National Diabetes Awareness Month

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For most people, November is the time of year to begin preparing for the holiday season, but November is also National Diabetes Month.  In the United States alone, 25.8 million children and adults have diabetes.  This makes up about 8.3% of the population, and is projected to reach 21% by the year 2050.  There are millions of Americans with undiagnosed diabetes.

Many more who will eat candied apples, canned cranberries, apple and pumpkin pie, and all the turkey and stuffing they can handle; and may likely be precipitating their diabetes and obesity even further without even being aware that they have the signs/symptoms of diabetes in the first place. 

Early warning signs of the disease:

• Increased thirst
• Increased hunger (especially after eating)
• Dry mouth
• Frequent urination or urine infections
• Unexplained weight loss (even though you are eating and feel hungry)
• Fatigue (weak, tired feeling)
• Blurred vision
• Headaches

Diabetes can affect the entire body, including the foot and ankle.  Neuropathy is one of the most common complaints of diabetic patients.  Neuropathy results in damage to nerves, specifically the peripheral nerves, or nerves outside of the brain and spinal cord. Peripheral Neuropathy causes a burning or tingling sensation usually on the feet and legs, or on the arms.  This damage to the nerves is caused by excess blood glucose, or high blood sugar.  Over time excess glucose injures the walls of blood vessels that supply the nerves.  As neuropathy worsens, the ability to feel the lower extremity becomes diminished, which makes diabetics more prone to injuries that go unnoticed.  Neuropathy is the leading cause of diabetic foot ulcers.  Diabetic foot ulcers are caused from a combination of neuropathy, trauma, and deformity.  Deformities such as hammertoes, equinus (limited upward bending of the ankle), or bunions in diabetic patients are more problematic than in non-diabetic patients because of the other complications that come with diabetes.  If diabetic foot ulcers are left untreated they may end up getting infected, and even result in amputation.  Diabetic patients often have decreased circulation in the extremities due to hardening of the arteries or vessels, and this may slow healing time, which is why it’s vital for diabetic patients to take extra precautions when it comes to caring for their feet. 

Although diabetes is a life altering disease keeping a tight control on blood glucose levels can minimize complications.  Other ways to protect the feet in individuals with diabetes are by wearing special shoes made for diabetics, examining the feet daily, washing the feet and making sure to dry them completely, avoiding smoking, wearing clean, dry socks that are changed daily, and never walking barefoot.  Management of diabetes is the key to preventing complications, and for those that do not have diabetes the key to prevention is exercise, maintaining a healthy weight, and eating a well balanced diet.

Brian Timm, DPM, FACFAS

Board Certified by the American Board of Foot and Ankle Surgery in Foot and Reconstructive Rearfoot and Ankle surgery

External fixation here in Naples Florida

External fixation may look very high-tech, and maybe even scary.  However, external fixation has been used in one way or another since almost 2400 years ago.  External fixation techniques were described by Hippocrates, and were used in treating tibia fractures.  External fixation is a minimally invasive technique to reduce displaced fractures and has become a very important part of deformity correction and nonunion and pseudo arthrosis repair as well.

Jean François Malgaigne was one of the many pioneers that made advancements with external fixation devices.  In 1846, Malgaigne used a device that consisted of a clamp and four metal prongs to reduce and stabilize a fracture of the patella, or kneecap.  Following this external fixation device many other similar inventions were used to treat fractures in various locations.  In 1938, Raoul Hoffman made advancements that made external fixation even more useful, and allowed surgeons to place pins into a fracture for stabilization with guidance, while being minimally invasive.  In 1951, Dr. Gavriil A. Ilizarov developed the external fixation device that is still in use today.  Ilizarov’s fixation device consists of a metal frame that encircles the limb, and is attached to underlying bone by pins.  Threaded rods and hinges allow movement of the bone to the correct alignment.  Ilizarov’s external fixator is great because adjustments can be made without opening the fracture site, and the device provides stability. Also it can be converted to internal fixation once the soft tissues have become less swollen. 

Modern day external fixation not only provides stability to a fracture, but can also be used for soft tissue deformities, as well as other bony deformities.  External fixation is preferred when slow correction is required, and even more useful in high risk patients with vascular disease and even open fractures with high risk of infection.  The chance of getting a blood clot is lessened because with external fixation patients can be partial weight bearing, or weight bearing as tolerated following the procedure due to the stability that the fixation provides.  External fixators have been used for other bony deformities, such as Charcot, ankle arthritis, and clubfoot.  External fixation can also be used to lengthen amputated foot and toe stumps.  External fixation has definitely helped many people, but there are still some cons.  Pain and infections are two issues associated with external fixation, and rates vary depending on the extent of the procedure, and the location of the device.  External fixation devices are used by specially trained physicians and all three of the doctors at FFLC are capable of utilizing these various techniques for patients that require such interventions.  

Brian Timm, DPM, FACFAS

Board Certified by the American Board of Foot and Ankle Surgery in Foot and Reconstructive Rearfoot and Ankle surgery

Swimming and your feet

Everyone is starting to return to Florida for the seasonal upgrade in weather.  Fire up the pool warmer, and get ready to swim.

 Swimming is known for being an activity that is less damaging to the joints of the knee, foot and ankle, and can even offer a means of exercise for athletes of other sports with certain foot injuries!

Just about the worst thing a runner can hear is that they are injured and going to have to take time off from running.  Luckily, swimming can help soften this blow by offering an alternative way to get some cardiovascular activity.  Stress fractures are small fracture that occurs from excessive force on normal bone and can force runners to talk a break from running for several weeks.  For the runner with a stress fracture, swimming is often a great alternative that will not bear weight on the injury.  Swimming can also help an athlete ease back into their favorite sport after other serious injuries.  For example, after a peroneal tendon tear, swimming can help to make the transition from being immobilized in a cast or a CAM walker boot to normal running or other weight bearing sports go more gently by allowing the muscles to slowly adapt.  

Swimmers should also be careful to take care to avoid injuries that can occur from intense pool training.  Ankle pain is a common complaint from the repetitive motion the ankles are forced through while swimming.  The Achilles tendon, which is responsible for flexing the foot, may also become irritated from the repetition and develop Achilles tendonitis.  While the Achilles is doing much of the work, the extensor tendons on the top of the foot can also become irritated by being tightly pulled.  By taking care to stretch the feet and ankles properly and always listen to your body when working out, these injuries can be minimized.  Swimmers also need to take extra care to avoid developing warts, Athlete’s foot, and fungal nails from bacteria and fungus that may live in locker rooms and poolside surfaces where other bare feet have deposited them.  If these conditions do develop, see us at Family Foot and Leg Center for an urgent evaluation, as to help prevent spread to others. 

Dr Timm, DPM, FACFAS

Board Certified by the American Board of Foot and Ankle Surgery in Foot and Reconstructive Rearfoot and Ankle Surgery.