Diabetic Peripheral Neuropathy

Diabetic peripheral neuropathy is multifaceted and does not only cause pain in the feet toes and hands, it will also cause an intense burning pain, numbness, tingling, and parasthesias to name only a few neurological symptoms that can lead to such disastrous ends. For this reason, it is especially important for the diabetic patient who routinely can experience nerve damage in their feet, to have his or her lower extremity nerves tested at least once a year. Screening with the mono-filament test that doctors have been using, is inaccurate and can give false results causing one to believe that there is no nerve damage while the diabetic patient is on the verge of physical disaster.

It is this type of insidious nerve damage in the diabetic that is responsible for the majority of the atraumatic amputations. Atraumatic amputation refers to that type of amputation that is not the result of an auto accident, or gunshot wound, etc. These amputations have usually very little to do with poor circulation. Poor circulation along with the loss of protective nerve sensation (peripheral neuropathy), certainly speeds up the probable.

Advanced Surgery Workshop

Dr. Neil L. Horsley completed the Advanced Surgery Workshop at the Institute for Peripheral Nerve Surgery. This intensive workshop was offered at the Johns Hopkins Medical Center in Baltimore, MD, December 12 – 14 2001.
The workshop is the brainchild of Dr. A. Lee Delon, Professor of Hand, Plastic and Neurosurgery. Dr. Delon developed the research, testing instruments and surgical techniques over the last 25 plus years.

However, nerve damage alone in the presence of excellent circulation can lead to atraumatic amputation. Why and how does this happen? Those high pressure areas on the bottoms of the feet where calluses form or those areas on the toes where corns form or where ingrown toenails exist, are the same areas that eventually break down and cause sores on the feet known as ulcerations.

Once the ulcer forms on the foot, the patient has an open porthole for bacteria to enter the body and potentially infect the bone. Once this happens, gangrene is not far away. The foot may be red, feel warm, swell and may ooze fluids while these infectious conditions are present.

There is a separately identifiable atraumatic amputation that is caused by poor circulation alone. These types of amputations caused by poor circulation are the usual results of smoking, hereditary vascular disease, poor dietary habits (such as greasy foods and a diet high in dietary fats and cholesterols), systemic conditions that have vascular problems and aging factors.

With poor circulation conditions the foot feels usually cool or cold and sometimes the skin color is dusky, gray or cyanotic (bluish). These circulatory conditions may be accompanied by the inability to walk more than a block before experiencing severe leg pain or cramping that is relieved by rest. If rest does not relieve the pain then the condition is very serious and requires vascular consultation immediately.

Diabetic peripheral neuropathy is reversible and when successful, can restore up to 100% of the normal nerve sensation. These surgical procedures are very precise and are designed to address those specific nerves that are directly related to the sensory changes.

The first step is the nerve testing. The Nerve Sensory Testing device is called the Pressure Specific Sensory Device (PSSD). It is a painless test that is done in a comfortable setting where you are completely relaxed.

It is important to stress that there is no pain involved concerning taking this test. The results of the test are then clinically correlated and a determination can be made to recommend the surgical procedures or other state of the art forms of currently used modes of therapy.

For more information on this subject, or to schedule an appointment with a footDrHorsley Podiatrist, please call (877) 372-6048

If you are experiencing any of the symptoms addressed, we strongly recommend that you seek the advice of your podiatrist for proper diagnosis.

Are You Still What You Eat?

Years ago a popular saying started to circulate the community to help stimulate your dietary conscience. The saying “You are what you eat” was intended to remind us that the proper balance of foods has always proven to help provide the essential nutrients for good nutrition and aid in a healthy lifestyle. Even though the saying is less popular now, does it still have its merits? How much does what goes in your mouth and digestive system determine how healthy you are or what ailments you might have to suffer from? Being overweight, inactive, and always starving yourself to lose weight is not such a good thing.

When I hear, “I get plenty of exercise at work” or “I’m so busy with the family and kids that I don’t have time to work out,” I know that this individual has needs major lifestyle overhaul.

Another frequent statement is, “I don’t eat much, and I don’t know where this extra couple of hundred pounds came from, -It must be a thyroid condition.” Well, very seldom is the problem with the thyroid! The problem is you. The junk you eat and swallow gets in your system and causes major health issues. What do you think that extra 50 – 200 pounds is doing to your feet? The feet are constructed to accept about 400 pounds of pressure per square inch during the walking process or “gait cycle”. You should see the x-rays of an overweight person and how the bones have had to adapt to the additional weight. I’ve seen multiple stress fractures, degenerative joint disease and bone spurs as a result.

People forget to increase their shoe size and width to accompany all that extra weight. They keep on wearing that size 8 medium shoe on a size 9.5 or 10 wide foot. Keep in mind that the average difference from a size 8 to a size 9 pair of shoes is only about 1/4 inch! So it’s easy to squeeze into that too small shoe in the morning but find that later that evening, if it takes that long, the foot is too swollen to fit comfortably. So they either squeeze into the too small shoe, which can cause obvious damage or just take the shoes off and carry them to the car and back home.

People are able to eat virtually anything to survive. We can adapt to most any environment and eat those foods common to that region of the world. In Alaska the Native Americans ate whale and blubber as their main dietary entrèe. Other parts of the world with warmer climates eat more vegetables, fruits, and nuts, tubular and berries to stay healthy. My concern is that other people in some parts of America have such unhealthy eating habits that they are at a higher risk of type 2 diabetes, hypertension, obesity, poor circulation and tooth decay. These poor eating habits are passed on from generation to generation along with the ailments they may cause. You may add on excessive tobacco and alcohol consumption to complicate matters.

Even in countries with low occurrence of cardiac problems (heart attacks), minimal hardening of the arteries and normal blood pressures can fall prey to the all American diet of fast foods and no exercise thereby increasing health risks. Studies show that when American fast food restaurants show up in foreign countries, so do the health problems. Do the math!

Sure your grandparents smoked tobacco, ate pork and lived to get almost 100 years old. But you are not your grandparents and times have changed. Now we have genetically modified foods that are larger, yield a greater harvest and last longer on the shelves or in the coolers. Did you know that some tomatoes have DNA from pigs added to make them grow larger and plumper?

Try eating foods that are not genetically altered and not bleached like white rice and white flower. Eat more natural rice and flowers that still are fresh with the natural oils and nutrients still in them. What about the five fruits a day theory? Do you eat a salad at lunch and dinner? Why do we like to cook the life out of our vegetables before serving them? Eat to live, don’t live to eat!

A variety of recipes is available in our LifeStyles @ footDrHorsley section for you to try at home to help provide a balance to our meat and potato diets that we rush home to after work.

Feel free to submit your favorite recipes and we will publish them on our web site. Break the food chains that enslave you and keep you taking multiple medications to reverse the effects of poor eating habits. To your medical doctor who treats your high blood pressure, type 2 diabetes, blurred vision, headaches, colon and breast cancer, heartburn, obesity, etc., with prescription medications: what’s in your body system? How healthy are you? Do you lead by example or just eat “whatever” and take the same pills you give to your patients?

Get a check up and begin a daily exercise program. Try walking a mile or two and drinking plenty of water. So many people are functionally dehydrated. Coffee, juice, tea, Gatorade™ and cool-aid requires the bodies own water to be digested. Those liquids actually dehydrate you! Here’s how much water you should drink daily; divide your body weight in half and change the pounds to ounces. Therefore if you weigh 160 pounds divide by 2 and you get 80 pounds. Change the pounds to ounces and you should be drinking 80 ounces of water a day. It’s that simple. 80 ounces is about 2 1/2 quarts. Do the math! Drink up! News flash: the human body needs water to function properly. Drink up!

If You Have Diabetes

The following recommendations will help in your fight against diabetes:

  1. Wash feet daily.
    Using mild soap and lukewarm water, wash your feet in the mornings or before bed each evening. Dry carefully with a soft towel, especially between the toes, and dust your feet with talcum powder to wick away moisture. If the skin is dry, use a good moisturizing cream daily, but avoid getting it between the toes.
  2. Inspect feet and toes daily.
    Check your feet every day for cuts, bruises, sores or changes to the toenails, such as thickening or discoloration. If age or other factors hamper self-inspection, ask someone to help you, or use a mirror.
  3. Lose weight
    People with diabetes are commonly overweight, which nearly doubles the risk of complications.
  4. Wear thick, soft socks.
    Socks made of an acrylic blend are well suited, but avoid mended socks or those with seams, which could rub to cause blisters or other skin injuries.
  5. Stop smoking.
    Tobacco can contribute to circulatory problems, which can be especially troublesome in patients with diabetes.
  6. Cut toenails straight across.
    Never cut into the cornets, or taper, which could trigger an ingrown toenail. Use an emery board to gently file away sharp corners or snags. If your nails are hard to trim, ask your podiatrist for assistance.
  7. Exercise.
    As a means to keep weight down and improve circulation, walking is one of the best all-round exercises for the diabetic patient. Walking is also an excellent conditioner for your feet. Be sure to wear appropriate athletic shoes when exercising. Ask your podiatric physician what’s best for you.
  8. See your podiatric Physician.
    Regular checkups by your podiatric physician-at least annually-are the best way to ensure that your feet remain healthy.
  9. Be properly measured and fitted every time you buy new shoes.
    Shoes are of supreme importance to diabetes sufferers because poorly fitted shoes are involved in as many as half of the problems that lead to amputations. Because foot size and shape may change over time, everyone should have their feet measured by an experienced shoe fitter whenever they buy a new pair of shoes.

    New shoes should be comfortable at the time they’re purchased and should not require a “break-in” period, though it’s a good idea to wear them for short periods of time at first. Shoes should have leather or canvas upper, fit both the length and width of the foot, and leave room for toes to wiggle freely, and be cushioned and sturdy.

  10. Don’t go barefoot.
    Not even in your own home. Barefoot walking outside is particularly dangerous because of the possibility of cuts, falls, and infection. When at home, wear slippers. Never go barefoot.
  11. Don’t wear high heels, sandals and shoes with pointed toes.
    Those types of footwear can put undue pressure on parts of the foot and contribute to bone and joint disorders, as well as diabetic ulcers. In addition, open toed shoes and sandals with straps between the first two toes should also be avoided.
  12. Don’t drink in excess.
    Alcohol can contribute to neuropathy (nerve damage), which is one of the consequences of diabetes. Drinking can speed up the damage associated with the disease, deaden more nerves, and increase the possibility of overlooking a seemingly minor cut or injury.
  13. Don’t wear anything that is too tight around the legs.
    Panty hose, panty girdles, thigh-highs or knee-highs can constrict circulation to your legs and feet, so can men’s dress socks if the elastic is too tight.
  14. Never try to remove calluses, corns or warts by yourself.
    Commercial, over-the-counter preparations that remove warts or corns should be avoided because they can burn the skin and cause irreplaceable damage to the foot of a diabetic sufferer. Never try to cut calluses with a razor blade or any other instrument because the risk of cutting yourself is too high, and such wounds can often lead to more serious ulcers and lacerations. See your podiatric physician for assistance in these cases.

Bunions / Bunionectomy

The photographs below are of the left foot before and after a bunionectomy.

Before Bunionectomy Five (5) days after Bunionectomy Four (4) weeks after Bunionectomy Slideshow
Before Bunionectomy Before Bunionectomy Five (5) days after Bunionectomy Four (4) weeks after Bunionectomy
Four (4) weeks after Bunionectomy
Five (5) days after Bunionectomy
Before Bunionectomy
Before Bunionectomy

Bunions / Bunionectomy

A bunion is a deformity that usually occurs at the head of the first of five long bones (the metatarsal bones) that extend from the arch and connect to the toes.

The first metatarsal bone is the one that attaches to the big toe. The big toe is forced in toward the rest of the toes, causing the head of the first metatarsal bone to jut out and rub against the side of the shoe; the underlying tissue becomes inflamed and a painful bump forms.

As this bony growth develops, the bunion is formed as the big toe is forced to grow at an increasing angle towards the rest of the toes.

A bunion may also develop in the bone that joins the little toe to the foot (the fifth metatarsal bone), in which case it is known as a bunionette or tailor’s bunion.

Bunions often develop from wearing narrow, high-heeled shoes with pointed toes, which puts enormous pressure on the front of the foot and causes the foot and toes to rest at unnatural angles.

Injury in the joint may also cause a bunion to develop over time. Genetics play a factor in 10% to 15% of all bunion problems; one inherited deformity, hallux valgus, causes the bone and joint of the big toe to shift and grow inward, so that the second toe crosses over it. Flat feet, gout, and arthritis increase the risk for bunions.

Bunion FAQs

What is a Bunion?

A bunion is a bulge on the inside of the foot at the base of the big toe joint. It forms when the bone at the big toe joint moves out of place, forcing the big toe to move towards the smaller ones. A Bunionette or Tailor’s Bunion is another type of bunion that occurs on the outside of the foot at the base of the little toe. Common symptoms associated with a bunion are swelling, redness, corns, overlapping toes, restrictive motion, and pain.

What causes Bunions?

Most commonly experienced by women, bunions are bought about by years of abnormal foot function and pressure over the joint. Certain foot types (i.e. flat feet) are more prone to bunions, as well as foot injuries, the way we walk, and the shoes we wear. Many women wear dress shoes that are too small and narrow for their foot type. This causes the foot to take on the shape of the shoes, and forces the metatarsophalangeal (MTP) joint to stick out on the side of the foot.

A bunion happens when the long bone behind your big toe, first metatarsal, begins to shift away from the foot and the big toe begins to move toward the other toes. Genetics play a role in the development of bunions. Many people do not have discomfort until they are in improperly fitting shoes. Although it may seem that the shoe caused the bunion problem, an individual is usually predisposed to this condition by hereditary factors or abnormal foot function. Over time, bunions tend to get worse.

A Tailor’s bunion, also sometimes referred as a bunionette, is very similar to a bunion. While the bunion is located relative to the big toe, the bunionette affects the long bone behind the little toe.

What treatments are available?

For relief of pain caused by a bunion, the following treatments are usually recommended:

  • Wear shoes that fit properly
  • Apply ice packs daily to reduce swelling
  • Soak your feet in warm water
  • Use non-medicated foot products such as bunion pads, night splints, shields, and bandages
  • Ultrasound therapy
  • Cortisone injections
  • Orthotics
  • A bunionectomy may be necessary in severe cases

Treatment for bunion pains should be discussed with your podiatrist. Many times, conservative measures include changing to wider shoes, orthotics, or paddings to relieve the pressure. Your podiatrist can also discuss surgical options in many instances to correct the bunion deformity.

Treatment should be based on relief of pain and a quick return to your activities of daily living. In the evaluation of your bunion, your podiatrist will evaluate the big toe joint and x-rays to examine the bones associated with the area.

The purpose of this article is to educate and not replace the advise of a medical professional. If you should have any questions, please seek the assistance of a podiatrist or other health professional that will be able to further the discussion and recommend appropriate interventions.

If you are experiencing any of the symptoms addressed, we strongly recommend that you seek the advice of your podiatrist for proper diagnosis.

Grandma’s Potato Salad

Ingredients

  • 2 pounds clean, scrubbed new red potatoes
  • 6 eggs
  • 1 onion, finely chopped
  • 1 stalk celery, finely chopped
  • 1 cups miracle whip
  • 1/2 cup mustard
  • 1/2 cup sweet relish
  • Salt, pepper and hot sauce to taste

Directions

  1. Bring a large pot of salted water to a boil. Add potatoes and cook until tender but still firm, about 15 minutes. Drain and set in the refrigerator to cool.
  2. Place eggs in a saucepan and cover with cold water. Bring water to a boil and immediately remove from heat. Cover and let eggs stand in hot water for 10 to 12 minutes. Remove from hot water, cool, peel and chop.
  3. Chop the cooled potatoes, leaving skin on. Add to a large bowl, along with the eggs, onion, celery, miracle whip, mustard and relish. Add, hot sauce, salt and pepper to taste. Chill for an hour before serving.

Mmmmm, mmmmm, mmmmm…

Delicious Black Bean Dip

Ingredients

  • Vegetable cooking spray
  • 1/2 cup thinly sliced green onions
  • 1-2 cloves garlic, minced
  • 1 can (15 ounces) black beans, drained
  • 3/4 cup (3 ounces) shredded reduced-fat Cheddar cheese
  • 1/4 teaspoon salt
  • 1/3 cup vegetable broth or water
  • 1-2 tablespoons finely chopped cilantro

Directions

  1. Spray small skillet with cooking spray
  2. heat over medium heat until hot.
  3. Saute onions and garlic until tender, about 3 minutes.
  4. Process black beans, cheese, and salt in food processor or blender until almost smooth, adding enough broth to make desired dipping consistency.
  5. Mix in onion mixture and cilantro.

Serve with tortilla chips

Nerve Testing

Nerve Testing is not new. What is new is whether nerve damage can be reversed. Can the damaged nerve be restored to its normal function and the foot sensations be restored to normal? This has tremendous implications, especially for diabetics who suffer with the nerve damage called diabetic peripheral neuropathy. Others who can benefit from this type of testing include, those who suffer from tarsal tunnel syndrome (TTS), heel pain, deep puncture wounds, crush injuries, among other ailments.

The number one cause for amputation for the diabetic patient is not poor circulation. Rather, diabetic peripheral neuropathy causes the eventual damage to the tissues and that eventually leads to amputation. Poor circulation could be coincidental, but amputations in this population usually can occur even with a good vascular supply.

Dr. A. Lee Dellon, a professor of plastics and neuro-surgery at Johns Hopkins University Medical School, developed the research and the state of the art testing equipment that is designed to test quantitatively for nerve sensory loss. He also developed the surgical techniques and procedures designed to decompress the nerves (damaged) involved and ultimately reverse the loss of sensation, in about 85% of the cases.

Drs. Neil and Barton Horsley have studied under Dr. Dellon at the Institute for peripheral Nerve Surgery at Johns Hopkins in Baltimore. Drs. Neil and Barton Horsley and their technicians have been certified to conduct the necessary tests and have brought the testing equipment to Chicago. This will allow them to identify those patients who are affected by the nerve damage associated with the various medical conditions, especially those patients who are suffering with diabetes mellitus. The nerve testing equipment is called the Pressure Sensitive Sensory Device (PSSD).

The testing device (PSSD) has been approved by the FDA and the American Diabetic Association recommends that the test be performed on the diabetic patient at least once a year. Test results along with clinical correlation gives an accurate picture of the extent of nerve damage, and Drs. Neil and Barton Horsley can determine whether the patient is a candidate for the procedure(s). After the procedure is performed, some patients report that sensation has returned within a week of the procedure.

The testing equipment (PSSD) is also a useful tool for monitoring the patient after healing has occurred over the post operative period. Therefore the patient will typically be scheduled for periodicals.

This testing and surgical procedure is new and innovative. The research is well documented and can be searched using the Index Medicus at most libraries that have a link to medical schools.

Very soon, footDrHorsley will be adding testing centers in the offices of Drs. Victor L. Horsley and Barton Horsley, effectively offering this very valuable service to a large portion of the mid-west population.

If you have numbness, tingling or burning to your feet, sometimes associated with pain, you may be experiencing some from of peripheral neuropathy (nerve damage). The first step to reversing this condition is to call and schedule an appointment. The test is painless and can be done in the comfort of an office or clinical setting. After completing the test, a consultation is scheduled with Drs. Neil, Victor or Barton Horsley to review the test results and to determine whether you are a candidate for these procedures.

Contact Information for Nerve Testing

In Chicago, call the Center for Wound Care at Michael Reese Hospital, (312) 791-5703 and ask to speak with Lori.

In Detroit call (248) 559-5200, and ask to speak with Dr. Barton Horsley.

In St. Louis, Missouri and Belleville, Illinois, call (618) 222-1986, or Toll Free at (877) 372-6048 and ask to speak with Dr. Victor L. Horsley.

If you are experiencing any of the symptoms addressed, we strongly recommend that you seek the advice of your podiatrist for proper diagnosis.

Heel Pain

Heel pain is a vague term that describes pain located in the back, sides, or bottom of one’s feet. One of the more common types of heel pain occurs in the bottom of the foot. The pain isworse after periods of rest. Some even state that they feel like they are walking on a stone. This commonly caused by a process known as plantar fasciitis.

Within this process, the bottom of the feet may hurt upon standing. This pain is usually located at the bottom inside part of the heel. It may actually gradually get better after walking; but after a period of rest or extended periods of activity, the pain is once again felt.

The plantar fascia is a ligamentous structure that originates on your heel bone and fans out and inserts into the toes. The purpose of the plantar fascia is to hold the muscles of the foot in close relationship to the bones and also to provide some support in the arch of the foot. When the toes move upward against the foot, the plantar fascia stretches taught and pulls the heel bone closer to the ball of the foot. This is the mechanism that that provides the arch support.

Plantar fasciitis is most often caused by improper mechanics of the foot. The three fascial bands may encounter swelling or micro tears causing an inflammatory response and the associated pain people relate.

Many people have referred to this entire process as heel spurs. At times, there can be a heel spur present with plantar fasciitis. The heel spur is not the problem but rather a result of the problem. It forms because of the pulling of the plantar fascia. There are people who have heel pain without the presence of a heel spur. Conversely, there are people who have heel spur present, without heel pain.

If you have heel pain, a podiatric physician should evaluate you. While the explanation of the problem is very helpful, the doctor will need to feel all of the structures around the heel and possibly take x-rays to confirm the diagnosis and look for the presence of a heel spur.

After a history and physical, your podiatrist will be able to discuss the problem and treatments with you. Some of the treatments are aimed at relieving the symptoms while others are aimed at controlling how your feet move and function while walking. There are even times when your doctor might suggest surgical intervention for this problem.

The purpose of this newsletter is to educate and not replace the advise of a medical professional. If you should have any questions, please seek the assistance of a podiatrist or other health professional that will be able to further the discussion and recommend appropriate interventions.

If you are experiencing any of the symptoms addressed, we strongly recommend that you seek the advice of your podiatrist for proper diagnosis.

Red Beans And Brown Rice

Ingredients

  • 1/2 cup uncooked brown rice
  • 1 cup chopped onion
  • 1/2 cup diced celery
  • 1/2 cup diced green bell pepper
  • One 15-ounce can dark red kidney beans, undrained
  • 1/4 teaspoon hot pepper sauce
  • 1/8 teaspoon freshly ground pepper

Directions

  1. In a small pot, bring 1-1/2 cups water to a boil and then add rice
  2. Cover and simmer until rice is rice is done, about 30 minutes.
  3. Set aside.
  4. In a large skillet, cook the onion, celery, and green pepper over low heat, about 10 minutes.
  5. Add the undrained canned beans, pepper sauce, and ground pepper.
  6. Bring to a boil
  7. Cover and simmer 5 minutes.
  8. Add the cooked rice and mix lightly, adding a little water if the mixture is too dry.

The Effects of Tobacco on Your Feet

As many people now know, the use of tobacco products can be detrimental to your health. Many people understand the vast number of respiratory ailments, ranging from emphysema to lung disease and cancer can occur as a result of smoking tobacco. Does anyone understand that smoking can also affect your feet?

One of many ingredients in tobacco is nicotine. Nicotine is believed to have many effects in the human body, both positive and negative. As any smoker will attest, nicotine has a calming effect. Many scientists are researching the effects of nicotine on the human body. Nicotine and its derivatives have been studied for its potential beneficial role in patients with Parkinson’s disease and decreased attention span. Much of the literature clearly states that it is the nicotine receptors in our brain that need this purified nicotine or an analogue. The nicotine from tobacco does not provide this benefit.

The immediate effects of nicotine on the body include:

  • Increase in blood pressure
  • Increase in heart rate
  • Thickening of blood
  • Narrowing of arteries
  • Decrease in skin temperature
  • Increase in respiration
  • Vomiting, and
  • Diarrhea

Long term effects of nicotine on the body include:

  • Blockage of blood vessels, thus a slower heartbeat than a non-smoker’s at rest
  • Depletion of vitamin C
  • Reduction in the effectiveness of the immune system – making it harder to fight off dangerous infections
  • Cancer of the mouth; throat; and lungs
  • Cancer of the upper respiratory tract
  • Hurting physical fitness in terms of performance and endurance
  • Bronchitis and/or emphysema
  • Stomach ulcers
  • Weight loss
  • Dryness and wrinkling of skin, often times giving the skin a leathery appearance
  • Production of abnormal sperm, causing birth defects

Of importance in this discussion is the effect that nicotine has on your arteries, the blood vessels that carry blood away from your heart.

Nicotine has an effect on the sympathetic nervous system (part of the nervous system involved in the classic “fight or flight” response); part of this effect is to cause the blood vessels within the body to constrict. Since, hopefully, the same amount of blood is still going through the body, this results in a net increase in the pressure within the system (think of what happens when you squeeze a garden hose). Why is it bad? The increase in pressure has to come from somewhere, and that’s the heart that is trying to pump against this. Also, higher pressure can lead the “blowing up” of blood vessels, called aneurysms (think again of that garden hose and what happens if you hold it bent for too long).

As we all age, there are plaques building up on the inside walls of our arteries. Some people have this peripheral vascular disease (PVD). It is commonly recognized in the hands and feet because these are the points farthest away from the heart where the blood vessels are the smallest.

This PVD in combination with the effects of nicotine can lead to a painful lack of blood flow to our feet. Our skin is a living organ, which means it needs to have nourishment to remain healthy. The arteries are the conduits to bring that nourishment to all aspects of our body.

People relate to sharp, deep stabbing pains. Some people even relate to having very painful ulcerations, or openings in their skin. When ulcerations occur, it can sometimes be very difficult and time consuming for the skin to heal. When there is an opening in the skin, an infection can begin and spread throughout the human body, which can ultimately lead to amputation or even death in the worst cases. Appropriate wound care should be initiated after a thorough examination has taken place.

Smoking can play a vital role in your everyday health as well as in the health of your feet. As you know, your feet are important. They get you to the many places you have to go. Be wise, take care of your feet, and see your podiatrist.

The following are just a few of the thousands of links regarding tobacco:

If you are experiencing any of the symptoms addressed, we strongly recommend that you seek the advice of your podiatrist for proper diagnosis.