So many foot problems could be prevented if people with diabetes had their feet thoroughly examined by a podiatrist. Worldwide, guidelines for the management of diabetes recommend an annual foot examination at the very least.
Today we celebrate World Diabetes Day. What a pity that so many people with diabetes wont feel like celebrating because they suffer some foot complications. This can be as simple as a painful corn or as complicated as an amputation.
As a podiatrist I would like to be celebrating an improvement in the foot health of South Africans, but unfortunately many people with diabetes have never seen a podiatrist, mistakenly believing that since they have no visible foot problems everything is fine.
Diabetes causes changes to the circulation and nerves to the legs and feet which often develop slowly and almost without notice. Recently I have heard people say that they have the less serious diabetes “the second type”!
Managing diabetes is a team effort and the podiatrist is a member of the team. If you neglect your feet and have no idea if they are showing the effects of diabetes, you are probably going to develop, corns, callus, blisters, ulcers and worse. Do you know the quality of your circulation? Are you sure you can feel everything with your nerves?
Why not commit to better foot health today by making an appointment with a podiatrist for a diabetic foot assessment?
On July 28 2008, on this website I wrote about Dialysis and the diabetic foot, with a description of a foot ulcer patient.
Last week I was invited to speak to patients of the Cape Town Dialysis Clinics about foot care; during my preparation I came across some startling evidence proving that dialysis is an independent risk factor for foot ulceration if you have diabetes and require dialysis.
We already know that impaired kidney function increases the risk of foot ulcers – also referred to in my 2008 Blog – but this 2010 research proves that:
If you have diabetes and are receiving dialysis, you are 5 times more likely to develop foot ulcers, compared to someone with diabetes who is not on dialysis.
Scary but true clear evidence from a study completed at Manchester UK.
The research showed that patients on dialysis have more nerve damage, circulatory problems and a history of foot ulcers and amputations.
There is a 25% lifetime risk of people with diabetes developing foot ulcers so the key issue whatever your status is prevention.
Diabetic foot ulcers have multiple causes, some are: external trauma from footwear, neuropathy, arterial damage, poor self-care, lack of access to care, poor treatment.
However, as with all research you must ask – “so what?” This patient group did not include any people of colour, so it may not apply totally to South African patients.
So what to do? our objective is always to PREVENT complications.
Every person with diabetes must have an ANNUAL FOOT EXAMINATION so that they understand their level of risk for developing foot complications.
in addition individual education on self management of their diabetes. this is a team effort, paying attention to cardio-vascular health, eyesight, footwear selection and fitting, foot biomechanics (and possibly insoles or orthotics), plus probably the most important factor – can you invest in the care being offered?
Always “take care of your pair”.
I'm glad to be able to tell my patients that I am now offering podiatry services from 2 locations in Cape Town and Hout Bay.
You can find the new podiatry surgery locations together with opening times (in Wilderness Road, Claremont and Victoria Avenue, Hout Bay) on my Contact page.
For my patients I have regretfully had to leave behind in Johannesburg, please see my last post here with details of my podiatry colleague, Louise Stirk, who has kindly taken over your continued care.
Foot health care needs to be checked if you are going away for Easter.Wherever you go, you are probably going to spend more time on your feet! Most of you will be OK and recover quickly from the aches & pains of that long walk on the beach,in the Bush or mountains.It might even be running some extra kilometres because you have time off!Often it is that extra round of golf!
To prevent foot problems, make sure you have the right footwear for what you are doing. That romantic barefoot walk on the beach can be ruined if you develop pains in the soles of your feet( plantar fasciitis), so use your takkies for some of the time.
Watch out for blisters caused because your shoes were rubbing. Don’t open or burst them, rather put a plaster firmly over the area to bind it down for a few days until it dries up. If you really have to open them use a clean instrument and immediately put on an antiseptic dressing with gauze.
Don’t forget it is easy to get sunburn on the tops of your feet if they are usually covered up at work!
Just a few thoughts to help you to enjoy your break.
Free foot screenings for people with diabetes are still available from certain podiatrists nationwide this week. Due to the demand, in our practice we will still offer them during next week too.
Protecting your feet from the complications of diabetes is a serious responsibility.
Managing your diabetes is the foundation of protection against complications that affect your eyes (Retinopathy), kidneys (Nephropathy) and feet (Neuropathy).
Feet can be severely damaged by diabetes and yet they are painless. This allows injuries to occur undetected and often leads to ulceration and amputation.
The purpose of the FREE FOOT SCREENING is to establish your risk level for developing foot complications, because many foot injuries can be prevented by being informed about the status of your feet.
Even people with severe loss of sensation can and do avoid problems by a combination of good blood sugar control and regular foot inspections by a podiatrist.
PLEASE DON”T BECOME A STATISTIC
Last week I was invited to the Headquarters of ESKOM our Electricity Supply Commission, to talk about footwear selection and the effects of high heels, amongst other things!
From the outset it was clear that ESKOM is very concerned about safety – we were briefed on where and how to get out of the venue should there be a ‘problem’ – before the talks began.
It seems that the greatest cause of occupational injuries at Eskom HQ is Slips, Trips & Falls, nothing to do with electricity at all! So they decided to do something about the problem by discussing it. There were two scientists from the National Institute for Occupational Health also presenting and they showed some of the scary activities that employees do in incorrect footwear. Like climbing ladders, wearing high heeled shoes on slippery floors, or wet floors.
Even with the current fashion for lower heeled shoes amongst women, there was a slipping incident at ESKOM recently.
Flooring was identified as a major cause of slips at work, but also there is the choice of inappropriate footwear as I pointed out previously. Amongst other causes are uneven floors, poor lighting.
Having a spare pair of shoes at work is one solution, so that when you have to go to meetings or interact with clients you can put on your more fashionable ones.
However, perhaps the most basic concept is to be aware of your surroundings. For example, how many of us have fallen on our backsides at sometime in our lives, when at the poolside? In other words look where you are going!
Responsibility for foot health safety rests with employee and employer.
The Health & Safety legislation is designed to protect everybody. Including the forklift driver who says he must wear tekkies instead of safety shoes, because the safety shoes hurt. Fine, but remember that if you get hurt, there is no compensation.
However, I do blame employers who budget for only the cheapest safety footwear, when being distracted by uncomfortable footwear could lead to an accident at work. There is a real need to look to buy the best safety footwear the company can afford. It’s people’s health after all.
On the other hand, the beautiful corporate HQ with imported tiled floors, may actually be an accident waiting to happen.
Paying attention to where you are walking and what you are doing is another important measure in preventing slips, trips & falls. What do I mean? The dreaded cellphone! Walking & talking can be just as dangerous as driving and talking.
We had a good discussion about high heels!
On my way through the campus I noticed a beautiful young woman tip-toeing along past a wet floor [it was well-marked by the cleaning staff with warning boards] on what I guess were 7cm high heels. Her strides were very short and she wobbled along to keep from slipping on the tiled floor.
As I’ve pointed out before, a high heel shortens your stride and reduces your ability to walk normally. Add to this a shiny floor and there is an accident waiting to happen.
In the ESKOM HQ and many others I’m sure, the floors are spotlessly clean and shiny. Usually tiled and very smooth. This means that there is little grip between the sole of your shoe and the floor. An ideal situation for a slip, trip or fall.
Foot Health and Safety at work is everyones business and responsiblity.
81 pairs of feet belonging to podiatrists and University of Johannesburg podiatry students will hit the road tomorrow, in the 702 Walk the Talk.
Look out for the UJ caravan where you can receive advice and screening for any foot problems before or after the walk.
Listen to well-known South African podiatrist Dennis Rehbock, live on Talk Radio 702 from 08.00 – 08.30.
The South African PodiatryAssociation and UJ are combining forces to support the feet of the more than 50,000 entrants on one of the World’s biggest walks!
If you are walking, “put your best foot forward”and enjoy it!
Walking is probably the easiest and cheapest form of exercise available to us. The 702 Walk the Talk takes place on 25 July and 50,000 entrants are expected to hit the streets of Johannesburg.
Podiatry students from the University of Johannesburg will be walking aswell as offering foot care advice and screening at their Caravan Clinic. Some podiatrists will also be joining them. Some to walk and others – like me – to talk!
There are many benefits of walking; improved circulation, increased energy, longer life, being happier and stronger bones, are just a few.
30 minutes a day and 3 times a week is recommended! Where to find the time? You may ask. Well it doesn’t have to be all at once. Just think about your day and see if you aren’t already doing some walking.
The important thing is – BRISK – not strolling to check out the neighbours new extension!
Brisk means just that and starts by moving around more quickly with everything you do. Start by taking the stairs when possible. Obviously it’s a bit silly to walk up 15 floors, but you can work up to it. I used to work in a building where I gradually worked up to 7 floors. When I was in there again recently, I could still do it, but slowly! I need to walk more.
Start slowly by putting in say 10 minutes [distance doesn’t matter] every day. Set targets and slowly increase. If you rush out and do 30 minutes or try to get kilometres in under a specific time, I look forward to treating you for shin splints, plantar fasciitis, blisters etc.
Become familiar with your normal speed and pace and maintain it. Sudden rushes and surges only increase the risk of injury.
Try to walk with someone. especially someone you can talk to. As you get better, one of the tests of improvement is being able to hold a converstaion with your walking partner.
You must wear a decent tekkie/trainer. After a few weeks if you do develop pains that won’t go away, look at whether the shoes are deforming in any way. That could suggest a biomechanical problem. Then you need to see a podiatrist for advice.
Sometimes, starting a walking programme reveals an underlying condition. Specifically there is a condition called intermittent claudication which is felt as a cramping or tightening of the muscles at the back of the lower leg. It occurs every time an afflicated person walks a specific distance at their regular pace OR when they walk up a slope or incline. The distance will vary with individual physical status, but it occurs regularly at the same distance.
Basically, what is happening is that the muscles are starved of oxygen because the arteries are hardened and narrowed – usually by cholesterol plaques. If this does happen, then beware, it could also be happening to another muscle your heart! Pay your doctor a visit for a check up.
So if you want to:
Start walking. No excuses! We’ve had a month sitting watching football.
Now fight the winter chills, improve your health and WALK.
Football and podiatry. What a combination! The FIFA World Cup has arrived in South Africa. 64 games, each game with at 22 pairs of players feet, plus the 3 pairs of the officials, on the field at any one time! (Unless someone gets sent off).
Add the team officials and finally the fans – 98,000 of them for the first game. Feet for Africa. Call for the podiatrist.
The podiatrists associated with the World Cup are ready for foot problems that might afflict players, officials and fans.
I was surprised to learn from one of the World Cup podiatrists that very few countries have a podiatrist associated with their teams. I think this is a great opportunity to get them to understand that many foot injuries can be prevented and treated better by podiatrists than anybody else.
During the next month, I hope everybody enjoys this great event and when ‘footbal feet’ get sore, they will find some special South African podiatrists ready.
Over the past few weeks, I have seen an increasing number of patients of all ages complaining of Heel Pain – usually diagnosed as Plantar Fasciitis (PF).
The pain is usually persistent and occurs under the heel pad and around the heel. Often it only affects one foot, but after questioning and examination, they admit to “a bit of discomfort in the other foot.”
This extremely painful condition also called Plantar Fasciitis (PF), but strictly speaking PF causes pain into the arches and soles too, rather than just the heel.
In 1979, one of the founders of Podiatric Sports Medicine, Dr Steve Subnotnick, devoted an entire chapter to heel injuries, in his book Cures for Common Running Injuries. He was probably the original ‘running foot doctor’ when the surge in road running began to take off worldwide.
The pain is usually worse in the morning when taking the first few steps and then gets less with continued movement. This pattern is repeated if you sit for a while later in the day – say in a meeting, classroom, lecture or tea-break – and stand up to walk again.
Patients always point to the exact site of pain. This is right in the middle under the heel pad. On the inside (very common) or outside of the heel and at the back.
Overuse is the phrase we use to explain PF! It’s a bit like saying stress. The basic cause is the malfunctioning of the person’s foot and lower limb structure, what we call your Biomechanics. The normal -for you – rocking and rolling movements are exceeded and the tissues get strained and inflamed at the very point where the plantar fascia is attached to the heel bone.
This can be caused by too much exercise such as increasing your distance and not getting enough rest. Changing the surface you run on; for example: running on a treadmill, starting running without the correct preparation, suddenly running more quickly.
Another common cause as we get older is being overweight. Or a change of occupation where more walking or standing is required. Old worn shoes for day wear or exercise. Arthritis, a pinched nerve. All these and many more causes need to be identified.
With difficulty to be honest! You must let your podiatrist see a good selection of your shoes. Frequently we can provide relief from the symptoms by padding, taping and some anti-inflammatories.
The basis of treatment is the biomechanical assessment to identify what goes on as you walk/run. Orthotics may be necessary, but current therapy is team-based, so I might send you to a Physiotherapist or Biokineticist for strengthening of other muscle groups in your body.
We talk of core strengthening, to improve posture and alignment above the lower limb. If the pain is at the back of the heel gentle stretching plus raising the heeel helps. Nearly always lifting and cushioning the heel gives some relief. Wearing a higher heeled shoe also helps sometimes.
Yes, but not always. If you can diagnose the problem yourself then stop doing what caused the PF. We often get heel pain on holiday after a day of sightseeing or playing on the beach or more likely shopping!
Never let your trainers get badly worn, especially if they bulge on the inner side. Keep your weight under control. If you know you are going to have to do a lot of standing or walking, consider wearing your more comfortable shoes and change into your fashionable ones later.
At the first sign of pain seek professional help and advice – a proper biomechanical examnation will identify whether plantar fasciitis is the problem. Remember the basic First Aid of treating any inflammation of the soft tissues of your feet.