Diabetes and podiatry; what’s the connection?

Foot complications in diabetes are common yet the link between the two is not very well-known. Here to tell us more about it ahead of World Diabetes Day on 14 November is specialist and author for Journal of Foot and Ankle Research Trevor Prior, with colleague Debbie Coleman.

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Report: FDA Strengthens NSAIDs Warnings

The US Food and Drug Administration (FDA) is strengthening an existing label warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) increase the chance of a heart attack or stroke.

Based on the FDA’s review of new safety information, it is now requiring updates to the drug labels of all prescription NSAIDs.

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Report: Supreme Court Issues Ruling on Affordable Care Act Subsidies

The Supreme Court today voted to uphold the previous IRS ruling that the Affordable Care Act allows for tax subsidies in the 34 states that use federally funded health-care exchanges. The 6-3 decision preserves health-care coverage for millions of Americans who enrolled for health care on the federal exchange.

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We Treat Feet Supports Local High School After-Prom Program

We Treat Feet Podiatry recently pledged a donation to Franklin High School’s Project S.A.F.E. After-Prom Program. The program, according to organizers is an “all-night event [that] will provide a safe, substance-free environment for the students to share a memorable evening with their friends. The students will have a fantastic time celebrating safely!”

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Report: Gout Vastly Undertreated in USA & UK

Gout, the most common inflammatory arthritis worldwide, is treatable but vastly undertreated, according to epidemiologic studies that now encompass three continents. The undertreatment problems previously reported in the United Kingdom and the United States also characterize gout in Taiwan, according to a nationwide population study.

Chang-Fu Kuo, MD, from the Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, United Kingdom, and the Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, and colleagues report the study results in an article published online January 23 in Arthritis Research & Therapy. Dr Kuo was also the lead author on the UK study.

In the new article, Dr Kuo and colleagues report, although gout incidence in Taiwan decreased during the course of the study, prevalence remained high and stable and gout management remained poor, with only about one quarter of patients receiving potentially curative urate-lowering therapy.

Jasvinder A. Singh, MD, MPH, who led the US study and who was not involved in either the Taiwan or UK studies, told Medscape Medical News, “The rates of undertreatment of gout in the US are also quite high and have been widely published, and many of the observations published in this study have also been seen in many other countries. Undertreatment includes not only lower rate of use of urate-lowering drugs but also infrequent monitoring of the serum urate and a low proportion reaching the target serum urate of less than 6 mg/dL due to use of suboptimal dose of urate-lowering drugs.” Dr Singh is professor of medicine at the University of Alabama, Birmingham.

Dr Kuo and colleagues used data from the National Health Insurance Research Database for Taiwan, which covers the entire population of 23 million people, to identify gout patients, estimate prevalence and incidence for each year from 2005 to 2010, and examine patterns of gout treatment.

Gout prevalence was 1,458,569 (6.24%), and gout incidence was 56,595 (2.74/1000 person-years). Gout prevalence did not change significantly during the study, although gout incidence decreased 13.4% between 2005 and 2010 and 2.1% between 2007 and 2010. In comparison, estimates of annual incidence in US studies ranged from 0.45 to 1.73 per 1000 person-years.

Gout was most prevalent and had the highest incidence rates in eastern coast counties and offshore islets of Taiwan, which the authors note also have higher populations of indigenous Taiwanese. “However, genetic factors account for just one-third of phenotypic variation of gout in men and only one-fifth in women so environmental factors could also contribute to the variable geographical distribution of gout in Taiwan,” the authors write.

“To the best of our knowledge, our study is the first to report gout incidence in Asian populations. The incidence in Taiwan was much higher than other countries, suggesting significant racial and geographic variation in the aetiology of gout,” they add.

Dr Singh commented, “There are very few studies of gout risk in Asian patients in the US, so it’s not easy to say whether the problem is better, the same, or worse than Taiwan. There are no particular subgroups in the US that require particular attention, except that African-Americans have been shown to have poorer outcomes with gout compared to Caucasians, and lower rates of medication treatment.”

In the Taiwan study, in 2010, only about one third of patients with gout had contact with health services in relation to gout, and only one in five were prescribed urate-lowering therapy. Of those treated, 60.08% (95% confidence interval, 59.91% – 60.25%) received uricosuric agents alone, 28.54% (95% confidence interval, 28.39% – 28.69%) received a xanthine oxidase inhibitor, and 11.38% (95% confidence interval, 11.27% – 11.49%) received both. The authors add, “Unfortunately, this suboptimal care has not changed over the study period, despite the publication of national and international guidelines on gout management during this period.”

The authors have disclosed no relevant financial relationships. Dr Singh reported no financial conflicts related directly to this study but has received research and travel grants from Takeda and Savient and consultant fees from Savient, Takeda, Regeneron, Allergan, and Novartis.

Source: Janis C. Kelly, Medscape

Why Wound Care for Diabetes Patients is So Important

For the 26 million Americas affected by diabetes, and the 1.9 million diagnosed annually, approximately 15 percent of those will develop foot ulcers during their lifetime, a complication that may result in amputation without timely and proper care (66,000 diabetes-related amputations are performed annually).

But when it comes to wound care, especially foot ulcers, many in Contra Costa County, California managing the disease may not realize that there is dedicated center offering help.

“Denial and fear are the major factors as to why those affected hesitate to get the attention they need. Wound Care Services needs to be sought out earlier in their care when we can be of most help,”said Mandy Mori, Director of Wound Care & Hyperbaric Medicine Services with John Muir Health. “Many cannot distinguish how far their wounds have progressed until it is too late.”

Diabetes is a disease in which blood glucose levels are above normal. Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy. The pancreas makes the hormone insulin to help glucose be absorbed into cells.

When a person has diabetes, their body either doesn’t make enough insulin or can’t use its own insulin as well as it should. This causes sugar to build up in the blood.

Tips for wound care: when should treatment for a wound be sought?

Over time, diabetes can cause a lack of sensitivity in the feet. That loss of sensation can lead to cuts and sores going undetected. Diabetes can also diminish blood flow, preventing any foot wounds from properly healing. Taking care of your feet every day will lower the risk of amputation.

Seek out treatment at a wound care center when:

· You have a wound that hasn’t healed in 30 days (commonly experienced by people with diabetes).

· You have a sore with increasing pain, redness or swelling, foul odor, or a change in color.

· You have a surgical wound that has become infected

One way wounds can be cared for is with hyperbaric oxygen therapy, a type of medical treatment that works by increasing the amount of oxygen in the blood, stimulating blood flow. It is often used in conjunction with additional therapies to facilitate healing. During hyperbaric oxygen therapy, a patient breathes 100% oxygen inside a special chamber.

At the same time, the pressure surrounding the body is slowly increased to two to three times normal atmospheric pressure.

At John Muir Medical Center, Walnut Creek, hyperbaric oxygen treatments are provided in one-person chambers, allowing for comfortable, private treatment.

Each chamber is constructed using clear plastic material, so a patient can visit with family or friends or even watch TV during treatment. Hyperbaric oxygen treatment has many therapeutic benefits, including:

· Greatly increases oxygen concentration in all body tissues

· Shortens the healing time of stubborn wounds

· Stimulates the growth of new blood vessels in areas of reduced circulation

· Enhances white blood cells’ efficiency in killing bacteria and controlling infections

· Preserves skin grafts, flaps, and other tissues where circulation is suddenly reduced

· Reduces swelling (edema)

If you or a loved one is suffering from any of the aforementioned issues relating to diabetes, please contact our staff at We Treat Feet Podiatry (410-363-4343 or info@wetreatfeet.com) as starting treatment early is the key to a full recovery.

Interesting Article on How DPMs are Helping to Rebuild in Haiti

Cool article about how DPMs are helping to rebuild in Haiti, from the blog of Patrick DeHeer DPM written by Fairuz Parvez DPM:

When asked about my experience in Haiti, at first I did not know where to begin. If I were to sum it up in a word, it would be: shocking.

It was eye opening to say the least. I was at a loss for words when I first landed in Haiti. I knew there was some structural destruction but I did not truly understand at what level, the depth of the devastation, and why it was still so. I was as guilty as the next American assuming Haiti was not so bad off. Boy, did I get a crash course in the reality of things there.

The first thing that shook me to my core was just how impoverished the country really was. I have visited developing nations in the past and even there you can find modernized areas with better conditions and buildings that are comparable to those of the west. With Haiti, almost the entire country looks like the ghetto of a developing nation. High rises are almost nonexistent and modern buildings are truly in the minority. Most buildings are primarily plaster or poorly constructed one-floor concrete-ish structures. Then you have the tent cities and makeshift shacks that line the sides of the road.

Yes, I know, I know. You are probably thinking the same thing I was. “Well, what about those innumerable fundraising efforts for millions of dollars by members of Hollywood and various philanthropists? It has been five years since the earthquake. What’s been going on since then?”
The issues with Haiti are more complicated and deeper than just some physical damage to some buildings from the earthquake. If it were that simple, Haiti would have been “fixed” by now. Haiti has been in dire shape since long before the earthquake. If anything, the earthquake was sort of almost a service to the country. It forced the world to pay attention to a country that is so desperately impoverished and functionally broken at the most basic, fundamental levels. The country needs far more than a few well-meaning philanthropists throwing some money at it. That will not solve any problem. The country needs help to establish foundations and basic infrastructure in every field from healthcare to finance to education to agriculture and even to tourism. Without the right kind of help, Haiti will only fall deeper into despair.

As Dr. DeHeer so astutely put, “Haiti is devastatingly endearing.” It truly is. You see people in absolute, abject poverty along the streets in Haiti. Yet there they are, trying to carve out a meager existence, selling their wares. Somehow, they still push forward. Yes, invariably, with international efforts, a culture of dependency has also developed. Nonetheless, this has not completely taken over the psyche of the Haitians. There is great enthusiasm among them when they are afforded an opportunity to learn something new. However, things are still in a fragile state. After my week in Haiti, it us clear that our support is necessary more than ever.

Sure, coming to Haiti and doing a handful or even a large number of surgeries on a mission visit is satisfying, but useless nonetheless. I have always planned to do mission work, knowing it would be part of my practice in the future in some way. But after my visit to Haiti, my entire perspective shifted. Most of my concerns and thoughts seem so insignificant now. I realize I can’t just go to an impoverished country and provide treatment/perform surgeries, and expect to think it made some sort of difference. It is simply not enough.

That old adage “give a man a fish, you feed him for a day. Teach a man to fish and you feed him for a lifetime” rings true here. This is the only thing that will truly make a difference in Haiti. We really need give our Haitian colleagues the proper tools (be it medical equipment or medical training) so they can help themselves. Only then can they truly recover and grow.

Now before I give the impression that my trip to Haiti was a bust, let me clarify. It was a great success. The best part of my trip to Haiti was discovering that the organization, Step by Step Haiti, is doing all that and more. It was truly wonderful working alongside our Haitian colleagues. They took our direction and instructions so enthusiastically. They were exceptionally eager to learn what we had to offer. They asked insightful questions and truly try to apply their newfound knowledge to help their fellow citizens. There are real efforts now happening in the communities to educate and reach the average Haitian citizen. They see there is a chance and it is encouraging. It was quite enriching and exciting seeing our colleagues not only treat patients, but be able to demonstrate that they are actively sowing the seeds for preventative care in limb salvage as well.

There is still a long way to go but progress is surely happening. Once these clinics are fully established around the country with appropriate tools and protocols, we hope to establish a Haitian medical residency as a tradition for coming generations.

I am proud to say I have been consumed by my trip to Haiti. I am just getting started and am anxious to do more. All in all, my first trip to Haiti has been truly satisfying. With all of the wreckage I found, I also saw a silver lining. It is with this silver lining that hope springs eternal in the human breast. Hope for a better future for our Haitian brothers and sisters.

Source: Podiatry Today

No Surprise: High Heels Culprit of Most Women’s Foot Issues

The American Podiatric Medical Association (APMA) today announced the results of its Today’s Podiatrist survey, which measures the public’s attitudes toward foot health. The study, which surveyed 1,000 US adults ages 18 and older, revealed that nearly half of all women (49 percent) wear high heels, even though the majority of heel wearers (71 percent) complain these shoes hurt their feet.

These findings seem to fit the old adage that “beauty is pain.” Even chronic discomfort doesn’t appear to deter women from purchasing the strappy stilettos they love: The average woman who owns high heels has nine pairs! Asked what they do when shoes hurt their feet, 38 percent of women said they’d “wear them anyway if I like them.”

However, in spite of their extensive shoe collections, only two percent of women say they wear high heels every day, and just five percent say they wear high heels five days per week. Almost half say they wear heels rarely or never (46 percent)—which may give them a leg up when it comes to preventing permanent damage to their feet.

“With high heels, moderation is key. It’s best not to wear them every day,” said Matthew G. Garoufalis, DPM, past president of APMA. “Daily heel-wearing can cause the Achilles tendon, the strong tendon at the back of your ankle, to shrink. This increases your risk of an injury while doing activities in flat shoes, including exercise.”

Heel height also plays an important role in preventing foot pain. Almost half of women say they can withstand wearing heels that are three inches or higher, though podiatrists recommend staying more grounded.

“Heel wearers should avoid heels higher than two inches,” said Dr. Garoufalis. “Wearing heels three inches or higher shifts body weight forward, and puts great pressure on the ball of the foot and the toes.”

While high heels were far and away the biggest culprits of foot pain, affecting 71 percent of wearers, women said other types of footwear including barefoot running shoes (27 percent), boots (26 percent), flats (23 percent), and flip flops (23 percent) also caused discomfort.

“Foot pain is never normal, and it’s critical that anyone experiencing chronic pain—from footwear or otherwise—seeks care from an expert,” said Dr. Garoufalis. “We hope these findings encourage Americans to fight foot pain with the help of today’s podiatrist.”

For detailed survey findings and an infographic on high heel pain, visit the APMA website.

The American Podiatric Medical Association (APMA) is the nation’s leading professional organization for today’s podiatrists. Doctors of Podiatric Medicine (DPMs) are qualified by their education, training, and experience to diagnose and treat conditions affecting the foot, ankle, and structures of the leg. APMA has 53 state component locations across the United States and its territories, with a membership of more than 12,000 podiatrists. All practicing APMA members are licensed by the state in which they practice podiatric medicine. For more information, visit www.apma.org.

APHA ‘Get Ready Day’ Helps Americans Prep for Emergencies

The American Public Health Association (APHA) is creating awareness through their Get Ready Day campaign, which will be held on September 16, 2014. The campaign helps Americans prepare themselves, their families and their communities for all disasters and hazards, including the flu, infectious disease, natural disasters and other emergencies.

It’s certainly a good reminder to be aware of potentially dangerous situations and how they are safely handled. Here is a list of how to prepare for pretty much any emergency situation you can think of.

This is also probably the cutest video you’ll ever see about emergency situations…Get Ready Video

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