Diabetics who smoke cigarettes beware

Smoking releases a molecule known as norepinephrine, which triggers blood vessels to constrict, or narrow. When the already small vessels in the foot constrict, oxygen and the cells that fight infection and aid in healing are unable to reach tissues. Each cigarette smoked has been shown to cause oxygen levels to fall and remain low for 30 to 50 minutes. This is of great concern in those with a foot wound or incision after surgery, in which blood flow and oxygen are vital to skin healing.    

Each cigarette contains more than 4,000 natural and synthetic chemicals. Some of these chemicals include carbon monoxide, methanol (which is found in rocket fuel), ammonia, and nicotine.  Nicotine has been shown to decrease the molecules that are responsible for growth of new blood vessels and development of osteoblasts, or bone building cells. Carbon monoxide further contributes to the decrease in tissue oxygen caused by vessel constriction, by taking oxygen away from the molecule it is normally transported in in the blood. It is for these reasons that quitting smoking is imperative for individuals with foot problems. Studies have shown that there is a 2.7 times higher risk of bone not healing in smokers compared to non-smokers undergoing foot surgery.  

Prior to foot surgery involving bone, smoking should be stopped at least 6 weeks prior to the procedure if possible and then take that opportunity to stop smoking indefinitely. 

In individuals with diabetes or other disorders affecting their blood vessels, smoking is even more dangerous.  Pressure ulcers develop when sensation is diminished and the normal feeling of pain associated with a wound is not present. Tissue healing is impaired and there is a heightened risk of infection developing. Combined with smoking, such risks are furthered increased. Individuals with diabetes who notice a foot wound, whether they are smokers or not, should contact their podiatrist immediately. Early treatment can prevent infection and worsening of the wound that can potentially lead to a need for amputation.  Bill’s story in the smoking ad is a scary one, but by sharing it he may be able to prevent others from suffering a similar fate of amputation. 

The Lover's Fracture

The calcaneus bone, or heel bone, is among the most commonly fractured tarsal bone in the foot.  Calcaneus fractures account for 1-2% of fractures in the body.  

Calcaneus fractures are also known as the Lover’s fracture.  

Calcaneal fractures often occur due to a jump from a height, which is how the term “Lover’s fracture” was coined because a lover may jump from great heights to escape from a lover’s spouse or boyfriend.

Calcaneal fractures are generally traumatic fractures occurring from motor vehicle accidents, muscular stress, or falls from a height.  We usually see these injuries in worker's injury claim cases, whereby someone has fallen off of a ladder or rooftop. 

Calcaneal fractures are categorized based on whether the fracture is displaced (greater than 2mm displacement), open (with soft tissue or bony structure exposed), closed (with skin and soft tissue intact), or comminuted (3 or more pieces).  Treatment for calcaneal fractures varies based on the type of fracture.  Standard radiographs and CT scan are used to diagnose calcaneal fractures, and determine the severity of the injury.  Pain over the heel, inability to walk, or a hematoma that extends to the sole of the foot are all signs of a calcaneal fracture.  

Presence of a hematoma on the sole is known as the “Mondor Sign”.  In a non-displaced fracture nonsurgical treatment may be sufficient.  Displaced or comminuted fractures typically require surgical treatment consisting of some type of fixation with metal plates or screws or more recently we have used multiplanar external fixation for restoration of height, the angle, and joint space of the posterior facet in the subtalar joint. 

In closed fractures surgical treatment is often postponed until swelling has subsided.  In open (exposed soft tissue or bone) or avulsion fractures (when a tendon pulls off a piece of bone), more urgent treatment is required.  Open fractures are exposed to the environment and need to be cleaned and then surgically corrected within a short time period to prevent infection which is another advantage of external fixation. 

 

Minor calcaneal fractures usually heal within a few months, and cause minimal long-term limitations.  More severe fractures may take years to heal, and never return to the previous condition.  

Long-term complications may include pain, limb length discrepancies, and changes in gait with chronic swelling, and reduced endurance and strength.  

Early treatment by the foot and ankle surgeon (ie Family Foot and Leg Center)  is the key to minimizing long-term complications. 

-Dr Timm

4 Tips to Reduce Diabetes Risk

Diabetes Mellitus affects more than 230 million people worldwide!  

That is equivalent to approximately 10 times the number of people living in the state of Florida alone.  

One out of every three people with diabetes is unaware they have the disease.  

There are three types of diabetes: type 1 diabetes, type 2 diabetes, and gestational diabetes.  The number of Americans with diabetes is expected to double or triple by the year 2050.  While these statistics are grim, there are many things that can be done to prevent type 2 diabetes. 

Here are some simple lifestyle changes that can prevent diabetes:

• Stay at a healthy weight.  Type 2 diabetes and obesity are closely linked, and maintaining a healthy weight can really make a difference!  The goal is to maintain a BMI less than 25.
• Eating well is also important in prevention.  Surprisingly, studies have shown that women that consume processed red meat are at increased risk of developing type 2 diabetes.  Eating less meat may be preventative as well as avoiding foods high in saturated fats, cholesterol, and sugar.  Eating whole grains, nuts and citrus fruits have also shown to be preventative.  Having a diet high in fiber can also help control blood sugar, thus lowering the risk of developing diabetes.  Stay away from fad diets, and make it a goal to simply make healthier choices.
• Ditch the soda for coffee!  Drinking soda can increase your diabetes risk by 26%, but drinking more than 1 cup of coffee a day can be preventative. 
• Be active.  Walking for just a few minutes about half an hour after dinner has shown to be helpful by lowering blood sugar levels.  Weight lifting can also lower blood sugar better than aerobic exercise can, while maintaining muscle mass and speeding metabolism.  However, a good mix of aerobic exercise and weight training is ideal for maximum benefit.

These are just a few tips for a healthier lifestyle that may aid in the prevention of developing type 2 diabetes.  Type 2 diabetes has some genetic components, but developing the disease is greatly affected by lifestyle.  It is never too late to start living a healthier lifestyle, and if you are at increased risk of developing diabetes it is important to talk to your doctor and get screened for diabetes.

-Dr Timm