AF&A Blog

As diabetes awareness month comes to a close, let’s spend some time talking about wounds. Earlier in the month we talked about the determination it takes to properly heal wounds complicated by diabetes. Because of complicating factors, this is definitely an area where ‘an ounce of prevention, is worth a pound of cure’.

By examining your feet daily for changes in color, texture, and temperature, you can detect problems early and seek appropriate intervention. There is actually a lot of ongoing research within the podiatry field to assess or predict wounds before they occur. This research attempts identifying ‘hot spots’ or areas under increased stress, so that your podiatrist can put you in specialized footwear or inserts to stop the problem before it occurs.

Examining your feet daily is doubly important if you have any neuropathy of sensation loses. When you lose the ability to feel pain, a small cut or splinter can go unnoticed and quickly lead to infection. Infections that are undetected can easily invade the muscle and bones. If the infection becomes septic, or reaches your blood, you may experience nausea, fever, chills or vomiting for which you must go immediately to the hospital. The sooner you see a podiatrist or make a trip to an appropriate medical facility the quicker steps can be taken to limit the damage and put you on the path to recovery. Delays in treatment, especially when infection is involved, can result in surgery and amputations.

We would encourage everyone who has diabetes or is close to someone who has it to join the American Diabetes Association. The ADA offers plenty of resources and helpful advice. One such recommendation is yearly foot check-ups with a podiatric physician. Regular healthcare can help you avoid many of the complications we’ve mentioned. We at AFAS are calling all to action by continuing to learn about and be aware of diabetes.

Stay tuned next month as we discuss holiday travels and some the things you should keep in mind. Until next time, keep those feet happy and healthy, Austin!

There are so many topics to address when it comes to talking about diabetes. Living with diabetes, provides daily challenges and many changes to the routines you have developed over the years. Early diagnosis of type 2 diabetes is often first managed with changes to diet and exercise. Hopefully the word ‘diet’ doesn’t elicit images of tasteless cardboard like food (we will dispel this idea in the future). ‘Exercise’ shouldn’t conjure images of hours on the treadmill, repetitive weight lifting, or being covered in sweat. Small changes to your daily activities can add some of the exercise you need to best manage your diabetes. Here are a few ideas from your friends at AFAS:

· Raking leaves: While you should take caution if you have any kind of lung or heart condition, raking the leaves in your yard can really get your blood flowing. The action of raking includes muscles in your back, arms, chest, and legs. By using these muscles, your body can better process the glucose in your blood and more efficiently use the insulin you produce.

· Parking in the back: You may have heard this one a few times before, but instead of parking right up front, opt for one of the many open spaces in the back. This, of course, requires that you have a little extra time. Instead of looping around the parking lot to find a space closer to the entrance of your work or shopping center of choice, grab one of the many empty spaces in the back of the lot and get a little extra walking in everyday. Walking is one of the best and simple exercises you can do to boost your health.

· Take the stairs: If you work on the 20^th floor of the office building, hoofing it up the stairs in your business attire probably won’t do. Now taking it to the 18^th floor and walking a couple flights of stairs will provide some added activity without sweat beading up on your forehead.

Remember that living a healthy lifestyle, no matter how long or severe your diabetes is, can only help you better manage your blood sugars. This November be aware of your diabetes or help a friend or family member to be aware of theirs. There is a wealth of information from the American Diabetes Association^®, family doctor, podiatrist, dietitian and other health care providers to help you best manage this challenging disease.

Until next time, watch your blood sugars and keep those feet happy and healthy Austin!

In honor of diabetes awareness, this month’s blogs will focus on different topics concerning the disease. We have discussed some aspects of living with diabetes in past blogs. It is a challenging disease to manage, but one that should not limit your aspirations. With a growing incidence of diabetes in a growing population, not even athletes, a physically fit population, are immune to acquiring this problem. There are actually a number of athletes who have reached the professional level while living with diabetes. The NFL boasts three such athletes in Jay Leeuwenburg, Mike Echols, and Mike Sinclair.

Both Leeuwenburg and Echols have type one diabetes. This type of diabetes is also known a juvenile diabetes as it is frequently discovered when you are young. Before the advent of the portable glucometer, a blood glucose measuring device any diabetic is quite familiar with, the ability to manage this disease was quite difficult. Medicine today offers many tools to monitor blood sugars and treatments to stop damage caused by changes in blood sugar from occurring. While a different beast than adult onset, or type two diabetes, the diligence of management is of equal importance in juvenile diabetes. The players we mentioned have to keep very close tabs on their blood sugars, using diet and insulin to keep the proper levels.

Players like Mike Sinclair, DE Philadelphia Eagles, face the same disease that affect tens of millions of Americans. Type two diabetes is often associated with obesity and poor diet and increases in prevalence with age. When diagnosed early, changes to diet and exercise can often be enough to keep this disease a bay. In the case of Mike, who is getting plenty of exercise, swapping the double bacon, half pound burger for a turkey sandwich helped him get his blood glucose in check. Regular checkups with your primary doctor as well as your podiatrist can help you detect changes early. By discovering glucose changes early, changes to diet can have a greater effect on managing this disease. Lifelong medication may be needed to manage if your diabetes goes undetected for months or years.

Don’t let diabetes interfere with your life. Educate yourself about your disease, visit your primary doctor, consult Dr. Thomajan and learn the things you can do you keep your diabetes in check. Doing so early will help you continue doing the activities you like to do.

Until next time, keep those feet happy and healthy Austin!

The Texas Rangers face the San Francisco Giants in Game 5 of the World Series tonight.  Trailing the series 3 games to 1, a win at Rangers Park is the only thing to keep hope alive.  This team has won some tough games throughout the season to arrive at this point.  They have had a rough time with the Giants for several of the first 4 games, but they’re not about to let that history play on their future.  Every member of that team is going out to win tonight and bring that trophy back to Texas. Doing so will make them only the 6^th team in history to make such a comeback.

We want to use all that excitement and determination to explore a facet of foot health.  Wound care, especially combined with diabetes, can be a difficult challenge.  For our younger audience, wound care more than likely consists of a bandage and maybe a little Neosporin.  This paradigm becomes a little more complicated when age and disease, like diabetes, are added in.   Wounds that occur in the diabetic foot can require a large dose of determination to go along with the proper care.  While there are many different doctors who will help to get you well, the care of a podiatrist is of utmost importance when dealing with problems in the feet.  Some of the components that go into healing foot ulcers may be overlooked by other physicians.  One such component may be what is causing the wound. Typically, footwear and foot structure can cause unfavorable pressure points which eventually lead to ulceration.  A podiatric physician will off-load these pressure points with a special boot or shoe. Doing so, allows the wound to heal by eliminating further insult.  Along with this assessment, a podiatrist may take a swab of the wound to assess for possible infection.  Flushing, debridement, gels, grafts, or other modalities may all be used individually or together to promote healing.  What methods are utilized is all dependent on the type of wound you have.  As the patient, you need the determination to follow your doctor’s instructions for the weeks or months it may take to get you better.  Just a reminder, but anyone living with diabetes should examine their feet every night and seek treatment at the first sign of a problem.  If you have diabetes and a foot wound that won’t heal, make an appointment at AFAS today!

Until next time, keep those feet happy and healthy, Austin! Go Rangers!

We are halfway to the NFL’s Week 8 and there are a number of high profile quarterback’s whose seasons have become questionable. Tony Romo, who may not recover from his shoulder injury until the last few games of the season, and Brett Favre, who severely injured his ankle, are just two of them. While there may not be a lot of us rooting for the Vikings, the career achievements of Brett Favre have made him a much publicized player. Records including most consecutive starts by a player, most consecutive wins, and most career playoff completions just a few of a long list of achievements for him. The latest injury to the aged player caused him to limp off the field after a loss to the Packer’s on Sunday. This injury may cause him to end his streak of consecutive starts as well as his ability to be an effective player.

He may be the first one to admit that he’s ‘no spring chicken anymore.’ As with any older individual, it takes your body a little longer to heal than it may have when you were younger. Brett Favre, at around $1 million per game salary, isn’t your average 41 year old and has expressed a desire to play through the pain. While it has been reported that he can’t do further damage to the broken bone by playing, we here at AFAS have our reservations. This week he has been seen in a walking boot to help off load the ankle allowing it to rest and heal. While rest is important, it may be of no use if he rests all week only to jump into a game on Sunday. This athlete has played through injury before, and his high profile status may bring him to do it again, but at what peril to his health and performance?

This should be a word of warning to any ‘weekend warriors’ out there who are anxious to bounce back from an ankle injury. You must be sure to give your injury ample time to heal. Additionally, you should slowly work up to your activity with the proper exercises and physical therapy. Conditioning your body for your activities is the best way to prevent initial or recurring injuries. Failure to properly rehabilitate an injury can cause re-injury and continued complications…..even for professional athletes.

Until next time, keep those feet (and ankles) happy and healthy Austin!

It was game 3 of the Western Conference semifinals in May 2009 that Yao twisted his ankle. That year was one of his healthiest since a long list of injuries that began in 2005. That year, osteomyelitis infected his big toe; the 06-07 season brought a break to the right leg and 07-08 required foot surgery for a stress related fracture of the left foot. After coming back from all that, Yao was a significant factor in the 08-09 Rockets march to the NBA semifinals. He told reporters after game 3 that he played through a ‘twist’ in his ankle each quarter. Doctors took subsequent CT scans of the injured ankle and noted another fracture. After spending the year recovering from that surgery, Yao has spent the preseason slowly working up to his old self.

So, why are basketball players, especially the tallest ones, so susceptible to injury? There are several factors that play into this. One factor that we have talked about before is the compounding pressure and weight applied to your feet when you run. Many of the tallest players in the NBA are also the heaviest. When one foot takes the impact of a 300+ pound athlete sprinting down the hardwood floor, their bones and ligaments are put under a stress many of us will never experience. Add to that, a second factor. Quick changes in direct, pivots and cuts all subject the foot to ligamentous strain that can easily turn into injury. For these reasons, footwear and orthotic inserts are of the utmost importance to basketball players be they professionals or high school players.

Let’s get back to Yao. Is there hope for our center? Can we expect a productive season out of this international star? Only time will tell. For now, his doctors have limited him to playing only 24 minutes per game. This will provide time for him to work back to performance condition, but will provide challenges for the Rockets team. We can hope that Yao follows in the footsteps of Zydrunas Ilgauskas of the Miami Heat who has fully recovered from a similar surgery. Unfortunately, there is the old adage ‘the bigger they are the harder they fall’ and there are many big players who have never recovered. Here’s hoping some medical expertise, the proper physical therapy, and a little luck make Yao Ming the strong center that has helped the Rockets out in the past.

Until next time, keep those feet happy and healthy Austin!

The President mentioned the costs associated with it long before the healthcare bill was passed. For anyone living with diabetes or struggling with ulcerations that won’t heal, it is a scary thought. Amputation is the last resort option to save an individual’s life, but at a cost that can only be understood by someone who has experienced it. According to the National Institutes of Health (NIH) diabetic complications are the main cause for amputations of the leg not due to trauma.

Earlier this summer members of the American Podiatric Medical Association gathered for their yearly seminar to teach, learn, and share knowledge with one another. One of the studies that were presented at that meeting dealt with the issue of amputation. The researchers examined 32,000 patients with diabetes and compared their risk factors to their ultimate outcomes. Their findings were that diabetic patients who visited a podiatrist had a significantly lower number of amputations than those who did not. If you are already a patient at AFAS, you should receive a yearly letter to remind you to schedule your annual diabetic foot exam.

We try to take our weekly blog space to educate you on keeping in good health and preventing problems with your feet. Inspecting your feet for changes and maintaining your blood glucose within the recommended ranges are your daily priority if you have diabetes. Living with diabetes can mean changing habits you may have had your whole life, but anything you can do to live healthier can add years to your life. Regular visits with Dr. Thomajan can detect problems early. By assessing where an ulcer might occur, proper off loading and changes to your shoes can stop the issue before it even happens. Don’t become an NIH statistic and make sure a podiatrist is involved in your healthcare.

Until next time, keep those feet happy and healthy Austin!

You don’t have to go very far these days to run into an advertisement for toning shoes. On a recent visit to the store, I noticed almost a fifth of the shoe section was devoted to these types of shoes! It’s high time we take a closer look at their design and claims so that you can make an informed decision next time you go shopping.

The first question everyone asks is “Do they work?” A fair question for any device you are shelling out your hard earned money for. Well, let’s say they accomplish what they are designed for. These shoes create an unstable surface to walk on and your muscles have to help you maintain balance in addition to walking forward. Over long periods of time these added tasks can increase fatigue and lead to injury. Many of these shoes claim to shape your legs, tighten your abs, and help you become more fit. While these shoes may help to some extent, there is no getting around good old physical activity.

Each brand of shoe accomplishes their toning regime a little differently. A shoe made by Reebok claims to offer the benefit of a balance ball workout in their shoe. This is a prime example of the instability we discussed previously. Other shoes marketed by Sketcher and Fila have pretty strange shape. While it may appear to be a new design, this sole is actually a type of shoe modification used by orthopedists and podiatrists for decades. We have a very technical name for this type of modification, a heel to toe rocker sole. The times when these modifications are required are no laughing matter. Rarely prescribed for health individuals, these shoes are most often used in people who have lost motion at the ankle and middle of the foot. This type of sole is thickest in the middle causing a decrease in the forces of the heel striking the ground and increasing propulsion as the toes leave the ground. Pain, such as it associated with arthritis, is another place to allow the shoe to perform the motion that the ankle and foot should do. Eliminating or limiting the natural motion of the foot and ankle in a healthy individual can emphasize some muscle groups but cause problems in others.

We hope to have given you enough information for you to make an informed choice your next visit to the shoe store. You should always remember to ‘ease’ your way into any new footwear or orthoses. Start with limited wear, increasing slowly as time progresses. Until next time keep those feet healthy and happy Austin!

With ‘deep sadness’, tennis pro Serena Williams has decided to listen to her doctor and not play in the US Open. This is obviously a difficult decision for her as friends have noted this is one of her favorite tournaments to play in.

This is also a big headline as she is the number one ranked player in the world. Her absence also prevents her sister Venus and her from defending their doubles title. Though not a happy decision, we here at AFAS feel she is making the best decision. Returning to any activity before allowing proper time for healing will only increase the risk or re-injuring, cause more extensive damage, or leave one with permanent deficits.

The injury that will prevent Serena from competing occurred in early July. While dining at a restaurant, her foot was injured by a broken glass. This type of injury involves a sharp, foreign body. Any foreign body carries inherent risk of infection and your Podiatric physician will clean the wound clean promptly. Depending on factors such as the type of object and the depth of the wound, you may be prescribed antibiotics. A sharp object, like broken glass, can cut tendons, blood vessels, or nerves. The recoveries for injuries such as these are varied. Tendon injuries typically require 6 weeks to heal, with additional time to be toned back to their original strength. It is important to follow your doctor’s instruction when you are recovering from any type of surgery. If Serena Williams can sit out the US Open, you can surely keep yourself off you feet long enough to heal properly. Until next time, keep those feet happy and healthy Austin!

You have decided enough is enough. That nail has become so painful; you are going take care of it right now! Grabbing a pair of nail clippers buried in your bathroom drawer you prop your foot on the tub and test the limits of your pain tolerance. That ingrown nail of yours has come back time and time again even with your attempts to trim it back. Unfortunately, you there is a pretty good chance you didn’t use proper technique to avoid infection and you probably don’t have a good understanding of the anatomy you are digging into.

A better idea would be to visit a foot specialist like Dr. Thomajan. Four years of medical education beyond college as well as several years of residency training at a hospital allows podiatrists to diagnose and treat a variety of pathologies of the foot. The particular issue of an ingrown toenail too often is complicated by infected or inflamed before making an appointment at AFAS. Don’t wait for this to happen! Remember that pain is never normal and an easy in office procedure, under toe anesthesia, can be done to eliminate the offending nail. One of the most important parts of this procedure is the cleanliness needed to avoid infection, something that bathroom surgery doesn’t afford. Next time you find that ingrown nail causing you pain, opt for a visit to AFAS and put those old nail clippers away! Until next time, stay happy and healthy Austin!