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Diabetic Foot Wounds: Myths, Care and Healing

In my podiatry practice, it goes without saying, I see a lot of foot issues. But for people with diabetes, foot problems and wounds take on a whole different meaning. Usually they are chronic conditions.

The way you care for your feet can have a big impact on your lifestyle so I thought it might be helpful to share some of the more common misconceptions and myths, as well as good practices, when it comes to foot wound care.

What is the most common foot wound for people with diabetes?
The most common issue I see is the diabetic foot ulcer. This is a break in the skin or a deep sore. Foot ulcers can be caused by minor scrapes, cuts or from the rubbing of shoes that don’t fit properly. It’s important to treat these as soon as you notice them.

Why are people with diabetes at higher risk of foot wounds and wounds that don’t heal?
Most often, people with diabetes are at an increased risk because many suffer from a condition called diabetic peripheral neuropathy. This is when you lose sensation in your feet because of extended periods of elevated blood sugars.

When this happens, you may step on something sharp or on a hot stretch of concrete, or have a rock in your shoe – it could even just be a high pressure point in your shoe. But you won’t notice these things because you can’t feel them. So you’ll continue to walk until the area breaks down and becomes an open sore, or ulcer.

And to make matters worse, having elevated blood sugar levels impede healing. So, it’s an added layer of complication, and that’s why it’s so important to stay on top of foot wounds if you have diabetes.

What are some common myths about wounds and healing?

MYTH #1. Use alcohol or hydrogen peroxide.
While these are good first aid tools for one-time use to disinfect a wound on a skinned knee, they don’t help with long-term wound care or wound healing. In fact, prolonged use of either of these is actually cytotoxic, meaning it kills both unhealthy cells and healthy cells, and slows wound healing.

MYTH #2: Soak a wound.
Soaking an open wound predisposes it to bacteria. On the other hand, showering is great for wounds; it rinses bacteria off and makes it tough for bacteria to stick to the wound.

MYTH #3: Wounds need air to heal.
I think we’ve been told this from our grandparents for generations! What studies actually show is that a moist wound will heal up to five times faster than a dry wound. To provide moisture apply a topical medication then keep it covered with a Band Aid or dressing 24 hours a day.

MYTH #4: Foot wounds need an antibiotic.
The Infectious Disease Society of America recommends that if there is no infection, we don’t need to treat it with antibiotics. Patients with diabetes are already at increased risk of developing antibiotic resistance. So, we only use them if the wound becomes infected.

What about socks and footwear?
If you have a wound on your foot, it is best not to wear shoes. For the wound to heal, you’ll need to remove any pressure to the wound. This may mean using crutches, a wheel chair or a walking boot for a bit. Once healed, it’s critical to be very careful with the shoes and inserts you wear, so there aren’t any pressure areas that may cause the wound to return.

With socks, you should avoid those with seams, because they can rub on your feet or toes and cause issues, too. Your socks also should be made with a breathable fabric that won’t cause excess sweating.

Is it important to examine my feet, and if so how often should I do this?
The American Diabetic Association recommends people with diabetes have their feet checked at least annually by a doctor. If you have diabetic neuropathy, you should check your feet daily.

What are some tips for checking my feet?
It can be hard to see the bottom of our feet, and if you have neuropathy it’s especially difficult to know if anything is wrong because you don’t have feeling in your feet. Here are a couple of ways to check your feet:

Apply lotion to your feet after bathing or showering. When you run your hands over your feet, you can feel with your hands if there is something new happening with your feet.
Take a handheld mirror (like you use when you’re checking the back of your hair) and set it on the floor in your bathroom or bedroom. Then hold up your foot so that you can see it in the mirror. This way you can see the bottom of your foot and look for problem areas.
If you see or feel something abnormal with your feet—whether it’s a blister, a cut, a wound or bleeding—call your doctor as soon as possible. This is especially true for those with diabetes and neuropathy.

Your Ankle Pain: Could It Be Arthritis?

How many times have you stepped off the curb or out of your car the wrong way, and twisted your ankle? Probably more than you’d like to admit! Ankle injuries are pretty common. It’s easy to make a misstep and give yourself a strain or sprain. But as an ankle surgeon, many of my patients are surprised when they learn that arthritis can also be the source of their ankle pain.

So What Causes Arthritis in Our Ankles?
The most common form of ankle arthritis is actually caused by a previous trauma or injury. Perhaps you were in a car accident, or had a sports injury and had surgery for it. Then this injury, in a way “re-awakens.” This is different than when you get arthritis in your hip or knee, as these cases are usually caused by overuse or general wear and tear over time. With trauma, we can see deformities of the ankle caused by the injury.

Symptoms of Ankle Arthritis
There are several grades of arthritis, and your symptoms and treatment largely depend on these.

Grade 1
This is a very mild form of arthritis. You may only feel pain when you exercise or perform certain work duties or chores. Your pain might be in a specific area of your ankle joint. Pain will come and go; you’ll have good days and bad days.

Grade 2
This is a more moderate form where a significant portion of your cartilage may be lost. You’ll have more pain, and more limited range of motion and function. You might feel the changes in weather because your ankle might swell and be painful.

Grade 3
This is what we often consider end-stage arthritis, where we see bone-on-bone in the joint. This means the two bones now grind together because there is no cartilage to provide a nice gliding surface and lubricating joint fluid. Think of an engine trying to run without motor oil. This friction causes inflammation, and the ankle further deteriorates and starts to deform. When you reach this stage, ligaments and tendons can become compromised as your ankles are now weakened and unstable. At this stage, your pain is persistent.

Treatments for Aching Ankles
For those with milder symptoms, there are several things we recommend. Anti-inflammatory medications, using a brace or wrap, and shoe modifications such as orthotics are great first steps. As podiatrists we may recommend specific types of rocker bottom shoes or modifying certain activities. We also prescribe physical therapy to strengthen muscles around the ankle. There are also some injections that may help.

Some patients benefit from minor arthroscopic procedures that enable us to go in and clean up scar tissue or remove bone or cartilage fragments that may be the cause of pain. These are the types of treatments we consider for those with both grades 1 and 2. Again, frequency and intensity of these treatments depend on the each person’s case. If you’re at grade 3, surgery may benefit you. Two types of surgery are ankle replacement and ankle fusion.

Who Needs Surgery and What Kind of Surgery?

Ankle fusion
This is the tried and true method of treating end-stage ankle arthritis. It’s been described in the medical literature since the 1850s believe it or not! This is where arthritic bone is removed, the joints are “welded” shut, and held in place at a 90 degree angle with plates and screws. This eliminates grinding and eases inflammation and pain. It does a great job of relieving pain, but the ankle does become quite stiff. This is good for those who perform high-impact activities or whose job entails heavy labor, because it’s sturdier than ankle replacement.

Ankle replacement
With ankle replacement, we take out the arthritic joint and replace it with two metal surfaces with a plastic liner in the middle. This allows patients to have some flexibility and range of motion. The goal is to ease or eliminate pain while preserving range of motion as much as possible. You will have a more normal walk compared to joint fusion, but not as complete as before surgery. This is a great option if you prefer low-impact activities, such as walking, playing golf, swimming, etc. It’s also a very good option if you are in your 50s or older.

What to Expect After Ankle Replacement Surgery
After your ankle replacement surgery, you probably won’t do any weight bearing activities for 2-6 weeks. This timeframe really depends on your surgeon and your situation. When your surgeon thinks it’s appropriate, you’ll ease into exercises for range of motion, strength and balance. After that, you can expect several months of physical therapy. You’ll likely stay in touch with your surgeon periodically for months or even years to ensure your joint is still in its proper place and your pain is still relieved.

In the final analysis, we want to make sure that you get the right treatment for your lifestyle and life stage so that you can live as pain-free as possible.

Floating Metatarsal Osteotomy

Forefoot ulcers are a chronic problem and have significant morbidity. One out of every 5 foot ulcers results in a leg amputation. With that said, it is so important to get wounds to heal quickly and prevent them from coming back.

The statics show that even when we are successful at healing a foot ulcer, 81% of the time they come right back in the first two years!

If only there were a simple way to keep these wounds healed… well, there is! It is called the floating metatarsal osteotomy! This is a simple, 2-minute surgical procedure that will elevate the metatarsal head to reduce pressure on the skin. In the photo, you can see where we cut through the bone. This allows the end of the bone to lift up when it is stepped on, decreasing pressure on the skin.

After surgery, patients need to wear a walking boot for 3-4 weeks. After the incision and the wound are healed, patients will transition back to diabetic shoes and will not have to worry about the ulcer returning.

Check out the link below to watch a video on the procedure.

For this and other advanced options for wound healing, visit us at Capital Foot and Ankle!

Navicular Stress Fractures

Michael Jordan suffered a navicular fracture

The year is 1985 and Chicago Bull’s Michael Jordan, widely regarded “Greatest of All Time” , sees his foot specialist for foot pain. X-rays were negative and showed no broken bones, but with a CAT scan, which shows X-rays in layers, uncovered a fracture in his navicular bone. This story is revealed in ESPN’s new documentary, The Last Dance.

What is a navicular?

The navicular is a bone in the middle of your foot. Its name is derived from its shape, which has the appearance of a boat. This bone serves a very important role as it allows significant motion and stress forces to pass from the ankle to the foot.

What is a navicular stress fracture?

A navicular stress fracture is a small crack in the bone that has a gradual onset of pain across the top of the foot. These fractures occur due to overuse or ongoing stress on the bone rather than a sudden injury. Due to its pivotal role in transferring forces from the ankle to the foot, the navicular bone is prone to repetitive forces that can cause damage to the bone. Repetitive activities that could result in navicular stress fractures include jumping sports (ie basketball), running, and increased exercise.

How are navicular stress fracture diagnosed?

A history and physical exam are the two most important pieces for diagnoses. X-rays may show a hairline fracture, but may time x-rays will appear normal. CAT scans and MRIs are helpful in confirming the diagnosis if x-rays are negative.

How are these injuries treated?

Your foot and ankle surgeon may recommend non-surgical or surgical options. Typically, the repetitive activity that caused the stress fracture should be stopped for 6-8 weeks. People who perform these repetitive activities due to their job, or are a high-level athlete, or still have pain after non-surgical treatment sometimes do undergo surgery. Surgery allows the patient to recovery more quickly and prevents the return of stress fracture. This treatment involves placement of a screw across the fracture.

When should I be evaluated by my foot and ankle surgeon?

Patients should make an appointment if pain persists after 1-2 weeks with walking or participating activities.

CBD Oil

Many of us have been stuck in traffic and noticed roadside signs or smoke shops advertising for CBD oil. But, does it work? Is it safe? Is it legal? How is it different than marijuana?
Well, we are here to tell you that it is legitimate and it works! CBD (or Cannabinoid) oil is extracted from the marijuana plant. The CBD portion of the plant is extremely valuable, particularly in treating pain. CBD oil is used to unlock the body’s own endocannabinoid system, which effects metabolism, diabetes, pain regulation, inflammation, digestion, and so much more! CBD oil also has none of the hallucinogenic properties typically associated with marijuana or THC.
The benefits of CBD oil are:
– Natural
– Powerful anti-inflammatory
– Fewer/no side effects compared to current medications
– No hallucinogenic properties
In our experience, CBD oils work well for a number of patients including:
– Patients that can not tolerate NSAIDs
– Patients with allergies/dependence issues with opioids
– Patients who have tried numerous options unsuccessfully
– Patients who are not surgical candidates
– Patients with chronic pain
At Capital Foot and Ankle, we carry a wide range of CBD oils. We carry numerous sublingual options and flavors. Most of our sublingual options are full-spectrum, meaning they contain more of the hemp plant than just the CBD, including small amounts of THC (less than 0.3%), however we do carry isolated CBD sublingual oil as well. We also carry gummies and softgels than can be taken orally, as well as several topical options.
If interested, stop in and ask our experts. All of our staff have been trained on the use of CBD oil and are available to answer questions. CBD oils are available over the counter at Capital Foot and Ankle, so no appointment is necessary! Stop in today!

What is a Podiatrist?

What is a podiatrist?

 

This is a question that we get a lot. Sometimes we get confused with pediatricians or pathologists because both specialties begin with “P.” Sometimes, we get confused with pedorthists, because we both deal with feet. Other times we get confused with nail care technicians, because that is where podiatry got its’ start.

Years ago, the practice of podiatry was called chiropody.   At that point, all we were able to do is palliative care like trimming toenails and callouses. Over time, the profession evolved to what it has become today. Looking forward, it is likely that the profession will continue to evolve.

Today, podiatrists have become the experts in everything involving the foot and ankle. Podiatrists are required to first complete undergraduate school. After college, students must apply for and be accepted to one of only 9 podiatric medical schools across the country. The competition for a spot is fierce.

Podiatric medical school is a specialized medical school where students have to decide, prior to starting school, that they will specialize in the foot and ankle. Over the next 4 years, students are taught medicine, often times taking classes with their allopathic peers. However, throughout medical school, systems are taught with a focus on their effects on the foot and ankle.

After medical school, graduates must then complete a 3 year surgical residency. Again, during residency, graduates will rotate through different specialties including anesthesia, orthopedics, emergency medicine, general surgery, and numerous others, all the while still focusing on the treatment of the foot and ankle.

After completing residency, podiatrists will then go through one of the most difficult board certification processes across medicine. Once completed, podiatrists are the experts on the foot and ankle. Podiatrists treat numerous conditions including toe nail issues, diabetic foot ulcers, bunions and hammertoes, arthritis, strains and sprains, plantar fasciitis, broken bones, and so much more.

If you are having trouble with your feet or ankles, come and see our team including the best podiatrists in the area, at Capital Foot and Ankle.

What’s wrong with Cam Newton’s foot?

Cam Newton sees foot specialist for Lisfranc injury

Carolina Panther’s quarterback Cam Newton injured his foot during a Week 2 loss to the Tampa Bay Buccaneers. He has been sidelined due to the injury and hasn’t made progress with this rehabilitation. “I was hiding an injury where I could have easily said, I don’t think I’m ready. Maybe I need to sit this one out…” Newton Said.

What is a Lisfranc injury?

A Lisfranc injury occurs when the bones or ligaments that support the middle part of the foot are broken or torn. The bones and ligaments of the midfoot allow you to walk and transfer your body weight from the heel of the foot to the toes.

How does a Lisfranc injury happen?

A common way to sustain a Lisfranc injury is by directly twisting the midfoot. This type of injury is common in contact sports (ie football). The spectrum of injury severity varies widely from only single-ligament injury to a full fracture-dislocation, which is more severe. Car accidents and crush injuries are other mechanisms that can cause a Lisfranc injury.

How do I know if I have a Lisfranc injury?

Lisfranc injuries are very painful. The pain is most severe to the middle part of the foot. You may not be able to stand on your foot due to the pain. Oftentimes there is significant bruising and swelling that occurs on the top and bottom of the foot.

How are Lisfranc injuries treated?

Treatment of these injuries depends on the severity of injury, mechanism of injury, and patient activity level. Nonsurgical treatment is possible if there are no fractures and the ligaments are not completely torn. The patient may be in a cast or removable boot walker for 6-12 weeks. Surgery is often required when there is a break in the bone or if the joints are out of place. Surgery will put the bones and joints in their proper position and alignment.

How long is recovery?

After surgery, the patient may be non-weightbearing for 6-8 weeks. Weight-bearing is allowed when bones show good healing on X-ray. Regular follow-up visits with your foot and ankle surgeon is critical. Return to sport or activity is entirely possible if proper rehabilitation is followed. Former Nebraska Cornhusker running back Ameer Abdullah sustained this injury several years ago but made a recovery and is now playing for the Minnesota Vikings.

For Cam Newton, return to play this season is unlikely. Even with nonsurgical treatment, the recovery process is extensive. If you suspect you have a Lisfranc injury to your foot, make an appointment with one of our foot and ankle specialists.

Wound Care Myths

“Wounds need air to heal” is probably something that you have heard your parents or even grandparents say. And, it makes sense. Wounds need oxygen to heal and the air is 21% oxygen. This concept dates back to Hippocrates in 400BC! Back then, they didn’t have many options for wound care other than air for wound healing!
However, in the 21st century, we have much better science, research, and options. Drs. Hess and Kirsner did a study in 2003 that actually demonstrates that moist wounds heal 3-5 times faster than dry wounds! Leaving wounds open to air will dry them out and actually slow healing.
Other myths include hydrogen peroxide: effective for first aid, not daily washings as it kills healthy cells, soaking: increases risk of infection and dries out the wound, and covering the wound in the shower: rinsing the wound in the shower lowers bacteria counts and lowers infection risks.
If you develop a wound on your foot, the best treatment is to shower, cover the wound at all other times with a moist dressing such as an antibiotic ointment and a band-aid, and if the wound doesn’t improve rapidly, call and schedule an appointment with us at Capital Foot and Ankle before a small problem turns into a big problem! We have same-day appointments available. Call 402-483-4485 to schedule an appointment.

Ingrown Toenails

Ingrown toenails are a common issue seen in patients both young and old.  They can be painful, and if not treated appropriately, an infection can occur.  Some will very rarely develop an ingrown toenail, while others struggle with chronic ingrown nails.  The good news is that you don’t have to continue struggling with ingrown toenails and there are treatment options available to prevent future ingrown toenails from returning.  We will cover a few causes, signs and symptoms of ingrown toenails, and potential treatment options available.

Potential causes of an ingrown toenail may include trauma to the nail.  This may be something as simple as someone stepping on the toe or could be from stubbing the toe.  The way the toenail is cut can contribute to the development of an ingrown toenail.  You must be careful to not cut back or round the sides of the nail too much because if a piece of nail breaks off there may be a portion that begins to become ingrown.  Occasionally we will see patients who have had a pedicure that may develop an ingrown toenail.  Others are genetically predisposed to developing ingrown toenails based on the curvature and growth of the toenail.

Typically, the first signs and symptoms of an ingrown toenail are discomfort along the nail border accompanied with developing irritation or redness.  Tight fitting shoes may increase the symptoms.  Pressure on the toe from walking, running, or other exercise may be uncomfortable.  Having the toe stepped on often causes increased discomfort.  If the toenail is not properly treated the ingrown toenail may become worse and over time there may be drainage, increased redness and pain, and potentially extra tissue growth may be seen along the nail border.  It is important to seek medical advice early in the process as this makes it less likely you will develop an infection.

You may have read about various treatment options for your ingrown toenails.  The common things people will initially try are digging the toenail out themselves, soaking in warm water or with Epson salt, and an antibiotic may be prescribed if redness develops.  These treatment options are good initial first steps, but often the nail border needs to be addressed to resolve the ingrown toenail.  Fortunately, we have good treatment options for removing ingrown toenails, along with preventing them from returning.  The physicians at Capital Foot and Ankle offer a couple different treatment options to help treat your ingrown nails.  We perform a simple procedure along the nail border to remove the ingrown toenail, which then allows the toe to heal.  If you have not struggled with ingrown toenails in the past, then you may only need a simple border removal.  We typically only need to take a small portion of the nail border which makes the overall appearance of the toenail look relatively normal following the procedure.  If you have struggled with ingrown toenails in the past, then we also offer an effective procedure to prevent the ingrown toenails from returning.  We can remove a small portion of the toenail border and then apply a chemical to the nail cells to prevent regrowth of the border.  This helps to eliminate the portion of the nail which tends to grow and curve into the skin.  This is a simple in office procedure that can be performed at your initial visit which will greatly reduce the likelihood of an ingrown toenail returning.  Most patients who have this procedure performed state that they should have done this much sooner as their toe feels much better and they no longer have to struggle with ingrown toenails in the future.  Again, only a small portion of the nail border is removed, and therefore most people don’t notice a difference in the appearance of their toenail once the toe has healed.  We provide simple care instructions following the procedure, and rarely is much activity restricted.

Capital Foot and Ankle encourages anyone who struggles with ingrown toenails to call and make an appointment to go over your treatment options.  We specialize in caring for your feet and nails and would like to help keep you active and pain free.  Give our specialists a call today if you are tired of struggling with your painful ingrown nails.  We can help eliminate this aggravating problem from returning.

It’s cold outside…..

This has been an exceptionally cold winter here in Nebraska.  We are seeing lots of foot problems associated with the cold weather, including thermal injuries such as frostbite.  Your feet need protection in cold conditions!  Not doing so can lead to long-lasting problems.

It doesn’t take very long – brief exposure to the cold can cause foot problems.   Previous frostbite and cold exposure will certainly make any subsequent cold exposures worse.  People with a history of frostbite are much more susceptible to reinjury.

Cold weather injuries are especially a concern for those in outdoor occupations, outdoor enthusiasts, and people with certain health conditions such as diabetes, Raynaud’s disease, and especially with those that have poor circulation.

Key factors that can increase risks of cold injury

  1. Poor circulation
  2. Previous frostbite
  3. Alcohol
  4. Smoking
  5. Inadequate protective gear
  6. Dehydration
  7. Exposure to moisture
  8. Sweaty feet
  9. Medical conditions
  10. Diabetes
  11. Peripheral neuropathy
  12. Cardiovascular disease
  13. Raynaud’s

Recommendations for protecting your feet

  1. Appropriate shoe gear and socks
  2. Things to look for in shoes

Shoes (or for that matter, socks) that are too tight cause pressure which can decrease blood flow. Shoes that are too loose, or that are made of a mesh, will allow for wind exposure and heat loss.  We recommend being fitted by a professional.  Boots are even better than shoes in the cold weather, especially hunting or hiking boots that come above the ankle.  Look for boots that have insulation like Thinsulate®, and waterproofing such as Gore-Tex®.  You might need to travel to the hunting/hiking/workboot section of your retailer.  ALWAYS fit your cold weather shoes or boots with the accessories you plan to wear (socks, inserts, orthotics).

  1. Things to look for in socks

I like a 2 layer sock regimen for the cold.  The sock against the skin should be a synthetic liner sock made from a material such as polypropylene.  This will allow moisture to be carried away from the skin, and help prevent blisters.  This can be worn under a thicker, full-length sock designed for colder weather, with materials such as Coolmax®, Smartwool®, and Dacron®.

  1. Appropriate clothing

You need to keep warm head to toe.  If the body is cold, the feet will be colder.  Dress in layers, again with a base layer that is synthetic in nature (cotton will hold sweat against the skin), and the outer layer being waterproof.  Modern materials have really changed cold weather gear options!

  1. Change shoes or socks when they become wet

Moisture is the enemy and accelerates heat loss.  This can be avoided with a good waterproof boot.  If you have a condition which your feet are excessively sweaty, your podiatrist may prescribe an antiperspirant.