Tuesday, January 27, 2015

Diabetes Deadlier than Cancer

iabetic Foot Disease Has Higher Death Rate than Most Cancers

Diabetes remains the 7th leading cause of death in the United States in 2010, with 69,071 death certificates listing it as the underlying cause of death, and a total of 234,051 death certificates listing diabetes as an underlying or contributing cause of death1. One of the common contributing causes of death in diabetes is a diabetic foot ulcer (DFU), and if left untreated could lead to lower extremity amputation (LEA). Five-year mortality rates after new-onset diabetic ulceration have been reported between 43% and 55% and up to 74% for patients with lower-extremity amputation2. These rates are higher than those for several types of cancer including prostate, breast, colon, and Hodgkin's disease.

Approximately 15% of all diabetic patients will get a foot ulcer in their life3. Foot ulcers occur due to lack of sensation to the foot. Peripheral neuropathy, another condition commonly found in diabetics, damages the nerves, impairing sensation to the foot. This allows injuries to go unnoticed, leading to infections and ulceration. Diabetic foot ulcers are extremely difficult to treat, and it would take months for the wound to heal and incidence of reoccurrence is high. In the U.S., approximately 67% of all lower extremity amputations occur in diabetics, and approximately 85% are preceded by a foot ulcer4.

What to do?

The key in stopping diabetic foot ulcers and possible amputations is to practice proper foot care and to control diabetes.

Foot care regimen:
  1. Wash feet regularly. Use a mild antibacterial soap and towel dry.
  2. Keep foot dry. Use antiperspirant powder when wearing shoes to keep your feet dry. Excess moisture can soften the skin, making it vulnerable to skin breaks and infections.
  3. Moisturize. A foot that is too dry is susceptible to skin cracks, moisturize with your favorite lotion.
  4. Cut nails carefully.

Daily Foot inspections:
  1. Look for cracks or scratches and treat immediately with an antibiotic ointment.
  2. Check for sensation on your foot. If there is decreased sensation than usual, immediately visit your doctor.
  3. From time to time, inspect the insides of your shoes if there is a pebble or anything protruding that could injure your foot.

Control Diabetes:
  1. Take medications regularly.
  2. Go on a diet. Control food consumption to prevent increase in blood sugar levels.
  3. Do not miss your doctor’s appointments/check-ups.

1 http://www.diabetes.org/diabetes-basics/statistics/?loc=db-slabnav#sthash.k3SPUfEL.dpuf

2 “Mortality Rates and Diabetic Foot Ulcers” in Journal of the American Podiatric Medical Association, Vol 98, No 6, November/December 2008

3 National Diabetes Data Group: Diabetes in America, Vol. 2. Bethesda, MD, National Institutes of Health 1995 (NIH publ. no. 95-1468)

4 Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation: basis for prevention. Diabetes Care 1990;13:513--21.

Monday, January 26, 2015

Michelle Yeoh with bad bunions

Michelle Yeoh’s #Bunions and  #Corns

I remember as a child watching Michelle Yeoh doing kung fu movies along side Jackie Chan, etc. She needs a minimally invasive bunionectomy bad before she gets major arthritis in her big toe joint then forget the high heel after a fusion.  Fusion is when the big toe joint or any joint for that matter is locked via plates and screws by a surgeon to limit motion, restore anatomy as well as remove diseased tissue.  

Malaysian-born Chinese actress Michelle Yeoh, popularly known for performing her own stunts in the Hong Kong action films, caused a stir when she was seen with her heavily corned feet at an appearance. Chosen as among the 50 Most Beautiful People in the World in 1997, the Crouching Tiger, Hidden Dragon star is gorgeous, but her feet are another issue, especially those bunions.
Feet constantly stuffed in very tight stilettos may look stylish but can be unforgiving to the toes. Women do love their high heels but wearing them all the time may lead to foot problems and foot pain. The foot conditions associated with these towering shoes include corns, calluses, hammertoes, and the most commonly seen bunion. The condition often gets worse over time but surprisingly, almost half of women admit to wearing a pair of shoes that they liked even if it gave them discomfort.

Michelle Yeoh,as a fan and a foot and ankle surgeon, give my office a call about the minimally invasive bunionectomy:    239 430 3668. 

Monday, January 19, 2015

LeVert Possible Repeat Stress Fracture Injury

LeVert Possible Repeat Stress Fracture Injury

Michigan’s shooting guard Caris LeVert will be sitting it out for the rest of the season due to a foot injury. LeVert was limping after a victorious game against the Northwesterns Wildcats and later that night he was seen on crutches. He is scheduled for surgery this week, following a 12-week and rehabilitation period.

LeVert injured the same foot he had surgery on last May due to a stress fracture, and most likely, he may have the same injury since the recurrence of stress fractures are very high.  

What is a stress fracture?
Stress fractures are small but painful cracks on the bone, usually affecting the foot. This occurs because of muscle fatigue, the over used muscle can no longer absorb shock, thus transferring all the stress to the bone, leading to tiny cracks. Stress fracture is one the most common injuries in sports.   I always refer this to thinking about an egg shell with cracks but not fully broken so that the content does not spill out.    MRI's are excellent at diagnosis this condition, but the advent of ultrasound provides a quick and more cost effective alternative. 
Some patients may have pathological fractures: eg bone tumors or osteoporosis, this needs to be checked thoroughly by a physician. 


Rest is the best treatment for stress fractures. Allow the injured bone to heal for 6 to 8 weeks, the patient should not engage in with the activity that caused the fracture during this period. Recurrence of stress fracture is common, which causes larger cracks  or a full fracture that can move out of place and that takes longer to heal and lead to possible surgery.

Another treatment available is injection of stem cells or amniotic stem cells to the fracture site to aid the body in healing of this condition.  This is not covered by insurance but has been proven to cut the healing time in half in fusion cases whereby the surgeon creates a fracture on purpose to allow two bones to mend together.  Fusions are done for generative joint disease and severe deformities such as a collapsed foot or multiple fractures that require stabilization. 

If you have a nonhealing stress fracture or repeat stress fractures see your doctor. 

Thursday, January 15, 2015

Courtney Love have Plantar Fascitis?

Plantar fascitis remains one of the most common problems seen in our practice. in the picture below is   Courtney Love wearing a posterior night splint that is usually one at night to help stretch out the Achilles tendon and the plantar fascia.  This is part of the treatment protocol for plantar fasciitis at our office. Most of the time people will complain about pain upon first steps in the morning that is because the plantar fascia , a ligament on the bottom of the foot that attaches to the heel, is inflamed as well as contracted during the night of sleep. This is why the plantar fascial night splint is very important to use at night when you have an attack of plantar fasciitis. We do not recommend walking on your plantar fascial night splint however for it is not meant to be a weight bearing apparatus  The most common treatment for plantar fasciitis is an injection of corticosteroid, or injection of PRP, or the newest injection is amniotic stem cell injection into the  plantar fascia to allow for healing.  I cannot over emphasize the need for stretching at physical therapy as well as arch supports to help aid in the healing and prevention of future attacks of plantar fasciitis. This is a very painful and preventable problem. I am sure Courtney Love's podiatrist  would not have approved her walking on the beach with her night splint.

Wednesday, January 14, 2015

Victoria Beckham wearing corrective orthotics and reasonable shoes for her bunions.

Victoria Beckham and her Bunions
A bunion is a bony bump at the joint of the big toe. Over time, the bunions can progress and become more and more painful. It is estimated that around one in four people between the ages of 18 and 65 have bunions. Furthermore, the prevalence of bunions increases with age.
Victoria Beckham, for instance, has suffered from bunions for the longest time. She was probably predisposed to bunions from birth. Her misshapen feet have brought her years of agony. Constantly wearing those pointy high heeled shoes has contributed to its progression.

Because she did not want to ruin her stylish look, she puts up with the pain. She has previously voiced her dislike for flat shoes, saying “I beyond hate ballerina flats. I just don’t get it. I love heels.” She was so into heels that she even wore wedge sneakers when she was invited to pitch and open a Dodgers baseball game.

Thus, she has resorted to wearing corrective insoles in the hopes of avoiding bunion surgery. However, she has been advised to undergo bunion treatment soon, otherwise, it could lead to more serious foot problems.

Victoria Beckham faced bunion surgery to correct the painful condition. On one occasion, she was seen wearing a pain or manly brogues. This was quite a leap from the usual towering stilettos that Posh Spice often wore.

Bunion surgery does not have to be a painful experience. Newer techniques along with scarless bunionsurgery methods have allowed patients to start walking in a surgical boot much sooner. Bunionectomies have come a long way. Choose by reputation of the surgeon as their skills vary by their experience and training. 

Call for an appointment with Dr. Kevin Lam 239 430 3668 with the Family Foot and Leg Center, PA in Naples, FL.   

Monday, January 12, 2015

How to lose your feet to diabetes

Your feet and Diabetes
Diabetes mellitus or commonly referred to as diabetes is a lifelong condition that affects the body’s ability to absorbs sugars from food. Normally, the body breaks down carbohydrates from food and converts it to glucose, a simple sugar our cells use for energy. In order for our cells to absorb glucose, insulin is needed. Insulin is a hormone produced by the pancreases to control blood sugar levels in our body.
There are two types of diabetes mellitus. Type 1 is the loss of insulin producing cells in the pancreas and Type 2 is the lack of insulin production by the pancreas, which may be combined with the lack of response or resistance the cells and tissues to insulin.
Due to the lack glucose absorption in the body, there is an increase in blood sugar levels. High blood sugar levels can damage or obstruct small blood vessels all over the body resulting to renal problems, high blood pressure, heart disease, blindness and nerve damage.
Risk of Diabetic Foot
Since diabetes can cause obstruction to the small blood vessels, this can drastically decrease the blood flow and damage the nerve ending of the extremities especially the foot. The risk of having foot problems with diabetes are as follows:
  1. The patient has diabetes for a long time.
  2. The patient does not comply with the prescribed medications, leading to increased blood sugar levels.
  3. Lives a sedentary lifestyle
  4. The patient is smoker.
Lack of blood supply
Uncontrolled blood sugar levels can reduce blood circulation to the feet; making the patient prone to infections after any injury to the foot. Below are signs of poor blood supply to the feet.
  1. Cold feet.
  2. Wounds are slow to heal.
  3. Feet look pale or bluish in color.
  4. Frequent leg cramps after walking a short distance.
Nerve damage
Chronic diabetes can cause nerve damage due poor blood circulation. Symptoms of nerve damage are numbness or pins and needles sensation to the feet, while some patients feel a burning sensation in the legs during rest.
What to do?
  1. Take your diabetes medications regularly. Controlling your blood sugar levels is the key to preventing complications from diabetes.
  2. Stop smoking.
  3. Exercise. Regular activity will help improve blood circulation to your feet.
  4. Visit your podiatrist if you notice decrease sensation on your feet, if you have ulcers or cuts.
  5. Infections can quickly get out of control to blood infection and stays in the intensive care unit.

Diabetics are at high risk to impaired sensations, lack of blood flow, impaired nutritional status as well as impaired immune systems in most cases.   

See a podiatrist to save you limb and your life as 5 year survival rate after an amputation is grim. Diabetic complications have killed more people than cancer in the US. 
This it is a small problem still? 

Dr. Kevin Lam