AF&A Blog

With Thanksgiving fresh in our memories, Christmas is fast approaching. We hope you enjoyed your Thanksgiving meal and spent a little time throughout the month to educate yourself about diabetes. Dr. Thomajan has written a book to help you learn more about this disease and if you still don’t have it, be sure to get a copy of this free book with this weblink.

We have talked before about wearing the proper footwear for the activity you engage in. With the fast approaching holidays and New Year, it is a fairly safe bet to assume that most of us will be doing some traveling to be with family and friends. Whether you travel by car, plane, or train, it is important to wear comfortable and supportive footwear. A comfortable pair of ‘tennis shoes’ are likely the best option as discussed in the AFAS e-newsletter. Sign up to receive it here under inquiry type.

Two things to keep in mind when wearing for comfort are size and lacing.

Our bodies are always changing and your foot size is something you should check periodically. If there is not a thumbs width of space between your toes and the tip of your shoe, you need to find a larger size. Those funny looking devices you stand on at shoe stores, are called Brannock devices, and are made to measure your foot. As you should stand upright, their use requires a second person and the measurement should be from the heel to the ‘ball’ of your foot. Make sure whoever measures you does it accurately, or better yet, next time you visit AFAS be sure to have your foot measured properly. Once you have the right shoe size, you may want to consider an alternative lacing pattern. The ‘normal’ lacing pattern, or what you might see out of the box, is perfectly fine most of the time. When you are sitting for long periods of time, such as an airplane flight or long car ride, you feet may swell. Consider lacing your shoes to help better accommodate these changes. You can find information on lacing patterns here.

Take a moment to sign up for out E-newsletter while you are here and check back with us throughout the month as we talk about different things to keep in mind while you’re traveling this holiday season. Until next time, keep those feet happy and healthy, Austin!

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!

We all know of Colt McCoy.  This Longhorn had a 45-8 college record making him the NCAA’s winningest quarterback.  After being selected in the 3^rd round of the NFL draft, Cleveland Browns president noted that Colt McCoy would be unlikely to see much playing time since the team already had three quarterbacks.  That prediction proved to be completely untrue after ankle injuries to Jake Delhomme and Seneca Wallace.  McCoy made an impressive rookie NFL start in week 7 when he led the Browns to a win against the defending Saints.  After a bye week, McCoy then helped the team to their 3^rd win of the season against the Patriots in week 9.  Weeks 10 and 11 were disappointing, even with over 200 passing yards from McCoy they couldn’t pull out another win.

This former Longhorn had a noticeable limp as the game progressed, but that didn’t stop him from leading a valiant effort late against Jacksonville.  After leaving the stadium with his right foot in a walking boot, it has been reported that he sprained his ankle.  We have talked about ankle injuries, especially in the NFL, several times before.  The collection of ligaments that keep your ankle in place are prone to injury when the leg and foot are strained in different directions.  For the average individual, getting knocked off your feet by a sack isn’t too much of a worry.  Even so, there are a variety of activities that can cause you to strain, or in other cases tear, the ligaments in your ankle.  Colt McCoy was able to continue playing through his injury, we hope without furthering his injury.  We here at AFAS would never recommend this course of action.  The possibility of making your injury worse and keeping you out longer should always keep you from continuing your activity once you are hurt.  Instead implement the RICE principle and seek medical attention.

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

While most holidays involve some component of gathering with others for a meal, Thanksgiving, by far, focuses the most on eating. This holiday typically conjures up images of feeling stuffed, ‘turkey coma’, or post meal naps. Unfortunately, this type of gorging isn’t healthy for anyone. Living with diabetes should mean that you focus on what you eat. Your body’s inability to keep the sugars in your blood at the appropriate levels translates into you changing the when you eat, what you eat, and the level of activity you get.

It may be helpful to think of diet as all the good things you can eat and not the limiting of other not so good things you may be used to eating. If you have any input into the types of foods you’ll be eating this holiday, visit the American Diabetes Association website. This is an excellent organization to be a part of if you live with diabetes. They offer a plethora of resources and ideas for living better while managing your sugars. For the holiday season, they offer such ideas as mashed sweet potatoes, sage stuffing, and pumpkin pie with maple ginger crust to help you have an enjoyable meal without sacrificing your blood sugars and ultimately your health. If you have the luxury of letting someone else prepare your meal, you should use a little caution in what and how much you eat. Standard fair like turkey and yams can actually be ok as long as you don’t stuff yourself. Sweet rolls are one of the foods you should limit or remove altogether as simple breads are one of those foods that can quickly elevate your blood sugars. You should take full advantage of the many resources to help guide your choices at meals this Thanksgiving.

While we talked last time about ‘hidden’ exercise, you should consider taking an easy walk after your meal instead of that nap.

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!

Several months ago we blogged about an injury to tennis star Serena Williams. To refresh your memory, she cut her foot on a piece of glass at a restaurant after winning Wimbledon. The injury and repair lead her to sit out the US Open where she would have defended the doubles title she won with her sister. We all have tough decisions to make concerning our health and one can easily empathize with the tough decision she made to sit out that tournament. Unfortunately, she began training too much and too soon after her surgery. Last week she announced that she will not play for the remainder of this year.

She reported last week that after a morning practice she felt pain in her previously injured foot and consulted her doctor. After imaging the area, it was concluded that she had restrained the injured tendon. She admitted that she had been attempting to get back in shape to play and may have trained too hard. This could happen to anyone who is trying to get back to daily activities quickly after surgery.

By attempting to return to tennis too quickly, she has lengthened her recovery time and possibly set the stage for further injury. She admitted that she had been training a lot over the last few weeks in order to get back into competition. This is easily understandable to anyone who must set aside their livelihood to recover from an injury. In Serena’s case, the decision to ‘get back to work’ may have cost her much more money in future winnings than the tournaments she had already passed on. This can hold true for anyone healing from foot surgery. You may feel you need to get back on your feet ASAP and return to your normal activities, but doing so puts you at risk for an even longer healing time with more varied results. Always be sure to follow your doctor’s recommendations for post-op care and subsequent physical training. By taking the time to heal properly, you can avoid further problems that can occur.

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