Diabetes-related Foot And Ankle Problems
EndocrineWeb spoke with Dr. Nere Onosode about diabetes-related foot and ankle problems. Dr. Onosode is a Doctor of Podiatric Medicine and board-qualified by the American Board of Foot and Ankle Surgery. Here, he answers the many questions of interest to people with diabetes. What are some of the common types of foot problems you see in patients with diabetes? Dr. Onosode: I tend to see underlying structural bony and soft tissue problems. These include digital contractures commonly known as hammertoe deformities. Another is hallus abducto valgus deformities—commonly called bunions. A bunion affects shoe fit and comfort when walking, and causes soft tissue problems. Frankly, anything (eg, irritation) that causes bony or soft tissue enlargement of the front part of the foot (called the forefoot) can be problematic in the diabetic population. Is there a difference in the prevalence of foot and/or ankle problems in patients with Type 1 versus Type 2 diabetes? Dr. Onosode: In my practice, Type 2 definitely tends to be more prominent than Type 1. I believe this is because patients with Type 2 diabetes are diagnosed later in life, tend to be more overweight, and have developed complications by the time they see me. The onset of Type 1 diabetes occurs in children and teenagers, and they are usually diagnosed and managed early. Do people with diabetes tend to have more foot problems than people who do not have the disease? Dr. Onosode: People whose diabetes is not properly controlled tend to have more foot problems than nondiabetics. However, having diabetes is not a sentence to developing problems with the feet! I tell patients, if you are controlling your diabetes well, checking your feet daily, seeing the right specialist—whether that is your endocrinologist, primary care Continue reading >>
Type 2 Diabetes And Sprained Ankle
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Sprained Ankle Treatment: How To Treat & Heal An Ankle Sprain
To help your sprained ankle heal, youll need to ease the pain and bring down the swelling. Make an appointment right away for any ankle sprain, mild or severe. You doctor will examine you and let you know if something more serious is wrong with your ankle. Go to the emergency room if you have any of the following symptoms: Bleeding, numbness, or change in color of the affected area Your ankle looks deformed or seems dislocated If your ankle is just painful and swollen, remove ankle bracelets or toe rings right away. Then try the RICE method to ease your symptoms. RICE stands for rest, ice, compress, and elevate. Heres how it works: Ice the ankle for 20 to 30 minutes every 2 to 3 hours for the first 2 days Compress (wrap) the ankle lightly -- not tightly -- with an elastic bandage or ankle brace For the first 48 hours, elevate (raise) the ankle higher than your heart whenever you're lying down Take the compression wrap out of the packaging and unroll it. Place a small section of the cloth just behind your toes and begin to wrap it in a spiral toward your heart. Each layer should cover about half the width of the previous one. Continue wrapping around the foot, heel, and ankle until every bit of skin -- up to several inches above the injury -- is covered. If you still have pain and swelling, ask your doctor about over-the-counter pain relievers. Dont give aspirin to anyone under age 19. WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on April 28, 2017 Continue reading >>
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The Impact Of Diabetes On Patient Outcomes After Ankle Fracture.
The impact of diabetes on patient outcomes after ankle fracture. Duke University Medical Center, Durham, North Carolina 27707, USA. [email protected] Ankle fracture is one of the most common injuries treated by orthopaedic surgeons, and the presence of diabetes complicates treatment and recovery from this injury. Although a higher prevalence of adverse postoperative events has been found in small series of diabetic patients with an ankle fracture, we are not aware of any large national series with specific documentation of the outcomes following ankle fracture in patients with diabetes. We analyzed data from the Nationwide Inpatient Sample database for the years 1988 through 2000. Information regarding the hospitalizations of 160,598 adult patients with an ankle fracture who underwent subsequent surgical procedures was extracted from the database. Multiple linear and logistic regression models were used to ascertain whether patients with diabetes mellitus were more likely than patients without diabetes mellitus to die while in the hospital, to have in-hospital postoperative complications, to stay longer in the hospital, to have a higher incidence of non-routine discharge, and to have a higher total cost associated with the hospital stay. Significant increases in in-hospital mortality, the rate of in-hospital postoperative complications, the length of hospital stay, the rate of non-routine discharge, and the total charges were found in the diabetic patient group (p < 0.001). Specifically, we found that diabetic patients across all levels of fracture severity (closed unimalleolar, closed bimalleolar or trimalleolar, and dislocated or open fractures) stayed in the hospital for about one additional day (mean, 4.7 compared with 3.6 days) and incurred more than dollar 200 Continue reading >>
Basics of diabetes Diabetes is a condition caused by lack of a chemical in the body (a hormone) called insulin. There are two major forms of diabetes. In type 1 diabetes eventually no insulin is produced and individuals require insulin injections for survival. It used to be thought this only presented in children, but it is now clear this can occur at any age. The other more common form of diabetes called type 2 diabetes occurs due to the body's resistance to the effects of insulin in addition to an insufficient quantity of insulin. However, in this type of diabetes there is usually some insulin produced. For both types of diabetes, blood glucose levels are elevated. Furthermore, people with diabetes are prone to certain complications not seen in those without diabetes. These complications involve the eye (retinopathy), kidney (nephropathy) and nerves (neuropathy). People with diabetes also get early hardening of the arteries (atherosclerosis), leading to early heart attacks and strokes. The good news for people with diabetes is that with proper care all of these problems can be avoided. Immediate medical attention Uncontrolled diabetes presents with frequent thirst and urination. Over time, patients will become dehydrated as the glucose is "spilling" over into the urine. If insulin deficiency is severe enough, fat stores are used for energy as glucose cannot get into cells. This problem is much more common with type 1 diabetes and is called "ketoacidosis". It can be diagnosed at home with a simple urine test. When significant ketones are found in the urine, it is important to be in touch with a physician immediately. There are other conditions that require immediate attention. Blurry vision in someone with known diabetic eye disease or someone with a long history of di Continue reading >>
Take Ankle Sprains Seriously, Or Face Possible Complications | Healthmark Foot & Ankle Associates
Complications of Ankle Sprains and How to Deal With Them As Philadelphia area foot and ankle specialists, we see many, many sprains each year. And, while frequently these injuries can be healed with a bit of time and care, many times ankle sprains are more serious and complications arise. An ankle sprain occurs when the ankle joint is twisted unnaturally and the ligaments are damaged. This can happen in sports or when you are simply walking on uneven ground or step down with too much force unexpectedly. Because of the common nature and increased frequency of this injury, many people just shake it off and think it will heal on its own. This is a big mistake, as many complications can occur and your sprain becomes much more serious than it needs to be. These complications occur when: You do not get a proper diagnosis and the injury is more serious than you thought. You do not give the ankle the healing time it needs and go back to activities too soon. You have repeated sprains on the same ankle. The Most Common Complications of Ankle Sprains Include: Chronic pain: Once your ligaments are stretched or torn, they need about eight weeks to be fully healed and are pain free. But other problems might go undiagnosed, like a bone fracture, tear in the cartilage, nerve damage or a torn tendon. Delaying treatment of these other conditions leads to continued pain, weakness//giving way and disruption of your normal daily activities. Instability of the ankle joint: Sometimes an ankle sprain can heal incorrectly, leaving your ligaments permanently stretched. This will, in turn, cause your ankle to be weak and instable, frequently resulting in abnormal movement. If this happens, you will be much more likely to sprain again and experience swelling and pain long after you should have he Continue reading >>
Ankle Pain In The Diabetic Patient – Is It Just A Sprain?
Columnist presents radiographs to determine whether the patient has Charcot, chronic osteomyelitis, gout or septic arthritis. Upon initial consultation, a 42-year-old man presented to the emergency room with complaint of left ankle pain following a sprain roughly one week prior. He related gradual onset of a “dull ache” over the ensuing week without any recollection of true injury or episodes of swelling. During more in-depth questioning, he admitted to history of chronic ulceration, greater than six months in duration, about his lateral left ankle, which presently was healed. His past medical history included diabetes, neuropathy and osteomyelitis. His past surgical history was unremarkable. His medication included insulin and was otherwise unremarkable. The patient was afebrile. Physical examination demonstrated palpable pedal pulses and unremarkable left lower extremity edema with regard to discernible differences to his contralateral leg and foot. No apparent cellulitis or increased warmth was noted to the involved ankle. Radiographs of the left foot showed erosive changes about the metatarsophalangeal joints (Figures 1 and 2) as well aggressive destruction about the ankle joint with proximal extension along the tibia and fibula (Figures 3 and 4). Labs revealed a white blood cell count within normal limits, no left shift and inflammatory markers were normal as well. Based on the radiographs, what would your diagnosis be? Charcot Chronic Osteomyelitis Gout Septic Arthritis CASE DISCUSSION The correct answer is B. The patient was diagnosed with chronic osteomyelitis. Due to the extensiveness and location(s) of the osteomyelitis, a below-knee amputation was recommended along with hospitalization and intravenous antibiosis in addition to obtaining bone scans and MRI Continue reading >>
Ankle Sprain Treatment: Surgery, Rehab And Recovery
Ankle Sprain Treatment: Surgery, Rehab and Recovery Ankle Sprain Causes, Symptoms, Prevention and Treatment Options Almost everyone has experienced the moment when your left or right ankle twists the wrong way and you end up with a sprain. In fact, this type of scenario happens so frequently that 150,000 people are sent to the emergency room or urgent care center each year for ankle sprains. And that figure doesnt even include those who dont seek medical help for their injury. Even though all of us have experienced a sprained ankle (or know someone who has), not everyone understands how these injuries happen so easily. Your ankle has three main lateral ligaments made up of resistant and flexible fibers that support/defend against side to side or awkward movements. In addition to those ligaments there are also a few medial ligaments that add support. A sprained ankle occurs when one (or more) of your ankle ligaments is stretched out or torn. A stretched ligament is the least severe of this injury, while the most severe includes multiple ligaments being injured or fractured; including if it becomes partially or completely torn. Grade I sprains are the least severe. A grade I sprain cover slight tears with a little swelling, stiffness or tenderness. You can usually still walk without much pain. Grade II sprains are larger partial tears with greater pain, bruising and swelling. You might still be able to walk, but its going to be pretty painful. Youre better off in crutches. Grade III sprains are a complete tear of the inner or outer ankle ligaments. You shouldnt be walking. Needless to say, youll be off your feet for a while in recovery. You could have rounded third awkwardly in a beer league softball game or crashed and burn chasing your toddler around the backyard. Ther Continue reading >>
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People with diabetes are at high risk for developing problems with their feet. More than half of diabetics lose sensation in their feet due to nerve or blood vessel damage, and can hurt themselves without knowing it. To make things worse, diabetes slows healing and weakens the immune system, so what may seem like an inconsequential injury can quickly become a major problem. Even the smallest of foot and ankle injuries such as a blister or ingrown toenail can lead to infection and tissue death. One of the most serious complications of the diabetic foot is Charcot foot, a deformity that develops when people fracture bones in their feet without realizing it and then continue to walk on the injury because they don't feel any pain. Patients with diabetes have an elevated risk of serious foot problems. There are several reasons for this since diabetes involves: poor circulation, a damaged immune system and the possible development of nerve damage (neuropathy). Blood circulation in the feet is weaker than elsewhere in the body to begin with because of distance from the heart and the force of gravity. Further impaired circulation in diabetic patients may slow healing to a dangerous level. Poor circulation makes for slow healing and immune deficiencies allow infections to develop. In addition, diabetic nerve damage may keep patients from sensing heat or injury, and retinopathy which impairs their visual acuity, making detection of injury more difficult. These factors combine to make patients with diabetes highly susceptible to complications from foot problems. Diabetic neuropathy results from blood sugar levels that are elevated for a long period of time. Nerve damage may sometimes result in pain, but more often results in tingling, numbness, burning, or the inability to experi Continue reading >>
The Diabetic Foot And Risk: How To Prevent Losing Your Leg
Anyone who has ever had an elevated blood sugar level is at risk for foot complications. It may be as simple as knowing that once in your life, even during pregnancy, you have had an elevated blood sugar level. If so, you are at risk and must monitor your feet. Diet-controlled diabetics, whether diagnosed as an adult or as a child, have feet at risk of diabetic complications. The simple rule: If you have ever been told that you are at risk of developing diabetes, you need to consider your feet and work to prevent injury. It starts with daily foot checks: inspecting all sides, including the bottoms, which can be done best with someone's help or with a mirror. During a foot check, any changes in the foot's shape or color, sense of feeling/sensation, painful areas or skin integrity need to be evaluated. Any new bunions, calluses or corns need to be identified and shown to a medical doctor. The overall foot shape could change due to a bone fracture that would also need the attention of a physician. Stress fractures are very small breaks in the bone that will not usually change the shape of the foot, but may cause pain, bruising or swelling. The color of the foot is important as it helps show any changes in blood flow to the foot. Darkening or loss of hair may indicate that the blood or nerve supply has decreased. Less blood to the foot can mean slower healing of cuts and scrapes. Bruises indicate injuries. Especially important are the bruises or cuts found during a foot check that the person was not aware of at the time of injury. Any bruises within calluses are particularly important to show to a physician. To monitor sensation, a feather or facial tissue can be used to brush the foot and test its ability to feel light touch. It is also important to be sure the foot can se Continue reading >>
Diabetic Foot Care Victoria, Bc | Diabetes And Your Feet & Ankle Sprains | Dr. Doug Lamb James Bay Podiatry
Diabetes Management & Foot Care in Victoria, BC Diabetes is a lifelong chronic disease that is caused by high levels of sugar in the blood. It can also decrease your body's ability to fight off infections, which is especially harmful in your feet. When diabetes is not properly controlled, damage can occur to the organs and impairment of the immune system is also likely to occur. With damage to your nervous system, you may not be able to feel your feet properly. Normal sweat secretion and oil production that lubricates the skin of the foot is impaired, which can lead to an abnormal pressure on the skin, bones, and joints of the foot during walking and other activities. This can even lead to the breakdown of the skin of the foot, which often causes sores to develop. If you have diabetes, it is important to prevent foot problems before they occur, recognize problems early, and seek the right treatment when a problem does happen. When it comes to your feet, there are several risk factors that can increase your chances of developing foot problems and diabetic infections. First of all, poorly fitting shoes are one of the biggest culprits of diabetic foot complications. If you have red spots, sore spots, blisters, corns, calluses, or consistent pain associated with wearing shoes, new proper fitted shoes must be obtained immediately. Additionally, if you have common foot abnormalities such as flat feet, bunions, or hammertoes, prescription shoes or orthotics from your podiatrist may be necessary to further protect your feet from other damage. People who have long-standing or poorly controlled diabetes are also at risk for having damage to the nerves in their feet, which is known in the medical community as peripheral neuropathy. If you have nerve damage, you may not be able to Continue reading >>
Diabetic Foot Care Article
A A A Diabetes mellitus (DM) represents several diseases in which high blood glucose levels over time can damage the nerves, kidneys, eyes, and blood vessels. Diabetes can also decrease the body's ability to fight infection. When diabetes is not well controlled, damage to the organs and impairment of the immune system is likely. Foot problems commonly develop in people with diabetes and can quickly become serious. With damage to the nervous system, a person with diabetes may not be able to feel his or her feet properly. Normal sweat secretion and oil production that lubricates the skin of the foot is impaired. These factors together can lead to abnormal pressure on the skin, bones, and joints of the foot during walking and can lead to breakdown of the skin of the foot. Sores may develop. Damage to blood vessels and impairment of the immune system from diabetes make it difficult to heal these wounds. Bacterial infection of the skin, connective tissues, muscles, and bones can then occur. These infections can develop into gangrene. Because of the poor blood flow, antibiotics cannot get to the site of the infection easily. Often, the only treatment for this is amputation of the foot or leg. If the infection spreads to the bloodstream, this process can be life-threatening. People with diabetes must be fully aware of how to prevent foot problems before they occur, to recognize problems early, and to seek the right treatment when problems do occur. Although treatment for diabetic foot problems has improved, prevention - including good control of blood sugar level - remains the best way to prevent diabetic complications. People with diabetes should learn how to examine their own feet and how to recognize the early signs and symptoms of diabetic foot problems. They should also l Continue reading >>
Ankle Sprains & Injuries
Ankle sprains are common injuries that occur when ligaments are stretched or torn. The ankle sprain is the most common athletic injury. Nearly 85% of ankle sprains occur laterally, or on the outside of ankle joints. Sprains on the inside ligaments are less common. Many sprains occur when participating in sports, or by twisting the ankle when walking on an uneven surface. Some individuals, due to their bone structure or foot type, are more prone to ankle sprains. The ankle joint is made up of three bones. The bones are called the tibia, fibula, and talus. These bones form a socket in which the ankle joint moves. The tibia, fibula and talus are connected to each other by ligaments. When an ankle is sprained, a ligament is either stretched, partially torn or completely torn. Ankle sprain symptoms vary depending on severity. Often, the ankle is tender, swollen and discolored. The ankle can be quite painful to touch. Walking is usually hampered and may become difficult depending on the severity of the sprain. A feeling of instability may occur, especially in severe ankle sprains when ligaments are torn. Ankle sprains are classified by "types" and range from mild to moderate to severe. Classifying ankle sprains helps the physician diagnose the specific structures involved in the injury. This also helps determine appropriate treatment plans for each type of ankle sprain. Type I ankle sprain, the least severe, occurs when ligament fibers have been stretched or slightly torn. Type II sprain occurs when some of these fibers or ligaments are completely torn. Type III, the most severe, occurs when the entire ligament is torn and there is significant instability of the ankle joint. Fractures of the ankle bone or outside the foot bone may be present after any type of ankle sprain. F Continue reading >>
How A Diabetic Should Treat A Sprained Ankle
If a person has well-controlled diabetes without neuropathy or impaired sensation, then treatment is not much different than an ankle sprain in a nondiabetic patient, says Peter D. Highlander, DPM , Reconstructive Foot & Ankle Surgeon, Director, Wound Reconstruction Center, The Bellevue Hospital, Bellevue OH. Dr. Highlander continues, Neuropathy is a game-changer because the person cannot sense pain normally. The ankle sprain may actually be a more serious injury that could require surgery. Pain is our built-in protective mechanism against danger. Pain tells us to remove our hand from the hot stove, for example. Losing pain sensation as in the case of neuropathy places us at higher risk to injure ourselves. If someone with neuropathy twists their ankle, it is difficult for that person to differentiate pain typical of an ankle sprain versus pain associated with a broken ankle. Did you fall? Check your ankles! Make this an automatic response to any fall. Its not about what you feel; its about what you SEE. A broken bone will not go without swelling and bruising. However, when an ankle bone breaks, theres usually torn ligaments as well, and these will cause immediate swelling. Discoloration will be right behind. If your ankle looks normal, chances are its not broken. But if its swollen or discolored/bruisedyou need to get it examined even if you dont feel any pain. Check your feet every morning, because an ankle sprain or fracture can occur even if you have not fallen. I have had many neuropathic patients walk into my office after an ankle injury, says Dr. Highlander. These patients assume they merely suffered a sprain because it doesnt hurt to walk on the injured ankle. X-rays often tell a different story and may reveal a badly broken ankle which often requires surgery. Continue reading >>
Current Insights In Treating Diabetic Foot And Ankle Trauma
Current Insights In Treating Diabetic Foot And Ankle Trauma The management of diabetic foot and ankle injuries has raised significant debate and controversy over the last few years. Unfortunately, there is still no clear consensus on treatment protocols that necessitate surgical intervention. The main reason for this controversy is because there is no single correct way of treating even the most commonly encountered diabetic foot and ankle fractures and/or dislocations. The treating surgeon needs to be able to provide the most successful management and avoid potential inherent complications that are common in the diabetic population. A wide spectrum of injuries can occur that include neuropathic and non-neuropathic fractures, dislocations or both. In addition, concomitant soft tissue injuries present further unique challenges for overall surgical management. Evaluating And Addressing The Compromised Soft Tissue Envelope The foot and ankle have a limited amount of soft tissue coverage. Therefore, one needs to pay particular attention to minimizing wound healing complications when managing diabetic injuries. When it comes to patients with diabetes, one needs to ensure medical optimization in order to avoid any potential effects from diabetes, anemia, cardiac, renal, vascular and/or pulmonary disease. The presence of multiple comorbidities can have a deleterious outcome on the wound and bone healing process, and further complicate the patients overall medical status throughout the treatment course. The utilization of supplementary oxygen to prevent tissue hypoxia and appropriate glucose control are some measures one can initiate in order to reduce the risks of infection and wound healing complications. Successful management of diabetic foot and ankle trauma is dependent o Continue reading >>