Author: footDrHorsley

Diabetes Self Management

footDrHorsley Focus on Diabetes

Diabetes is a very serious disease which may cause damage to the blood vessels and nerves leading to the brain, eyes, heart, kidneys, toes and feet.

You the patient, are the most important person to manage your diabetes.
footDrHorsley will guide you and offer support as you manage your diabetes.
The following goals will help you gain and maintain diabetic control to reduce damage to your blood vessels and nerves.

Goals & Objectives

  1. I will work hard to keep my HbA1c below 7
  2. I will exercise (walk) 30 minutes _____ days per week.
    If I notice chest pain, shortness if breath or chest tightness, I will seek medical attention.
  3. I will check my feet daily. If I notice a sore or irritation I will seek medical attention.
    I will visit the Podiatrist yearly, or as instructed.
  4. I will follow my diabetic and low fat diet to reduce my blood sugar and cholesterol
  5. I will try to obtain my ideal body weight.
    I will lose _____ pounds by my next office visit.
  6. I will take a baby aspirin or enteric coated aspirin every day.
  7. I will stop smoking.
  8. I will have an eye exam every year or as indicated.
  9. I will check my blood sugar as instructed and will call if the results are consistently below 70 or above 180.
  10. I will talk about how I feel about having diabetes to family, friends, & or chaplain. I will attend a Diabetes Support Group.

Diabetic Ulcers

footDrHorsley Focus on Diabetes, Foot Health

Non-traumatic lower extremity amputation most often occurs as a result of a diabetic foot problem, skin ulcers. The development of skin ulcerations on a patient with diabetes can be caused by any number of things. Some include, pressure from poorly fitted shoes and trauma to the foot and toes. Patients with Peripheral Neuropathy are more likely to develop ulcers because they have loss the sensation in their feet. Most times they will simply notice stains on their socks and footwear.

Unfortunately, even those diabetic patients who take all the proper steps in maintaining their foot care can still get an ulcer. An ulcer is the primary opening for infection that can affect both the soft tissue and the bone. It is very important to stay off your feet once you notice your ulcer. Continuing to walk on it will cause the infection to spread and penetrate deeper into your foot. Delayed treatment of diabetic ulcers can lead to amputation and even mortality

Debridement of the wound is the first steps in treating this condition. Thick layers of skin (corns and calluses), which should be carefully removed until a satisfactory border is present, may cover ulcers. Your podiatrist may require that you wear special footwear, have a culture done, or get x-rays.

Additional treatments for ulcers other than local wound care include hyperbaric oxygen (HBO), growth factors, and electrical stimulation. Even after successful treatment, there is a very high probability of reoccurrence. Continue to thoroughly inspect your feet and see your podiatrist on a regular basis.

Dr. Horsley recommends that all diabetics:

  1. Become educated on diabetic foot care
  2. Wash and dry feet thoroughly
  3. Inspect your feet daily (or have someone else do it for you)
  4. Wear properly fitting shoes
  5. Wear seamless socks
  6. Do NOT walk around barefoot
  7. Visit your podiatrist regularly

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

Startling Statistics

footDrHorsley Focus on Diabetes

Diabetes mellitus is a chronic disease that affects the lives of about 16 million people in the United States, 5.4 million of whom are unaware that they even have the disease. Every day, 2,200 new cases of diabetes are diagnosed, and an estimated 780,000 new cases are identified each year. The disease is marked by the inability to manufacture or properly use insulin, and impairs the body's ability to convert sugars, starches and other foods into energy. The long-term effects of elevated blood sugar (hyperglycemia) are damage to the eyes, heart, feet, kidneys, nerves and blood vessels.

Symptoms of hyperglycemia may include frequent urination, excessive thirst, extreme hunger, unexplained weight loss, tingling or numbness of the feet or hands, blurred vision, fatigue, slow-to-heal wounds, and susceptibility to certain infections. People who have any of these symptoms and have not been tested for diabetes are putting themselves at considerable risk and should see a physician without delay.

Part of keeping your diabetes in control is testing your blood sugar often. Ask your doctor how often you should test, and what your blood sugar levels should be. Testing your blood and then treating high blood sugar early will help your to prevent complications.

The socioeconomic costs of diabetes are enormous. The costs have been estimated at $98 billion annually, about $44 billion of which are direct costs from the disease with $54 billion indirectly related. Diabetes is the sixth leading cause of death by disease in the United States, and individuals with diabetes are two to four times as likely to experience heart disease and stroke.

The growth of the disease worldwide is especially alarming. The World Health Organization (WHO) expects the number of new diabetes cases to double in the next 25 years from 135 million to nearly 300 million. Much of this growth will occur in developing countries where aging, unhealthy diets, obesity, and sedentary lifestyles will contribute to the onset of the disease.

  • According to the recent survey, about 86,000 lower limbs are amputated annually due to complications from diabetes.
  • Diabetes is the leading cause of end-stage kidney disease, accounting for about 40 percent of new cases.
  • Diabetes is the leading cause of new cases of blindness among adults, age 20 and 74.

While there is no cure for diabetes, there is hope. With a proper diet, exercise, medical care, and careful management at home, a person with diabetes can keep the most serious of the consequences at bay and enjoy a long, full life.

Calluses

footDrHorsley Foot Health

What is a Callus?

Calluses develop from a buildup of dead skin cells that become thick and hard on the foot. Usually found on either the heel, the ball of the foot, or inside the big toe, calluses develop as a result of excessive rubbing and pressure. Calluses that have a deep-seated core known as a nucleation are called Intractable Plantar Keratosis.

What causes Calluses?

Some of the most common reasons people develop calluses are:

  • Obesity
  • Deterioration of the fat pad located on the bottom of the foot
  • Wearing high heeled shoes
  • Wearing shoes that do not fit properly
  • Flat feet
  • High arched feet

What treatments are available?
When treating a callused foot, do not cut or trim them with a razor blade. This will only make the condition worses and is particularly dangerous for those with diabetes. The best thing to do is wear an orthotic that has been fitted for you by your podiatrist. They will redistribute your weight to relive the pressure being placed on your callus.

If you are experiencing swelling, inflammation, discharge, or pain, your toenail is probably infected and you should seek the treatment of a podiatrist. He or she may trim or remove the infected nail with a minor surgical procedure.

How Does One Get Diabetes

footDrHorsley Focus on Diabetes

No one knows why people develop diabetes, but once diagnosed, the disease is present for life. It is a hereditary disorder, and certain genetic indicators are known to increase the risk of developing diabetes. Type 1, previously known as insulin-dependent diabetes mellitus or juvenile-onset diabetes, afflicts five to ten percent of diagnosed cases of diabetes. This type occurs most frequently in children and adolescents, and is caused by the inability of the pancreas to produce the insulin needed for survival. Type 2, previously called non-insulin-dependent diabetes mellitus or adult-onset diabetes, affects the other 90-95 percent of all diagnosed cases of diabetes, many of whom use oral medication or injectable insulin to control the disease. The vast majority of those people (80 percent or more) are overweight; many of them obese as obesity itself can cause insulin resistance.

Certain characteristics put people at a higher risk for developing Type 2 diabetes.
These include:

  1. A family history of the disease
  2. Obesity
  3. Prior history of developing diabetes while pregnant
  4. Being over the age of 40
  5. Being a member of one of the following ethnic groups:
    • African American
    • Native American
    • Latino American
    • Asian American
    • Pacific Islander
  6. African Americans are 1.7 times more likely to have diabetes than the general population, with 25 percent of African Americans between the ages of 65 and 74 diagnosed with the disease.
  7. Hispanic Americans are almost twice as likely to develop type 2 diabetes, which affects 10.6 percent of that population group.
  8. Native Americans are at a significantly increased risk for developing diabetes and 12.2 percent of the population suffers from the disease. In some tribes, as many as 50 percent of its members have diabetes.

Of all the risk factors, weight is the most important, with more that 80 percent of diabetes sufferers classified as overweight.

Plantar Fibromatosis

footDrHorsley Foot Health

Plantar Fibromatosis is a common soft tissue mass found in the foot and one of the most common lesions found on the sole of the foot. It is a locally aggressive idiopathic proliferative fasciitis of the plantar aponeurosis or subcutaneous thickening of the plantar fascia. It is usually bilateral and frequently seen in children and young adults. In older people it is often associated with Dupuytren's contracture of the palmar fascia of the hand. The basic microscopic pathology of Dupuytren's contracture and plantar fibromas is about the same. The causes are obscure, but trauma does not play an important role. The disease usually occurs in adult males after 40 years. A relatively small number of cases are bilateral. Whether these tumors are familial is not clear, although cases have been recorded in multiple members of a family. Compared with palmar fibromatosis, the plantar variety is rare, although the exact incidence is not known, since a large number of theses cases are not reported. The lesion was described by Dupuytren, and later it was described in more detail by Ledderhose.

In Allen and Woolner's series of 69 cases, 35% were 30 years of age or younger, including two cases that were present at birth. Among 200 consecutive cases, which were reviewed at the Armed Forces Institute of Pathology between 1960 and 1978, 111 (55%) occurred in patients 30 years or younger. Of the 11 cases, 22 were children 10 years or younger. Aviles et al., reported that 77% of their cases were encountered in patients older than 45 years. Zamora et al., Journal of Hand Surgery, 1994 showed that there is an increase in transforming growth factor beta in the early phase of Dupuytren's contracture and Plantar Fibromatosis.

As far as clinical findings are concerned, the lesion (plantar fibroma) appears as a firm, single, subcutaneous thickening or nodule that adheres to the skin and is located in the middle and medial portion of the sole of the foot. It may be asymptomatic, but it may cause mild pain after long standing or walking.

Locke has classified plantar fibromatosis as proliferative(increased fibroblasts and cellular activity), active(nodules are formed), and residual(decreased fibroblastic activity).

One should consider surgery if there is pain and a change in the course of the lesion (increase in size, contracture).

Surgical incisions may be linear, S-shaped or zig-zag. The surgeon needs to perform a wide excision of the mass. The patient should try to remain non-weight bearing for 3 weeks if possible.

Some complications are recurrence, nerve entrapment, skin slough, scarring, hematoma, and arch fatigue. Simple excision appears to be a poor method of treatment. Allen et al. noted recurrences in 15 of 28 patients treated by simple excision. Patients who underwent local excision had a 57% incidence of recurrence at the excision site, whereas those who underwent side excision (fasciectomy) with or without skin graft had a more favorable result (8% recurrence).

Mallet Toes

footDrHorsley Foot Health

What are mallet toes?

A mallet toe occurs when the tip of the toe functions in a non-straightened manner. The tip of the toe is pointed down toward the sole of the shoe causing pain, discomfort and sometimes an infection. These infections are of major importance to the diabetic foot which is at a higher risk for abscess ulcerations, osteomyelitis (bone infection) and digital amputations.

It is very common to have a corn on the tip or top of a mallet toe due to rubbing against the sole and/or top of the shoe. The corn (hyperkeratotic lesion) is hard lifeless tissue which is discolored and looks bad.
This deformity alone has caused embarrassment when others see it sticking out like a "sore thumb". Sometimes a circular, light, hypo pigmented spot appears from the toe and shoe friction while other times a circular, dark, hyper pigmented spot discolors the skin on the toe. Changes in skin color can be permanent with a mallet toe deformity when left untreated.

Several other factors can lead to a good mallet toe going bad. Poor circulation, diabetes, edema (swelling) and non-leather shoes are examples of conditions that endanger the well being of a mallet toe. Complicating factors will produce sores on a mallet toe with puss, infection and drainage. Sometimes this scenario makes the toe begin to swell to almost twice its normal size, putting pressure on the surrounding toes causing those toes to be affected with lesions, sores, abscessed ulcerations and swelling too. Aching toes will alter ones walking pattern (gait cycle) and a cane or crutch could possibly be needed. Sometimes a lot of pain is present while other times absolutely no pain or discomfort is noticed because of nerve damage, decreased sensations in the feet from possibly a stroke or diabetes.

Most recently, sensory disorders in a patient's foot were caused by a closed head injury incurred during a snowmobile accident. Hemi paralysis of his right side required physical therapy to help regain function of his entire right side. Hard work and determination resulted favorable results for use and function of his right arm and lower extremity but the nerve damage is taking a long time to return to normal.

He decided to join some friends on a week long ski trip where he took beginner ski lessons and was able to manage this task quite well. The trip was uneventful, safe and he had a lot of fun on the slopes. Upon return he noticed some drainage from his second toe right foot coming from the side of his toenail. The toe was red and slightly swollen at the tip and around the eponychium (cuticle). The nail was partially detached and loose. His mallet toe deformity was exacerbated from the friction of his ski boot and he was unable to feel the pain secondary to the nerve damage existing in his foot and leg.

Without anesthesia, I removed the offending portion of his nail and had him soak his foot twice a day. No antibiotics were given and a week later the redness and infection were gone.

What causes a mallet toe?

Often times the bones and muscles in the toes are imbalanced causing mallet toes. You are more likely to develop mallet toes if you:

  • Are on your feet for the majority of the day
  • Participate in sporting activities on a regular basis
  • Already suffer from arthritis
  • Have nerve damage to your back, leg or foot
  • Have too high of an arch or very flat feet
  • Wear shoes that "just fit" or are too small
  • Have a toe deformity from birth

Some conservative treatments you could try are:

  • Wearing shoes with a large toe box
  • Toe crest or buttress pad
  • Gel toe shields and /or caps

Some surgical treatments your Podiatrist could try are:

  • Arthroplasty or partial bone/joint removal
  • Joint fusions in the toe
  • Flexor tenotomy or lengthening (spelling)
  • Amputation of the tip of the toe

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

Rice Varieties

footDrHorsley Cook Book Recipes

Ever thought about breaking away from the more traditional white rice? To make the recipes we suggest more interesting, we recommend experimenting with different varieties of rice to find the one right for you.
Here are several types you may consider trying:

  • Basmati

    This aromatic rice (tastes and smells like nuts or popcorn) is native to Pakistan and India. Its grains are dry, long and fluffy.

  • Black Japonica

    A spicy combination of Japanese short grain black and medium grain mahogany rice. Usually used to stir-fry.

  • Brown Rice

    Only means the husks have not been removed. The bran layers are still on the rice, making it very rich in vitamins and minerals. It has a chewy consistency and nut-like flavor.

  • Jasmine

    Grown in the U.S.A. and Thailand, this aromatic rice has a moist consistency and tends to cling together.

  • Texmati

    This is an aromatic rice that is a cross between U.S.A. grown long grain and white or brown basmati.

  • Wehani

    Another aromatic rice that has an unusual rust-colored bran that changes to mahogany when cooked.

  • Wild Pecan

    Grown in Louisiana, this rice is popular because of its pecan flavor.

Eggplant Parmagian (Vegetarian Entree)

footDrHorsley Cook Book Recipes

Ingredients

  • 2 Medium eggplants sliced 1/4"
  • 3 Organic eggs scrambled in large bowl
  • 1 Jar Kirshner's Wheat germ
  • 2 one pound packs firm organic Tofu sliced thin
  • 2 large Onions sliced julienne style
  • 2 large Bell Peppers sliced julienne style
  • 2 pounds of sliced Mushrooms
  • Powdered Garlic to taste
  • Gaylord Spike to taste
  • Tamari sauce to taste
  • 4 pounds of Marinara sauce
  • Soy Cheeses (Mozzerella, Parmagian) or your favorite regular cheese
  • 3 Cookie sheets coated with very thin layer of olive oil

Directions

  1. Combine scrambled egg mixture with garlic, spike and tamari sauce and set aside
  2. Prepare a separate tray large enough to hold wheat germ and pour 1/2 jar of wheat germ in tray. Shake to spread wheat germ around.
  3. Coat eggplant slices with egg mixture and place slices on the wheat germ. Coat both sides of the slices.
  4. Place wheat germ coated slices on pre prepared cookie sheets.
  5. Bake slices in pre heated oven at 425 degrees for 1/2 hour, or until wheat germ coating begins to brown. Remove oven baked slices from cookie sheets and let cool.
  6. Sautee onions, peppers and mushrooms in large pan
  7. In a large casserole dish, arrange the following ingredients into 3 layers:
    • Eggplant
    • Onions, Peppers and Mushrooms
    • Tofu slices
    • Sauce
    • Cheese
  8. After combining ingredients in casserole, bake in 425 degree oven for 1/2 hour or until cheese browns on top.
  9. Serve over brown rice, noodles or as a sandwich

Make eight(8) servings

Breaded Tomatoes

footDrHorsley Cook Book Recipes

Ingredients

  • 2 large tomatoes
  • 2 tablespoons of bread crumbs
  • 2 tablespoons of Parmesan cheese
  • 1 tablespoon of margarine
  • 1 1/2 teaspoons of oregano
  • dash of pepper and garlic salt

Directions

  1. Remove the stems and cores form the tomatoes and cut them in half.
  2. Place them, cut side up, into a baking dish.
  3. Combine all other ingredients and sprinkle on top of the tomatoes.
  4. Bake for 15 mins. in a 375 degree oven.