused by advancing age
Injury.
Tailor’s Bunion progression may be hastened by:
Wearing high heel and pointed toe shoes. These types of shoes apply abnormal pressure to the little toe and force it over toward the fourth toe; and, irritate the fifth metatarsal head causing a bump to form (when bone is irritated it enlarges).
Injury to the outer side of the foot, or little toe may damage the fifth metatarsalphalangeal joint, and speed up Tailor’s Bunion formation.
Arthritis of the fifth metatarsalphalangeal joint may cause the joint to become enlarged, and a bunion may then form.
One leg being shorter than the other. When walking, the foot on the short leg turns in and down, trying to “reach” the ground. The foot is trying to equalize the length of the legs. This action of the foot turns the fifth metatarsal head into the shoe, allowing the shoe to rub against the fifth metatarsal head with excessive force. This will cause swelling, inflammation, pain, and growth of the Tailor’s Bunion.
- Treatment
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Long-term treatment must be directed towards reducing abnormal pressure on the fifth metatarsal head. Re-balancing the foot, and allowing the foot to function as if it was not abnormally flexible best accomplish this. One of the best ways to accomplish this is custom-made orthotics. Our custom-made orthotics will:
Gently control and reduce flexibility of the foot. This allows the foot to function normally.
Protect the fifth metatarsal head from excessive pressure, by the use of our unique lateral wedge, which correctly supports the fifth metatarsal and reduces excessive pressure on the metatarsal head (the Tailor’s Bunion).
Compensate for a short leg with the addition of lifts, to equalize the length of the legs.
This will allow the feet to function normally. As a result, the deformity should not worsen, and the pain should gradually subside. If the foot is not re-balanced, the deformity and pain will become worse. In addition, comfort is also provided to the arch, shins, knees, and lower back by the use of modern materials. These unique materials provide semi-flexible support to the arch by absorbing the shock of each step, rather than our foot absorbing the shock. When your weight is removed from the orthotic, the arch returns to its original height since the material we use has a built-in “memory.”
Short-term pain relievers include the following:
Wear wider and flatter shoes, with a rounded toe.
Apply skin emollients to the bunion, before putting your shoes on. This may help to reduce friction on the skin overlying the bunion, which may help to reduce your pain.
Gentle massage with a topical pain reliever can help to provide comfort. By combining the pain relieving properties of Corganics Relief Topical Analgesic Cream with gentle massage, pain, swelling, and inflammation can be reduced or eliminated.
Exercise the toe. With your hand, move the toe up and down, and gently move it out as far as is comfortable, for 3 to 5 minutes daily. If this becomes painful, stop immediately.
If you ever experience open sores, extreme redness, or extreme pain, see a podiatrist immediately. If the problem persists consideration should be given to surgical correction of the deformity.
Corns
What is a corn?
Corns are areas of hard, dead skin that form in response to abnormal shoe pressure and friction. Corns can become inflamed and painful if the shoe pressure continues. But a corn is just a symptom of some underlying toe pathology, such as: |
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Hammertoes: Toes, which are bent so that the part closest to the foot is directed upwards, while the remainder of the toe is bent down, so that you walk on the tip of the toe. Corns may form on the top of the toe where the shoe rubs against it. Or they can form on the tip of the toe, because you do not apply weight to the entire toe when walking, but just to the tip. Click here to learn more about hammertoes.
Bone Spurs: A benign bone mass (extra bone) usually occurring between the toes. The bone spur places increased pressure on the overlying skin of the toe and the adjacent toe. The resulting pressure causes a build-up of hard, dead skin (a corn), which becomes painful when shoes are worn as the toes rub against one another.
Of Note: Corns not treated in patients who may be neuropathic and or diabetic may not feel the discomfort of the corn. These patients are at risk for ulceration of the affected corn. Ulceration may be serious as it can cause infection to reach the underlying bone. Ulceration in vascular compromised patients can lead to serious complications including infection and even possible amputation.
Types of Corns
Hard corns (heloma durums) are the most common type. They are caused primarily by ill-fitting shoes and toe deformities such as hammertoes. They usually develop on the tops and tips of toes. These corns are usually hard and dry.
Soft corns (heloma molles) usually are the result of bone spur formation in the toes. They are found between the toes and usually are white in color and frequently appear moist or macerated.
What Are The Differences Between Corns and Calluses? The two biggest differences are the location and size of the lesion. Corns are small and round and are located on the top, tips, or between the toes. Calluses on the other hand, are larger, flatter, and can be found on the bottom of the feet.
- Symptoms
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The symptoms produced by a corn vary according to:
How thick and hard the corn is.
The amount of shoe friction or pressure it is subjected to.
The thicker the hard dead skin of the corn, and the more it is irritated, the more noticeable are the symptoms.
Common symptoms of corns include:
Pain in the corn and surrounding toe joint.
Inflammation of the irritated skin and/or corn.
Thick, hard, rough, dry skin on the tops or tips of the toes. Tenderness or pain under the skin and corn.
Soft corns form between the toes and usually appear white or flesh colored.
Corns may have a hard, dry plug, or nucleus in their center. These plugs can extend deep into the top layers of skin, often pressing on superficial nerves and causing increased pain. Because of the shape of these plugs (funnel shaped – broad raised top and a pointed tip at the bottom), corns intensify the pressure at the tip and can cause deep tissue damage and ulceration. Hard corns are especially problematic for people with insensitive skin due to diabetes and peripheral neuropathy.
- Causes
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Corns are caused by excessive pressure or friction on the toes, usually from ill-fitting shoes or high heels. Since the skin acts as the body’s protector, corns form when the body attempts to protect the irritated area from more pressure by building up a mass of dead skin cells and secreting a hard substance called keratin. When this mass of dead cells is thin there is usually no pain. However, as the shoe pressure and friction continues to irritate the toe, the dead cells become thicker and harder, and eventually they may become painful and inflamed.
Predisposing Factors: Those factors, which increase your chances of developing corns:
Hammertoes
Bone spurs
Arthritis
Rigid feet with high arches
Presence of other foot deformities such as bunions
Toe injuries, fractures, and dislocations that were not treated properly
- Treatments, Self-Help, & Prevention
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Daily inspection of the feet in patients whose feet are insensitive due to Diabetes or neuropathy should be conducted.Inspection of the feet should also be included in those patients who have some evidence of circulatory disorders.
Regardless of the cause, the painful corn must be protected from shoe pressure for the pain to subside. Buying shoes with a wide and deep toe box (the part of the shoe where the toes sit) may give some relief. The following remedies are prescribed by doctors to relieve shoe pressure, toe pressure, and pain in these toes, or to help the toe lie straight, thus alleviating pain and preventing the corn from becoming worse:
Relief and prevention of corns due to hammertoes (corns that form on the top and tips of toes):
Kerasal One Step Exfoliating Moisturizer Therapy gently exfoliates and softens hard, dry, dead skin.
Budin Hammertoe Splints extend the hammertoe and allow it to lie straight; thus, pain is alleviated in the top and tip of the toe.
Removable, long lasting Crest Pads straighten the toes and prevent them from rubbing against the tops of your shoes, relieving your pain.
Removable, comfortable, and long lasting Gel Toe Pads
Artemis Woman Heel Smoother (Approved by the APMA) pedicure appliance smoothes calluses and removes dry skin on heels and toes in seconds, without the use of harsh chemicals or dangerous blades.
Exercise by stretching the toe straight for 10 seconds, and repeat for 3 to 5 minutes daily. Wear longer shoes. Wear flat shoes. (Do not wear shoes with a heel higher than 3/4 inch).
Gentle massage with a cool liniment will help to relieve your pain.
If you ever experience open wounds, intense redness, or extreme pain, see a podiatrist immediately.
Relief and prevention of corns due to bone spurs (soft corns that form between toes):
Adhesive foam corn pads. Use to protect painful and irritated areas on toes. Made with medical grade foam.
Removable, long lasting Digital Toe Caps. Slips over entire toe to ease discomfort from hammertoes and ingrown toenails. Cushions sore deformed toes and relieves pain.
Gel toe separators and spreaders comfortably prevent toes from rubbing against each other, thus eliminating friction and pain.
Foam toe sleeves will shield your toes from pressure and friction.
Wear shoes with a wider toe-box.
Wear flat shoes.
Do not wear socks or stockings that are tight.
If you ever experience open sores, extreme redness, or extreme pain, see a podiatrist immediately.
Self-treatment with the use of razor blades, knife blades, or nonprescription preparations of acids should not be attempted because of the risk of injury and infection.
If Conservative Care Fails
If conservative treatments fail and your symptoms persist, the doctor may recommend a surgical option. The procedures vary greatly, depending upon the reasons for the corn. If a hammertoe is responsible, the podiatrist can perform surgery to straighten the toe. There are a number of different operations to straighten the toe, the most common ones involve:
Soft tissue corrections such as tendon transfers, tendon lengthening, and joint capsule repairs.
Digital arthroplasty involves removal of bone from the bent joint to allow the toe to straighten. The temporary use of pins or K-wires may be necessary to keep the toe straight during the healing period. Joint implants are sometimes used to allow for a better range of motion in the toe following surgery.
Digital arthrodesis involves the removal of bone from the bent joint and fusing the toe in a straight position. If the corn is due to a bone spur, the most common procedure used is an exostectomy, in which surgically removing it or filing it down removes the bone spur.
Because of the possible complications involved with any surgery, one should be sure to understand the risks that may be involved with surgery to treat corns, correct hammertoes, and remove bone spurs.
Foot Odor and Sweaty Feet
Why Do Feet Smell?
Foot odor, whether it’s mild or the room clearing kind, is due to a combination of sweat and footgear (the socks and shoes we wear). With more than 250,000 sweat glands each, feet are among the most perspiring parts of the body. In one day, each foot can produce more than one pint of sweat! |
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Sweat is basically composed of just salt and water, so it does not have a smell of its own. The smell occurs when bacteria that normally live on the skin eats the sweat and excretes waste that has a strong odor. The bacteria combined with sweat produce Isovaleric acid which actually causes the odor.
So why don’t our hands, which have about the same number of sweat glands per square inch as our feet have, produce foul odors? Because hands are exposed to the air and the sweat has a chance to escape into the air, or evaporate. Sweat does not accumulate on our hands as it does on our feet.
Feet on the other hand, are trapped inside socks and shoes, where temperatures can easily reach 100 degrees Fahrenheit. The perspiration, which cannot escape into the air (evaporate) due to lack of airflow in the shoe, combines with the dark warmth of the shoe to create a breeding ground for bacteria. When the increased numbers of bacteria feed on the sweat, more foul smelling bacterial wastes are produced. The more waste produced, the worse the foot odor.