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.
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!”
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
The heel bone is the largest of the 26 bones in the human foot, which also has 33 joints and a network of more than 100 tendons, muscles, and ligaments. Like all bones, it is subject to outside influences that can affect its integrity and its ability to keep us on our feet. Heel pain, sometimes disabling, can occur in the front, back, or bottom of the heel.
Heel pain has many causes. Heel pain is generally the result of faulty biomechanics (walking gait abnormalities) that place too much stress on the heel bone and the soft tissues that attach to it. The stress may also result from injury, or a bruise incurred while walking, running, or jumping on hard surfaces; wearing poorly constructed footwear (such as flimsy flip-flops); or being overweight.
Common causes of heel pain include:
Heel Spurs: A bony growth on the underside of the heel bone. The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an inch. When there is no indication of bone enlargement, the condition is sometimes referred to as “heel spur syndrome.” Heel spurs result from strain on the muscles and ligaments of the foot, by stretching of the long band of tissue that connects the heel and the ball of the foot, and by repeated tearing away of the lining or membrane that covers the heel bone. These conditions may result from biomechanical imbalance, running or jogging, improperly fitted or excessively worn shoes, or obesity.
Plantar Fasciitis: Both heel pain and heel spurs are frequently associated with plantar fasciitis, an inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. It is common among athletes who run and jump a lot, and it can be quite painful.
The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length; this leads to inflammation, pain, and possibly the growth of a bone spur where the plantar fascia attaches to the heel bone. The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle.
Resting provides only temporary relief. When you resume walking, particularly after a night’s sleep, you may experience a sudden elongation of the fascia band, which stretches and pulls on the heel. As you walk, the heel pain may lessen or even disappear, but that may be just a false sense of relief. The pain often returns after prolonged rest or extensive walking.
Excessive Pronation: Heel pain sometimes results from excessive pronation. Pronation is the normal flexible motion and flattening of the arch of the foot that allows it to adapt to ground surfaces and absorb shock in the normal walking pattern.
As you walk, the heel contacts the ground first; the weight shifts first to the outside of the foot, then moves toward the big toe. The arch rises, the foot generally rolls upward and outward, becoming rigid and stable in order to lift the body and move it forward. Excessive pronation—excessive inward motion—can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom back of the heel bone. Excessive pronation may also contribute to injury to the hip, knee, and lower back.
Achilles Tendinitis: Pain at the back of the heel is associated with Achilles tendinitis, which is inflammation of the Achilles tendon as it runs behind the ankle and inserts on the back surface of the heel bone. It is common among people who run and walk a lot and have tight tendons. The condition occurs when the tendon is strained over time, causing the fibers to tear or stretch along its length, or at its insertion on to the heel bone. This leads to inflammation, pain, and the possible growth of a bone spur on the back of the heel bone. The inflammation is aggravated by the chronic irritation that sometimes accompanies an active lifestyle and certain activities that strain an already tight tendon.
Other possible causes of heel pain include:
rheumatoid arthritis and other forms of arthritis, including gout, which usually manifests itself in the big toe joint; an inflamed bursa (bursitis), a small, irritated sac of fluid; a neuroma (a nerve growth); or other soft-tissue growth. Such heel pain may be associated with a heel spur or may mimic the pain of a heel spur;
Haglund’s deformity (“pump bump”), a bone enlargement at the back of the heel bone in the area where the Achilles tendon attaches to the bone. This sometimes painful deformity generally is the result of bursitis caused by pressure against the shoe and can be aggravated by the height or stitching of a heel counter of a particular shoe; a bone bruise or contusion, which is an inflammation of the tissues that cover the heel bone. A bone bruise is a sharply painful injury caused by the direct impact of a hard object or surface on the foot.
When to Visit a Podiatrist
If pain and other symptoms of inflammation—redness, swelling, heat—persist, limit normal daily activities and contact a doctor of podiatric medicine.
Diagnosis and Treatment
The podiatric physician will examine the area and may perform diagnostic X-rays to rule out problems of the bone.
Early treatment might involve oral or injectable anti-inflammatory medication, exercise and shoe recommendations, taping or strapping, or use of shoe inserts or orthotic devices. Taping or strapping supports the foot, placing stressed muscles and tendons in a physiologically restful state. Physical therapy may be used in conjunction with such treatments.
A functional orthotic device may be prescribed for correcting biomechanical imbalance, controlling excessive pronation, and supporting the ligaments and tendons attaching to the heel bone. It will effectively treat the majority of heel and arch pain without the need for surgery.
Only a relatively few cases of heel pain require more advanced treatments or surgery. If surgery is necessary, it may involve the release of the plantar fascia, removal of a spur, removal of a bursa, or removal of a neuroma or other soft-tissue growth.
A variety of steps can be taken to avoid heel pain and accompanying afflictions:
-Wear shoes that fit well—front, back, and sides—and have shock-absorbent soles, rigid shanks, and supportive heel counters
-Wear the proper shoes for each activity
-Do not wear shoes with excessive wear on heels or soles
-Prepare properly before exercising. Warm up and do stretching exercises before and after running.
-Pace yourself when you participate in athletic activities
-Don’t underestimate your body’s need for rest and good nutrition
-If obese, lose weight
We Treat Feet’s Dr. Mike Daniels is ranked in the Top 1% of all podiatrists listed on the business social network LinkedIn!
Dr. Daniels is continually ahead of the curve in connecting with both his patients and colleagues and it’s great to see him recognized.
You can view his LinkedIn profile here!
If taking better care of your health is one of your New Year’s resolutions, start from the bottom up. We often don’t think of our foot health until there’s a problem with our feet. This year, promise yourself you’ll take better care of your entire body. Here are a few simple healthy foot habits to stick to in the new year.
Healthy Feet Resolution #1: Walk More
Walking is one of the simplest forms of exercise; it doesn’t require any special equipment, it can be done in almost any weather, and it’s good for your overall health – including your feet. Even in small 15-20 minute doses, walking will help keep your feet and your body in shape.
Healthy Feet Resolution #2: Shed a Few Pounds
If this isn’t already on your New Year’s resolution list, here’s one reason you should consider adding it. Less weight means less stress on feet, which is especially important if you play sports or work on your feet all day. If you’re already at a healthy weight, keep up the good work! Your feet are one step closer to staying healthy in 2015.
Healthy Feet Resolution #3: Have Regular Check-ups
Your feet help you get around even more than your car does, so you should definitely be taking them in for regular check-ups. Regular visits to the podiatrist will let you know if there’s anything you should be paying closer attention to. If you already have a foot condition or other condition that affects your feet (e.g., diabetes), skipping foot check-ups is bad for your health.
Healthy Feet Resolution #4: Eat for Your Feet
What goes in your mouth affects your body – even all the way down to your feet. In general, you should avoid or cut back on foods that cause inflammation in the body. If you have gout, maintaining a healthy eating plan can reduce your symptoms. Once you know which foods to avoid, you can find healthy alternatives that won’t trigger your symptoms.
Healthy Feet Resolution #5: Shape Up Your Shoes
When it comes to improving foot health, 2 quick-fix recommendations for improving your shoe collection are:
Ditch the super high heels and flip-flops. Both of these types of shoes can be hazardous to your foot health. High heels force the foot into an unnatural position, and can damage the foot’s structure, resulting in corns, calluses, and bunions. Flip-flops offer no support for the foot, and the open design leaves your foot more susceptible to injury and infections, like athlete’s foot.
Replace old athletic shoes. Over time, even the best athletic shoe loses its ability to adequately support your feet when you’re engaging in your favorite activity. If you continue wearing them, you could end up throwing off the alignment of your foot. Worn-out shoes also put you at greater risk for sports-related injuries. In the long run, the potential cost of wearing old athletic shoes is much greater than the cost to replace them every 300-500 miles of use.
The path to achieving your New Year’s resolutions awaits you, don’t forget to make sure your feet can take you there. Now’s the perfect time to schedule your New Year’s appointment.
Original Source: http://www.drjefflamour.com/foot-care/best-foot-forward-new-years-resolutions-healthy-feet/
Whether you’re slogging through deep snow and sub-zero temperatures in the north, or contending with dampness, chill, and muddy conditions in the south, it’s important to take care of your feet all winter long. You’ll want them to be healthy and ready for action when spring finally arrives.
Most Americans will have walked 75,000 miles by the time they turn 50. Is it little wonder, then, that APMA’s 2010 foot health survey found that foot pain affects the daily activities—walking, exercising, or standing for long periods of time—of a majority of Americans?
“Each season presents unique challenges to foot health,” said Matthew Garoufalis, DPM, a podiatrist and APMA president. “Surveys and research tell us that foot health is intrinsic to overall health, so protecting feet all year long is vital to our overall well-being.”
APMA offers some advice for keeping feet healthy in common winter scenarios:
Winter is skiing and snowboarding season, activities enjoyed by nearly 10 million Americans, according to the National Ski Areas Association. Never ski or snowboard in footwear other than ski boots specifically designed for that purpose. Make sure your boots fit properly; you should be able to wiggle your toes, but the boots should immobilize the heel, instep, and ball of your foot. You can use orthotics (support devices that go inside shoes) to help control the foot’s movement inside ski boots or ice skates.
Committed runners don’t need to let the cold stop them. A variety of warm, light-weight, moisture-wicking active wear available at most running or sporting goods stores helps ensure runners stay warm and dry in bitter temperatures. However, some runners may compensate for icy conditions by altering how their foot strikes the ground. Instead of changing your footstrike pattern, shorten your stride to help maintain stability. And remember, it’s more important than ever to stretch before you begin your run. Cold weather can make you less flexible in winter than you are in summer, so it’s important to warm muscles up before running.
Boots are must-have footwear in winter climates, especially when dealing with winter precipitation. Between the waterproof material of the boots themselves and the warm socks you wear to keep toes toasty, you may find your feet sweat a lot. Damp, sweaty feet can chill more easily and are more prone to bacterial infections. To keep feet clean and dry, consider using foot powder inside socks and incorporating extra foot baths into your foot care regimen this winter.
Be size smart. It may be tempting to buy pricey specialty footwear (like winter boots or ski boots) for kids in a slightly larger size, thinking they’ll be able to get two seasons of wear out of them. But unlike coats that kids can grow into, footwear needs to fit properly right away. Properly fitted skates and boots can help prevent blisters, chafing, and ankle or foot injuries. Likewise, if socks are too small, they can force toes to bunch together, and that friction can cause painful blisters or corns.
Finally—and although this one seems like it should go without saying, it bears spelling out—don’t try to tip-toe through winter snow, ice, and temperatures in summer-appropriate footwear. “More than one news show across the country aired images of people in sneakers, sandals, and even flip-flops during the severe cold snap that hit the country in early January,” Dr. Garoufalis said. “Exposing feet to extreme temperatures means risking frostbite and injury. Choose winter footwear that will keep your feet warm, dry, and well-supported.”
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 email@example.com) as starting treatment early is the key to a full recovery.
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
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.