The Diabetic Foot Problem
Thousands of leg or foot amputations are performed each year due to complications of diabetes. Very often this is a result of an open sore or ulcer on the foot that goes unchecked and subsequently becomes infected. You may ask why would someone not tend to an open sore. Wouldn’t that be painful, especially on the foot? Well, surprising to most, most of the time there is no sensation in these areas at all. This is one of the most common complications of diabetes…diabetic neuropathy. Neuropathy can present with many different diseases or syndromes, but it is often closely associated with diabetes due to its prevalence.
Diabetic neuropathy can present as a burning, tingling, pins and needles sensation (like when your arm falls asleep) or a more intensified painful feeling. When diabetics get into trouble, though, is when the neuropathy presents as numbness. It creeps up on them and they often times don’t know it is happening until they notice some drainage on their sock from a sore that they were not aware of. If the foot is numb, then the patient cannot experience pain, and therefore does not stop to check out what the problem is because they don’t realize that, for example there is a toothpick stuck in their foot or they have walked so much that the callus that has developed from wear and tear has broken down underneath. Unless they have a loved one checking their feet for them on a regular basis then this may go unnoticed for a long period of time. An ulceration will then often become infected. If the infection lingers it can eventually involve the bone. When bone becomes infected, IV antibiotics and often amputation of part or all of that bone or area must be performed to rid the body of the infection. The 5-year survival rate for all lower extremity amputation patients is less than 50%! This is a staggering statistic.
This is why education of diabetics is so important. Prevention of infections and amputations improves quality of life for the patient and the family. Too often the diabetic patient with neuropathy and an ulceration has the mindset of "It doesn't hurt, so it must not be THAT serious." Herein lies the problem. As practitioners it is our job to relay the gravity of this situation and its very realistic potential of significantly shortening the patient's life if they don't come to grips with their problem.
If you have a friend or family member with Type 1 or Type 2 Diabetes please make sure they are properly educated on their disease state. Look for some signs that they may have neuropathy. If you are riding in the car with them and they are not so great at applying the brakes or gas smoothly it's probably because they cannot tell how much pressure they are applying to the pedal. When they walk if they have a little bit of a slap when there foot hits the ground its something they are probably doing subconsciously because they aren't able to feel their foot hit the floor, so they can at least hear it. This sounds strange to us, but it is reality for many diabetics.
The Truth About Foot Orthotics
“Do I Need Orthotics?”
What is an orthotic and why would I need one? An orthotic is a device that is worn inside of a shoe that supports the arch of the foot and helps to place it in a biomechanically balanced position. Orthotics or orthoses are used for a variety of reasons, not just for foot and ankle problems, but some practitioners will prescribe them for knee, hip, and/or back ailments. The patients that benefit the most from orthotics are the ones that have the most unstable feet. This can be someone that has a flat foot who pronates (rolls their ankle inward) excessively during gait or someone that has a high arch that cannot find a shoe that provides enough support and therefore puts excessive stress on the midfoot joints and the ball of the foot. Many of the most common diagnoses seen in a podiatry practice are treated with orthotics. These include, but are not limited to:
1. Plantar Fasciitis
2. Tendonitis
3. Arthritis
4. Apophysitis/Sever’s Disease (Growth Plate Problems)
5. Ball of Foot Pain (Neuromas, Metatarsalgia)
6. Bunions and Hammertoes
Orthotics both treat these diagnoses and help to prevent or slow the progression of the deformity or painful condition. For example, orthotics will not get rid of a bony bump, such as a bunion, but they will place the foot in a better supported, balanced position which will slow or halt the bunion’s progression.
There are prefabricated orthotics and there are prescription custom orthotics. Both serve a purpose. A solid shell prefab device provides much more support than almost any shoe that is available and is great for someone with an average arch height and a foot that is pretty “normal”. A custom made device is made directly from imprints, casts, digital scans, etc. and is specific for that patient. These are better than prefab orthotics for this reason. Often times a patient will start in a prefab and improve, but may plateau. This is a time the fine-tuned custom devices will give that extra needed benefit. Most local insurance plans cover custom orthotics when they are deemed medically necessary.
At Westfield Foot and Ankle, LLC a digital gait scan is done of the patient's feet both in static(standing) and dynamic(walking)phases of gait. The majority of the information that is gleaned from this scanning comes from the dynamic portion, which tells us what the feet are doing during gait. The pressure distribution is clearly seen. Prior to the scan, a comprehensive examination of the feet is done to determine what modifications may be needed, such as posting to further reduce the amount of pronation or rolling in of the ankle while walking. Overpronation is the culprit in many foot and ankle pathologies. Orthotics prevent this.
To schedule an appointment with Dr. David Sullivan visit www.westfieldfoot.com or call Westfieldf Foot and Ankle at 317-896-6655.
What is an orthotic and why would I need one? An orthotic is a device that is worn inside of a shoe that supports the arch of the foot and helps to place it in a biomechanically balanced position. Orthotics or orthoses are used for a variety of reasons, not just for foot and ankle problems, but some practitioners will prescribe them for knee, hip, and/or back ailments. The patients that benefit the most from orthotics are the ones that have the most unstable feet. This can be someone that has a flat foot who pronates (rolls their ankle inward) excessively during gait or someone that has a high arch that cannot find a shoe that provides enough support and therefore puts excessive stress on the midfoot joints and the ball of the foot. Many of the most common diagnoses seen in a podiatry practice are treated with orthotics. These include, but are not limited to:
1. Plantar Fasciitis
2. Tendonitis
3. Arthritis
4. Apophysitis/Sever’s Disease (Growth Plate Problems)
5. Ball of Foot Pain (Neuromas, Metatarsalgia)
6. Bunions and Hammertoes
Orthotics both treat these diagnoses and help to prevent or slow the progression of the deformity or painful condition. For example, orthotics will not get rid of a bony bump, such as a bunion, but they will place the foot in a better supported, balanced position which will slow or halt the bunion’s progression.
There are prefabricated orthotics and there are prescription custom orthotics. Both serve a purpose. A solid shell prefab device provides much more support than almost any shoe that is available and is great for someone with an average arch height and a foot that is pretty “normal”. A custom made device is made directly from imprints, casts, digital scans, etc. and is specific for that patient. These are better than prefab orthotics for this reason. Often times a patient will start in a prefab and improve, but may plateau. This is a time the fine-tuned custom devices will give that extra needed benefit. Most local insurance plans cover custom orthotics when they are deemed medically necessary.
At Westfield Foot and Ankle, LLC a digital gait scan is done of the patient's feet both in static(standing) and dynamic(walking)phases of gait. The majority of the information that is gleaned from this scanning comes from the dynamic portion, which tells us what the feet are doing during gait. The pressure distribution is clearly seen. Prior to the scan, a comprehensive examination of the feet is done to determine what modifications may be needed, such as posting to further reduce the amount of pronation or rolling in of the ankle while walking. Overpronation is the culprit in many foot and ankle pathologies. Orthotics prevent this.
To schedule an appointment with Dr. David Sullivan visit www.westfieldfoot.com or call Westfieldf Foot and Ankle at 317-896-6655.
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