HIGH BLOOD PRESSURE

As a member of the health care team, your Podiatrist is vitally concerned about hypertension and vascular disease. Your Podiatrist should know if you have any of the following cardiovascular or related conditions:

• Hypertension and/or cardiovascular disease:
• Hypertension sometimes causes decreased circulation. A careful examination is required to determine if there is lower than normal temperature in any of the extremities, absence of normal skin color, or diminished pulse in the feet. 
• Rheumatic Heart Disease:
• Persons who have had rheumatic heart disease must be protected with prophylactic antibiotics prior to any surgical intervention. 
• Diabetes:
• This condition frequently affects the smaller arteries, resulting in diminished circulation and decreased sensation in the extremities.
• Ulceration:
• Open sores that do not heal, or heal very slowly, may be symptoms of certain anemias, including sickle cell disease; they may also be due to hypertension or certain inflammatory conditions of the blood vessels.
• Swollen feet:
• Persistent swelling of one or both feet may be due to kidney, heart, or circulatory problems.
• Burning feet:
• Although it can have a number of causes, a burning sensation of the feet is frequently caused by diminished circulation.

DIABETIC FOOT CARE

Diabetes is a chronic disease that affects the lives of about 20.8 million people in the United States, 6.2 million of whom are unaware that they even have the disease. Every day, 2,200 new cases of diabetes are diagnosed, and an estimated 1.5 million new cases are identified each year.

If you already have diabetes:

• Wash feet daily
• Inspect feet and toes daily
• Lose weight
• Wear thick, soft socks
• Stop smoking
• Cut toenails straight across
• Exercise
• See your Podiatric Physician
• Be properly measured and fitted every time you buy new shoes
• Don't wear high heels, sandals, and shoes with pointed toes
• Don't drink in excess
• Don't wear anything that is too tight around the legs
• Never try to remove calluses, corns, or warts by yourself

The Role of Your Podiatric Physician

Your Podiatrist is trained to look for the following warning signs (that you should look for as well):

• Skin color change
• Elevation in skin temperature
• Swelling of the foot or ankle
• Pain in the legs
• Open sores on the feet that are slow to heal
• Ingrown and fungal toenails
• Bleeding corns and calluses
• Dry cracks in the skin, especially around the heel

CRACKS AND FISSURES

Cracks and fissures are breaks in your skin. They may be the result of skin that is too dry or too moist. When skin is too dry, it can become rough and flaky. A large fissure often forms at the base of the heel. When skin is too moist, you may get a bacterial or fungal infection. This can cause cracks between the toes.

When Skin Is Too Dry

• Walking barefoot can strip your skin of its natural oil; so can wearing sandals or open shoes
• Without enough natural oils to form a protective layer on your skin, your skin may crack
• Cracks may widen, becoming deep fissures; these fissures may not be able to heal on their own

When Skin Is Too Moist

• Moist skin can result from not drying feet after bathing or from excess sweat
• Wearing shoes without socks or shoes and socks that don't ventilate can trap sweat on your feet
• Overly moist skin can encourage bacteria and fungus to grow; this weakens your skin, leading to cracks

Caring For Dry Skin

• Use moisturizer on your feet after bathing and at bedtime
• Ask your doctor before using a pumice stone to reduce calluses
• Never walk barefoot; avoid sandals and other open shoes

Caring For Moist Skin

• Always dry feet between your toes after bathing; don't apply moisturizer between toes 
• Ask your doctor about using anti-fungal powders and lotions or special foot anti-perspirants 
• Choose cotton socks instead of nylon

Remember to check your feet daily!

WHAT IS PERIPHERAL NEUROPATHY?

Peripheral neuropathy is a disease that can damage nerves in the feet and prevent them from working properly. It's most common in people with diabetes. Neuropathy can also be caused by poor nutrition, injury, and other diseases. When nerves are damaged, you may have changes in sensation, including numbness. Not being able to sense pain makes you more likely to injure your feet without knowing it. Over time, neuropathy can lead to permanent loss of nerve function, as well as bone and joint damage.

Common Symptoms

• Numbness
• Burning or pain
• Tingling, or a feeling of "pins and needles"
• Feeling like you're wearing an invisible sock

Treating Peripheral Neuropathy

• Eating foods high in vitamin B can help improve nerve problems caused by poor nutrition. In some cases, vitamin supplements may be needed.
• Gentle exercises, like walking or riding a stationary bicycle, are best. Daily exercise improves blood flow in your feet. In also increases foot strength and flexibility.

WHAT IS ARTHRITIS?

Degenerative arthritis is a condition that slowly wears away joints (the link between where bones meet and move). In the beginning, you may notice that the affected joint seems stiff and it may even ache. As the joint lining (cartilage) breaks down, the bones rub against each other, causing pain or swelling.

The Big-Toe Joint
When arthritis affects your big toe, your foot hurts when it pushes off the ground. Arthritis often appears in the big-toe joint along with a bunion.

Other Joints
When arthritis affects the rear or midfoot joints, you feel pain when you put weight on your foot. Arthritis may affect the joint where the ankle and foot meet. It may also affect other joints nearby.

Treating Arthritis

• Medications 
• Your doctor may prescribe medication to limit pain and swelling. Ice, aspirin, or ibuprofen may help relieve mild symptoms that occur after activity.
• Trimming Bone
• If the bone is not damaged too badly, your doctor may simply shave away bone spurs. Any excess bone growth related to a bunion may also be trimmed.
• Fusing Joints
• If damage is more severe, your doctor may fuse the joint to prevent the bones from rubbing. Afterward, staples or screws may hold the bones in place so they heal properly. In some cases, the joint may be removed and replaced with an implant.

An example of joint fusing of a patient with rheumatoid arthritis. 

TIPS FOR BUYING SHOES

From ancient Egyptian times down through the centuries, footwear has been designed to meet mankind's real and perceived needs: protection, support, comfort, sturdiness, and stylishness. Here are some tips to help you buy the right shoes:

• Have your feet measured while standing up
• Always try on both shoes, and walk around the store
• Always buy for the larger foot; feet are seldom precisely the same size
• Don't buy shoes that need a "break-in" period; shoes should be comfortable immediately
• Don't rely on the size of your last pair of shoes. Your feet do get larger!
• Shop for shoes later in the day; feet tend to swell during the day, and it's best to be fitted while they are in that state
• Be sure that shoes fit well (front, back, and sides) to distribute weight. It sounds elementary, but be sure the widest part of your foot corresponds to the widest part of the shoe
• Select a shoe with a leather upper, stiff heel counter, appropriate cushioning, and flexibility at the ball of the foot
• Buy shoes that don't pinch your toes, either at the tips, or across the toe box
• Try on shoes while you're wearing the same type of socks or stockings you expect to wear with the shoes
• If you wear prescription orthotics you should take them along to shoe fittings

For longer service, keep shoes clean and in good repair. Avoid excessive wear on heels and soles. Give your shoes a chance to breathe, don't wear the same pair two days in a row. Follow these steps to good care of your shoes!