Burning and Tingling in the Feet – Is it Neuropathy?

One of the most common complications of diabetes is the development of peripheral neuropathy. Along with the retina in the eye and the kidney, the nervous system is particularly vulnerable to unregulated glucose levels in the blood. This is because glucose, or free sugar in the blood, is able to freely move in and out of these cells without the use of glucose receptors.

Diabetic neuropathy comes in a variety of forms, depending on which nerves are involved. The sensory, motor, and autonomic (involuntary) nervous systems are all affected in diabetic neuropathy, but the sensory involvement is usually the first to become noticeably symptomatic. This often begins with a burning, tingling, or feeling of numbness in the feet. This may also occur in the hands at the same time. This pattern of distribution is commonly referred to as the “stocking-and-glove” distribution. Many theorize that the longest nerves are the first to be affected by peripheral neuropathy, hence the involvement of the hands and feet first. The pain is generally worse at night or at rest.

While the symptoms of numbness and pain of a burning or tingling nature may be uncomfortable, the later sequalae of peripheral neuropathy is certainly more of concern. Once the sensation in the feet is diminished or absent, the foot becomes prone to injury. This injury may go completely unnoticed, which can lead to an open, infected wound. Ulcerations secondary to diabetic peripheral neuropathy cause enormous amounts of morbidity, and can become complicated by systemic infections.

Signs of motor neuropathy in the diabetic patient include structural changes to the foot due to a loss of intrinsic musculature. This may include hammering of the digits, as well as a noticeable loss of the abductor hallucis, a muscle found on the inside (medial) of the foot near the arch. These changes may be more subtle than the subjective findings of pain due to sensory neuropathy.

Autonomic neuropathy also causes changes to the foot that can be appreciated on physical examination. Findings such as lack of hair growth to the digits, changes to the skin color or texture, changes in warmth, and decreased circulation to the foot can all be signs of autonomic neuropathy in the diabetic patient.

Unfortunately, there is no cure for diabetic neuropathy. The onset and progression of symptoms can be avoided by keeping tight control of blood glucose levels. Avoiding hyperglycemic events will prevent the nerves from being damaged by excessive glucose in the blood. In fact, many diabetics report an increase in pain after eating a carbohydrate-rich meal or if their glucose levels are running high.

Drugs that have been used to treat painful diabetic peripheral neuropathy are targeted at the symptoms rather than at the cause. This includes antidepressants such as amitryptiline or nortriptyline, gabapentin, topical capsaicin, and sedatives and pain relievers such as opiates.

A podiatrist will screen for neuropathy in diabetic patients. This is often a very simple, noninvasive test in the office where the protective sensation in the feet is tested. Further testing may be warranted for borderline cases, but is typically unnecessary. If you are diabetic and are concerned about peripheral neuropathy, have a discussion with your podiatrist or primary doctor today.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

863-299-4551

www.FLFootandAnkle.com

Thromboangiitis Obliterans

Thromboangiitis Obliterans is a rare disease that causes occlusion of the arteries in the hands and feet. It almost always affects men aged 20-40 with a history of cigarettes smoking or other tobacco use. It was first described by Von Winiwarter in 1879 in a patient with the affliction. It was later described by Leo Buerger, who documented and provided a full description of the disease. For this reason, it is commonly referred to as Buerger’s Disease.

The disease is caused by an inflammation of the blood vessels, particularly those of the hands and feet. When the vessels become totally occluded, a lack of blood flow to the affected area occurs. This can cause an immense amount of pain, and can lead to gangrene and ulcerations of the fingertips and/or toes.

In those with thromboangiitis obliterans, symptoms may include cold hands or feet, with the extremity appearing pale, red, or blue. Symptoms most commonly affect two or more extremities, but may also affect only one. There is usually pain in the affected limb, which may range from burning or tingling at rest to acute, severe pain. Symptoms are usually worsened by stress or cold. Thromboangiitis Obliterans is commonly seen in association with Raynaud’s Disease. The incidence is quite low, affecting approximately 6 in 10,000 people.

Treatment for thromboangiitis obliterans revolves around symptoms, as there is no cure for the disease. Increasing blood flow to the area may be achieved with vasodilators such as oral medications or nitroglycerin patches. Adding warmth and gently exercising the area can also increase blood flow.

Prevention of thromboangiitis obliterans is key to treatment. Quitting smoking and the use of tobacco products can prevent occlusions all together in many patients. Removing stress and avoiding the cold can also help.

The most serious complication of thromboangiitis obliterans is gangrene. The lack of blood flow to the hands and/or feet can cause the tissue to become gangrenous and die. If not cared for properly, this tissue can lead to serious infections, and possibly sepsis and death. Therefore, it is essential that thromboangiitis obliterans be cared for aggressively by the treating physician.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

Green Running Shoes

Running shoe manufacturer Brooks recently announced plans to release a new, environmentally friendly running shoe in 2010. The shoe, which will be known as The Green Silence, will be available to customers in February 2010, and will boast a design that is made entirely of recycled materials.

The heel cups of the shoe will be reinforced with recycled CDs, while the laces, mesh, lining, and stitching will all be made from discarded plastic water bottles. Foam from old sofas will be reused in the collar, or padded area of the shoe, and the soles will be constructed out of recycled rubber. Brooks even claims that the midsole of the shoe is entirely biodegradable, a claim which the Federal Trade Administration of the United States remains skeptical of.

Even with those doubts, the trend towards more green and eco-friendly footwear is here. Shoe brands are using sustainable materials like hemp and recycled rubber more often, and companies are using more environmentally-friendly methods of producing and transporting their products.

The recycled materials that Brooks is using for its Green Silence are coming from various countries around the world, a point that many environmentalists would make that the company is not using local resources, which would be the most eco-friendly. However, Brooks states that the transportation involved only makes up a small percentage of the shoe’s total carbon footprint.

Brooks also encourages it’s customers to donate old shoes to Soles4Souls, a non-profit organization that distributes shoes to those in need. A similar program is run by Nike, called ReUse A Shoe, where the rubber from old shoes is recycled into turf for fields and other equipment.

While it may not be possible for Brooks to please every environmentalist with the Green Silence shoe, it is certainly a step in the right direction. For years now, running shoe and apparel brands have been using more sustainable products as a way of marketing a greener product. Companies have experimented with Beachwood as a material for socks, as it is highly sustainable and has great moisture-wicking properties. Merino wool has been a very popular material in running socks and clothes, as it is a natural fiber with excellent moisture wicking and cooling properties.

Companies that use silver as an additive for its antimicrobial properties have cleaned up the manufacturing process as well. What used to be a very polluting process has been cleaned up, with fewer emissions and less pollutants.

As these products become available, customers will start to request them, and look at the materials used in the products they buy. With a trend towards sustainability and greening our routines, running brands may be leading the foot race.

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

New Drug for the Treatment of Gout

This Tuesday, a federal advisory committee recommended the approval of Krystexxa, a new drug that has been in development by Savient Pharmaceuticals. In clinical trials, the drug has shown to be an effective treatment for gout.

The committee recommended the approval by a landslide 14-1 vote. The drug now must be approved by the Federal Drug Administration (FDA) before Savient can begin producing, distributing, and marketing the drug. In the past, the FDA has been known to follow the advice of the advisory committees. If Krystexxa is approved, it will be the second drug for the treatment of gout approved this year, after 40 years without innovation in this particular area. Uloric, which is manufactured by Takeda Pharmaceutical, was approved for use in February.

Gout, which is a form of arthritis, is caused by a buildup of uric acid in the body. This uric acid can then be deposited in the joints. The deposits are known as tophi. The big toe is particularly susceptible to this searing pain caused by tophi, but other joints, including joints in the hands and elbows can also be affected.

The uric acid that builds up in the body is commonly associated with diet, as it is a metabolism defect. Foods such as alcohol (especially beer), red meat, and some seafood are commonly associated with gout. For this reason, gout has often been referred to as the “disease of the kings”, as these foods were historically only available to the wealthy. However, these foods have become more and more accessible to a larger percentage of the population, making gout more common, and less known as a disease of the rich. Increased incidence of gout has sparked a new interest in the medical research community.

Krystexxa is a form of uricase, an enzyme responsible for degrading uric acid in the body. The drug works by attacking the tophi, and helping to dissolve the deposits. In clinical trials, about forty-percent of patients saw significant improvement while taking the drug. Some patients reported that the tophi dissolved completely, and that they were able to walk and use their hands again without pain.

There are some side-effects that have been reported with the use of Krystexxa, including an increase in the prevalence of cardiovascular complications and allergic reactions. Committee members state that it is unclear whether the increase in cardiovascular conditions, however, is due to the drug or due to chance, based on the small trial size. The FDA, nevertheless, is expected to approve the drug, as the striking benefits for patients with chronic gout outweigh the side-effects.

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

Shin Splints! Are They Avoidable?

One of the most common injuries that runners suffer from is shin splints. Shin splints can be a very painful experience, but it is fairly avoidable and very manageable.  What causes the pain is an overloading of the tibialis anterior muscle and the connective tissue that connects this muscle to the bone.  The tibialis anterior muscle connects to the outside of the shin bone, and plays a crucial role in keeping the foot stable while walking and running. 

            Because it is an overuse injury, shin splints are most often treated with “RICE” therapy – that is rest, ice, compression, and elevation.  Resting is most important, because further exercise will only further aggravate the condition.  Icing the area, as well as taking over-the-counter pain relievers such as ibuprofen will help to relieve some of the pain associated with shin splints.  Compression with a sock or specialized compression sleeve, as well as elevating the leg while resting will help as well. 

            In addition to RICE therapy, check the shoes you’re wearing when you get the shin splints.  If you’re running, look at your running shoes.  Do they fit properly?  Are they heavily worn on the bottoms?  Do they support your feet well?  If you’re walking when you get them, are you wearing proper walking shoes?  Sometimes wearing thin sandals while walking long distances can give you shin splints quickly. 

            Shin splints may be painful, but know that they are usually only temporary.  It is no reason to give up the morning walk or run.  One way to prevent getting shin splints to add strength training to your exercise routine.  Strengthening the muscles of the calves can help prevent ever getting shin splints, as these muscles help to balance the activity of the tibialis anterior during gait.  Also, wearing the proper shoes will help give your shins extra cushioning, preventing some of the impact that causes shin splints.  Adding low impact exercise will also help lessen the burden on your body in general.  Try mixing in swimming or biking to your exercise routine, or some low impact aerobics.

            As with any injury or pain that you’re suffering from, it’s important to tell a doctor about it if it doesn’t go away with rest, ice, compression, and elevation.  If the shin pain develops after a fall or other impact, a doctor will need to take x-rays to rule out a stress fracture or other type of injury.  

Central Florida Foot and Ankle Center
101 6th St Nw
Winter Haven, Fl 33881
Phone: (863) 299-4551
www.FLFootandAnkle.com

New Treatment for Chronic Heel

New Treatment for Chronic Heel Pain (Plantar Fasciitis) and Tendinitis of the Foot and Ankle Heel pain represents 15% of adult foot complaints, 25% of foot injuries and 8% of injuries to runners and competitive athletes. Chronic heel pain and painful tendinitis of the foot and ankle affect countless people limiting their ability to walk, work, participate in sports and enjoy life. The Topaz™ Microdebrideris an innovative medical device developed by ArthroCare to treat both. Using a minimally invasive approach, the Topaz™ procedure uses Coblation technology to preserve and restore the normal anatomic structure of the damaged tissue while delivering a precise amount of radio frequency energy to stimulate an immediate healing response. What is the plantar fascia? The plantar fascia is a very thick, inelastic ligament that attaches from the heel bone to the ball of the foot. The plantar fascia functions like a bowstring to support the arch while standing, walking and running. What causes plantar fasciitis? 85% of people with plantar fasciitis have poorly aligned feet from arches that are either too high or too low. Poorly aligned feet allow excessive tension to develop in the plantar fascia. As the arch lowers during standing or walking, inflammation occurs as the ligament begins to tear away from the bone. Repetitive activities that stress the ligament, such as jobs that require prolonged walking or standing on hard or irregular surfaces or from sports such as running cause overuse (like tennis elbow), which leads to pain, stiffness and swelling. In the early stages, people think it will go away because they feel pain when they get out of bed in the morning and it dissipates during the day. And for some, it resolves without treatment. For others, however, the pain increases in intensity causing them to limp. What happened to the plantar fascia? With chronic overuse the ligament cells become damaged and are replaced by scar tissue. This scar tissue is inelastic and hypo vascular (no blood vessels), so oxygen and nutrients necessary to heal the damaged tissue can't be absorbed properly. Additionally, production of two key growth factors has stopped, both of which are required to recruit healthy fascia cells (fibroblasts) and encourage new blood vessel formation into the damaged area. In as little as 3 months, the damaged ligament has become very thick (3-5 times normal) and now behaves like a soft-tissue mass pressing on delicate nerves causing even more pain and disability. Professional treatment is usually required in 1-2% of the population just to be able to stand at the sink to wash dishes, let alone work, walk or play sports. Fortunately, non-surgical treatments, including Shock-Wave therapy (ESWT) are extremely effective at curing heel pain in the majority of patients. However, for those patients who have heel pain resistant to conservative treatment, this new, FDA-approved minimally invasive surgical procedure has been shown to resolve >95% of our patients chronic heel pain over the last 21/2 years since its application in our practice. Additionally, patients with chronic Achilles tendinitis as well as other tendon disorders have also benefited from this procedure. Why is Topaz™ better the traditional surgery? Most radio frequency-based surgical instruments such as lasers use heat-driven processes to remove or cut tissue. Coblation-based devices operate at a significantly lower temperature, allowing for more precision than would be expected by using traditional surgical tools. Coblation technology gently dissolves target tissue, minimizing damage to surrounding healthy tissue. Because TOPAZ™ is minimally invasive and induces a rapid healing response, only a small incision is required which provides for a significantly shorter recovery time. This is very important and exciting news for those patients who live healthy and active lifestyles. Our practice continues to utilize the latest non-invasive and minimally invasive techniques for eradicating heel pain and we have extensive experience with state-of the art technologies to get patients pain-free and back on their feet quickly. For more information on the Topaz procedure, please contact our office at 863-299-4551. Central Florida  Foot & Ankle Center, LLC 101 6th Street N.W. Winter Haven, FL 33881 Phone: 863-299-4551 http://www.flfootandankle.com