10 reasons why you should choose We Treat Feet

The We Treat Feet Podiatry group takes great pride in putting our patients’ feet and needs first. We pride ourselves on our expert clinicians and top-notch customer service.

Here are 10 reasons why you should choose We Treat Feet Podiatry for all your podiatric needs.

Read More

Why does my diabetic foot hurt?

In diabetics, neuropathy is defined as a loss of protective sensation.  The condition occurs in what we call and stocking and glove distribution.  It starts at the distal ends of the toes and fingers, and moves proximally up the foot/hand into the leg/arm.  While there are many causes of peripheral neuropathy, diabetes is the most common.

Neuropathy can occur in several forms.  The most common is sensory neuropathy.  This is a change in the ability of the patient to feel their feet and hands.  Starting in a stocking and glove distribution, a patient will not feel items touching their toes and feet.  Over time, patient can step on objects such as glass shards, nails, or tacks, and will not feel it.  This is a significant risk for infections and amputation.

Neuropathy can also occur as a motor neuropathy.  This is a loss of function in the distal most muscles, and can be combined with sensory neuropathy to be called sensorimotor neuropathy.  The most common examples of this include the development of hammertoes in a neuropathy foot, or ankle contractures causing ulcerations in the ball of the foot.

Lastly, neuropathy can cause an autonomic issue.  This will be symptoms such as a loss of ability to sweat or release oils (also called sebum) from the skin.  This is the type of neuropathy that also involves the cardiovascular system, gastrointestinal system, and genitourinary system.

With loss of sensation and function, patients become higher risk for infections, wounds and amputation.  Daily foot examinations, proper shoe gear, and regular diabetic foot care can prevent many problems.   So that begs the question, if I can’t feel it, why does it hurt?

60-70% of diabetics will eventually suffer from this condition.  The best way to think about it, is to use the telephone as an analogy.  If you are on the phone, and there is static, you can still hear, right?  The more static, the louder you have to yell to have the person on the other end hear you, until eventually there is so much static that you can’t hear anything, and they you hang up.  This is what happens with your nerves.

Each and every nerve in your body is connected directly to your brain.  Millions and millions of individual wires, from every aspect of your body, connected directly to your brain.  As neuropathy advances, the static to your brain increases.  Patients perceive this as neuropathic symptoms, burning, tingling, fire, ices, etc.  The louder the static, the more symptoms, until finally your brain hangs up, and then you have a complete loss of sensation.  This basically means that you can remove portions of your foot without anesthesia and not know it.

Treatments for painful diabetic neuropathy include proper glucose control, diet, exercise, and many different medication options.  You may have even seen a television commercial for Lyrica for example.  There are also sensory feedback options, cold laser and other light treatments, and even surgical options for releasing the nerves.

Best treatment for diabetic Neuropathy is prevention.  Good glucose control, exercise, and preventive foot care are essential.  Treatment once you have symptoms has been successful, but not for everyone.  You may not know you even have it.  The doctors at WeTreatFeet are well versed in this process and can offer you many cutting-edge treatments.  Call today if you want to have t

What is the diabetic foot?

If you have diabetes, one of the most common issues and concerns is your foot.  Your foot is a complex structure consisting of 26 bones, 33 joints, and 120 muscles/ligaments/nerves[1].  Each structure has a unique purpose, and diabetes can causes alternation in function for any of them.

The most common problem we see in diabetics is diabetic peripheral neuropathy.  This is nerve damage that is a result of elevated glucose that is the root cause of all other diabetic foot problems.  With neuropathy, there are 3 main types; Sensory, Autonomic, and Motor.  While most people have an understanding of the loss of sensation associated with sensory neuropathy, the other two types can cause significant problems, and must be considered in any article about the diabetic foot.

Autonomic nervous system is part of your body responsible for involuntary action.  These are things like your heart beat, dilation and constrictions of the blood vessels, and secretion of natural skin oils, called sebum.  [2]  In the diabetic foot, these cause changes in the flow of blood to the foot, the amount of sweat your foot can produce, and how fast the blood flows.  These symptoms develop over years of disease progression, and the progression is enhanced under poorly controlled glucose levels.[3]

Motor neuropathy is a progressive loss of muscle tone and strength.  This results in weakness and muscle atrophy.  Most common in the upper and lower extremities, symptoms include cramping, twitching, and muscle wasting.  As in sensory and autonomic neuropathy, diabetes is a common cause, but other factors can contribute to each of these problems.  [4]  Motor neuropathy is the cause for problems associated with progressive hammertoe and bunion deformities.

When diabetes causes complications to your foot, it is related to each one of these types of neurologic conditions.  Sensory loss creates a situation where you can’t feel your foot.  Autonomic changes allow skin to become dry, atrophic, and easily damaged.  Motor neuropathy causes changes in the foot shape and mechanics, increasing pressure points, leading to the development of musculoskeletal imbalance.

I always tell my patients that when it comes to diabetes, if you live long enough, you are subject to all of these problems.  That being said, the better controlled your diabetes is, the longer and slower these symptoms progress, and the less likely to result in an infection, ulceration, or amputation.  Good quality foot care, proper shoes, glycemic control, and some education can go a long way in preventing loss of limb or life, a problem that occurs 73,000 times a year.[5]  This number is more than half of what it was 20 years ago due to proper education and better understanding of these problems.

 

[1] http://www.nytimes.com/health/guides/symptoms/foot-pain/print.html

[2] https://medlineplus.gov/autonomicnervoussystemdisorders.html

[3] https://medlineplus.gov/ency/article/000776.htm

[4] https://rarediseases.info.nih.gov/diseases/11011/multifocal-motor-neuropathy

[5] http://www.healthline.com/health/diabetes/diabetes-amputation#is-it-needed2

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.

Read More

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.

Read More

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.

Read More

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

Dr. Daniels Ranked In Top Podiatrists on LinkedIn

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!

REPORT: Office Visits by Patients With Diabetes Rising Rapidly in United States

Office visits in the United States for diabetes rose 20% from 2005 to 2010, with the largest increase in adults in their mid-20s to mid-40s, according to a new data brief from the Centers for Disease Control and Prevention’s (CDC’s) National Center for Health Statistics (NCHS).

Nearly 29 million people in the United States have diabetes, putting them at risk for other chronic conditions, such as heart disease, eye disease, and stroke, Jill J. Ashman, PhD, and colleagues from the NCHS note in the brief.

On an annual basis, the cost of diabetes in the United States approaches $245 billion, and patients with diabetes have medical expenditures 2.3 times those of patients without diabetes.

The researchers analyzed recent trends in office visits by patients with diabetes using the National Ambulatory Medical Care Survey (NAMCS), a nationally representative survey of visits to nonfederal office-based physicians (excluding anesthesiologists, radiologists, and pathologists).

They found that office-based physician visits by patients with diabetes rose from 94.4 million in 2005 to 113.3 million in 2010 (a 20% increase). Visits by patients with diabetes made up about 11% of all office-based physician visits in 2010.

The number of office visits increased during the study period for all age groups except for those younger than 25 years. The largest percentage increase (34%) occurred in people in the 25- to 44-year age range.

However, the volume of visits was higher for older adults; individuals aged 65 and older made 53.7 million visits in 2010 compared with 2.6 million visits made by those younger than 25.

The researchers did not see any marked change in the rate of office visits by patients with diabetes in any age group during the study period. The highest rate in 2010 was among those aged 65 and older (1380 visits per 1000 persons) and lowest in those younger than 25 (20 visits per 1000).

“Diabetes is not the only health concern for the majority of patients who have it, with 87% of visits being made by patients who have additional chronic conditions,” Dr. Ashman and colleagues say.

Regardless of age, they found that patients with diabetes use “extensive health resources,” making frequent trips to the doctor and often receiving multiple prescriptions.

One of the federal Healthy People 2020 goals is to reduce the disease and economic burden of diabetes. “Continuing to examine office-based physician visits by patients with diabetes is especially important given changes in standards of care that may influence such visits,” Dr. Ashman and colleagues say.

Source: Medscape

What is driving a physician shortage and how can it be stopped?

As its name insists, the Affordable Care Act (ACA) is supposed to give more American access to reasonably-price healthcare, but this affordability would prove fruitless if the number of primary care physicians in the United States continues to decrease.

Recent findings from the likes of SERMO, the largest online community of physicians, show that amongst all provider specialties family and internal medicine are two of three unhappiest groups of physicians, 62 percent and 60 percent, respectively. Only obstetricians and gynecologists come in lower at 59 percent. For internists and family physicians, dissatisfaction with lifestyle was a common factor leading many to rethink their choice of specialty, 25 and 23 percent, respectively.

“These are the doctors on the front lines in medicine who are seeing the increase pressure and in particular now with the ACA in play and a higher stream of patients coming in,” SERMO CEO Peter Kirk tells EHRIntelligence.com. “It is still a challenging work environment and they are at the lower end of the pay scale. Those are the ones looking to change whereas those on the higher end of the pay scale — orthopedists, physiatrists, oncologists, etc. — are happiest with their professions.”

Although these physicians admit to dissatisfaction with their choice of specialty, it does not mean that they are leaving it for another. So then why is this problematic? The answer to that question is seen in the choices made by the next waves of physicians, residents, who are opting more lucrative and less stressful professional positions.

“Based on some of the conversations on the site, you can build a sense of how much there is a drive toward specialty right off,” Kirk explains. “Having your own private practice as a primary care physician is not the dream anymore. It doesn’t pay the bills. There’s too much complexity, too much involved in running a business. This is driving residents into searching for the best-paid specialties in order to help pay of their debt and have a nice head start moving forward.”

Here lies the basis on predictions that physician shortages are only a matter of time. The ACA and increase of insured Americans should only serve to exacerbate the stresses associated with primary care.

“There will not be enough real doctors at the front lines of primary care to handle the workload, especially with the ACA adding 30 million additional patients to the system,” maintains SERMO’s CEO. “More pressure and more of the primary care are being assigned to non-physicians. The NPs and PAs are likely to do more of the work. That’s going to play out over the next five to ten years.”

A solution to the problem?

The physician shortage problem is real, but what can be done about it? Both the Association of American Medical Colleges (AAMC) and American Medical Association (AMA) believe the solution to be found in graduate medical education.
Crediting medical schools for increasing enrollments and students for responding with an increasing number of applications, the AAMC is placing the onus on lawmakers:

Now Congress must do its part by lifting the cap on the number of federally supported residency training positions. Lawmakers have responded with proposals in the House and Senate to increase the number of residency positions. But they must act now in order to ensure that there are enough physicians for our growing and aging population.

Meanwhile, the AMA has developed a new policy to encourage state and federal legislators and private payers help fund residents in training with an emphasis on promoting the teaching of team-based and patient-centered care models by accrediting associations.

Through its Accelerating Change in Medical Education initiative, the AMA has convened nearly a dozen medical schools to decrease disparities in medical education. “As more patients continue to receive health care coverage, it is essential that the next generation of physicians is sufficiently trained,” said AMA Board Member Stephen Permut, MD.

Health information technology (IT) has a role to play in easing the burdens on providers if developed, implemented, and used properly. But it is still only a support and no substitute for the skill and expertise of physicians using it.

Source:
Kyle Murphy, PhD
EHR Intelligence

1 2 3