Paula Deen's not alone. The new show 'Fat Chef' follows a dozen kitchen pros as they try to drop the pounds and reclaim their health.
FRIDAY, Jan. 27, 2012 — Have you ever heard the expression "Never trust a skinny chef?" Paula Deen isn't the only kitchen pro who's struggled with obesity — or with diabetes. Many men and women who make their living in the food industry, whether they're professional chefs, restauranteurs, caterers, or bakers, have issues with weight and compulsive eating. A new show, Fat Chef, which premiered on the Food Network this week, focuses on 12 of them as they embark on a 16-week plan to lose weight and get in shape.
One of the Fat Chef participants, 36-year-old Michael Mignano, is a bakery owner and pastry chef who was diagnosed with type 2 diabetes in 2009 after his weight reached 500 pounds. He told ABC News Nightline, "I allowed the stresses of work and life to just compound and just literally eat me alive," adding that when his blood sugar was finally checked by a doctor, it was "to the roof." But after four months eating lean protein and fiber and working out, Mignano has lost 100 pounds — going from a size 6X chef jacket down to a 2X. He also says he's "cured his diabetes" and hasn't taken any medication in three months.
Another Fat Chef participant, 41-year-old Ally Vitella, didn't know she had type 2 diabetes until she underwent a check-up for the show. Vitella, who weighed 345 pounds, says that her excess pounds affected her catering business, leaving her physically unable to carry equipment to her clients' locations. She told the Associated Press, "I was eating hors d'oeuvres for lunch and dinner. I would scoop up half a tray of food and eat it.…We cook things you're supposed to eat once in a while, but I was eating them every day." After doing the show, she's lost nearly 60 pounds and dropped from a size 28 to a size 16.
Another chef interviewed by the AP, Art Smith, was diagnosed with diabetes three years ago and says he reached 325 pounds on a diet of refined sugar and caffeine. Although he isn't one of the show participants, Smith, who was a former chef for Oprah Winfrey, has now lost 118 pounds and now runs marathons.
Mignano acknowledges the dangers of his chosen profession, telling the AP, "You have this abundance of food all around you…You're constantly tasting, working late hours, eating late." But the chef whose signature recipe is a "candy bar" loaded with caramel, nuts, and chocolate has no plans to find another line of work. "I love what I do, so for me to get another job and replace my profession is unfathomable," he told Nightline.
What can you do if you're surrounded by tempting, rich food all day long and need to watch your weight? One thing that may help is practicing mindful eating, which focuses on quieting the mind and tuning in to the body's hunger and fullness signals — both of which can stop that automatic hand-to-mouth motion. A recent study in the Journal of Nutrition and Education Behavior found that using mindful eating techniques when eating out helped women lose weight, even when they weren't trying to.
Wednesday, February 8, 2012
Tuesday, February 7, 2012
5 Best Reasons to Drink Water
Of all the food and beverage choices you face every day, what's calorie-free, virtually cost-free, and, oh yes, essential to keeping you alive? Plain ol' water. But those aren't the only reasons to drink it.
"Water drives basic body performance," says Beth Reardon, director of nutrition for Duke Integrative Medicine, part of the Duke University Health System. "All of the systems in the body require water for proper functioning, and so do 90 percent of all chemical reactions in the body."
Here are the top five reasons to quench your thirst with water.
It will help you de-stress
Why: Being sure to sip water throughout a stressful day can soothe stress-induced symptoms as diverse as headaches, tense muscles, fuzzy thinking, a pounding heart, and low energy. That's because stress taxes all your basic body systems -- and when you're dehydrated, the effects are magnified.
Given that more than half your body weight is water, Reardon says, "just a 2-percent reduction in hydration has a dramatic impact on energy levels and cognitive function." And dehydration further raises levels of cortisol -- the "stress hormone."
Water won't wash your stressors away. But it can provide you with more energy, ease tension, slow breathing, and reduce the strain on your heart.
Water-drinking tip: "Eight by eight -- eight 8-ounce glasses a day -- is a good general rule of thumb," Reardon says, "but it's a myth that's the magic amount for everyone, because there are so many variables." The "right" amount for you depends on factors including your age, your activity level, your health level, medications you're taking, and the weather. So how do you know if you're drinking enough? Follow your thirst, and know that you're on the right track if you have straw-colored urine, Reardon says.
You'll lose weight
Why: In a 2010 study of adults aged 55 to 75, drinking two 8-ounce glasses of water before meals was associated with almost four pounds more weight loss in 12 weeks than in a control group who ate a similar diet but didn't have the pre-meal H20. Participants drank an average of 1.5 cups of water a day before the study.
In part, the Virginia Tech researchers say, water is filling, so you feel fuller and eat less. An earlier study found those who drink water before meals consume an average of 75 fewer calories per meal. (Make that twice a day over a year, and that could add up to 14 pounds!) The Virginia Tech scientists also believe the water drinkers began swapping this zero-calorie beverage for sodas and other caloric beverages.
What's more, when you're well hydrated, your body is working closer to maximum efficiency -- enhancing aspects of weight loss, like digestion and muscle function, when you exercise.
Water-drinking tip: For variety's sake, try flavoring your water. Drop some fruit into a pitcher and let it sit a few minutes -- lemons, oranges, watermelon, and berries all work well. Or let an herbal or flavored green tea bag steep in unheated water to accent the taste.
You'll be less apt to get sick
Why: Hydration keeps your mucus membranes in top working order -- they're gatekeepers to the natural defense system that helps keep out germs such as cold and flu viruses. When these tissues dry out, germs can more easily penetrate to the nasopharynx, where the nasal passages and mouth meet. And if you catch a bug anyway, the severity of your illness is more likely to be lower if you've been drinking a lot of water.
Water is an especially smart health move when you're traveling. Most commercial planes fly at elevations between 30,000 and 35,000 feet, where humidity is 10 percent or lower. That means you're breathing dry air in a tight space filled with germs from dozens of people. Water keeps your mucus membranes moist -- and your defenses high -- even in that challenging situation.
Water-drinking tip: Bring an empty water bottle with you to the airport that you can fill for free once you're past security. Or buy the biggest bottle you can right before you board, and aim to finish it by flight's end. Don't hesitate to ask the flight attendant for refills while you're in the air.
Water, the Drink of Longevity
You'll be more comfortable
Why: It doesn't matter if the water you sip is hot or ice-cold. The act of drinking it will keep you warmer on a cold day -- and cool you off on a hot one.
"Your internal thermostat works better when you're well hydrated," Duke nutritionist Beth Reardon says. "Water helps regulate body temperature."
The body's temperature-regulating system, governed by the hypothalamus in the brain, is constantly picking up information that allows it to make adjustments to maintain a fairly steady core temperature. Hot sun? You'll sweat to cool down. Hatless in snow? The hypothalamus will know you're losing heat through your head and work to produce extra energy, such as shivering.
But these mechanisms work less well if you're dehydrated – and dehydration is a common risk for people of all ages, in winter as well as summer. In cold weather, for example, you lose water vapor through your breath. And many people tend to drink less water in cold weather because they don't think they need it as much as on hot, sunny days.
Water-drinking tip: Start by swapping out one soda, cup of coffee, or high-calorie hot chocolate a day with an equal amount of water. Carry a bottle of water with you all day long as a visual reminder to pause and sip. Sip more when you're physically active, whether in water, snow, or any weather condition.
It will help regulate your blood pressure
Why: In 2010, the American Red Cross discovered that when blood donors were given 16 ounces of water to drink before giving blood, there was a 20 percent drop in fainting after the procedure. That was an important finding for them, given that many of those who faint then chalk blood donation up as a bad experience and never return to give again.
It's not entirely clear what mechanism is at work. But the Red Cross was inspired to conduct a study after researchers at Vanderbilt University noticed that drinking water activated the parasympathetic nervous system -- related to the "fight or flight" system that makes you more alert, elevates blood pressure momentarily, and boosts energy. Fainting after donating blood is often connected to a drop in blood pressure, and they theorized that the water would counter that effect.
(Not drinking enough water on a regular basis can also raise blood pressure. That's because dehydration causes blood vessels to constrict as the body strives to conserve water that it loses through perspiration, urination, and breathing. When blood vessels constrict, however, the heart pumps harder, bringing blood pressure up.)
Water-drinking tip: Start your day with a glass of water for a simple energy boost that remedies any dehydration that may have occurred overnight. Keep a filled glass or bottle on your nightstand or an empty one next to the bathroom sink.
"Water drives basic body performance," says Beth Reardon, director of nutrition for Duke Integrative Medicine, part of the Duke University Health System. "All of the systems in the body require water for proper functioning, and so do 90 percent of all chemical reactions in the body."
Here are the top five reasons to quench your thirst with water.
It will help you de-stress
Why: Being sure to sip water throughout a stressful day can soothe stress-induced symptoms as diverse as headaches, tense muscles, fuzzy thinking, a pounding heart, and low energy. That's because stress taxes all your basic body systems -- and when you're dehydrated, the effects are magnified.
Given that more than half your body weight is water, Reardon says, "just a 2-percent reduction in hydration has a dramatic impact on energy levels and cognitive function." And dehydration further raises levels of cortisol -- the "stress hormone."
Water won't wash your stressors away. But it can provide you with more energy, ease tension, slow breathing, and reduce the strain on your heart.
Water-drinking tip: "Eight by eight -- eight 8-ounce glasses a day -- is a good general rule of thumb," Reardon says, "but it's a myth that's the magic amount for everyone, because there are so many variables." The "right" amount for you depends on factors including your age, your activity level, your health level, medications you're taking, and the weather. So how do you know if you're drinking enough? Follow your thirst, and know that you're on the right track if you have straw-colored urine, Reardon says.
You'll lose weight
Why: In a 2010 study of adults aged 55 to 75, drinking two 8-ounce glasses of water before meals was associated with almost four pounds more weight loss in 12 weeks than in a control group who ate a similar diet but didn't have the pre-meal H20. Participants drank an average of 1.5 cups of water a day before the study.
In part, the Virginia Tech researchers say, water is filling, so you feel fuller and eat less. An earlier study found those who drink water before meals consume an average of 75 fewer calories per meal. (Make that twice a day over a year, and that could add up to 14 pounds!) The Virginia Tech scientists also believe the water drinkers began swapping this zero-calorie beverage for sodas and other caloric beverages.
What's more, when you're well hydrated, your body is working closer to maximum efficiency -- enhancing aspects of weight loss, like digestion and muscle function, when you exercise.
Water-drinking tip: For variety's sake, try flavoring your water. Drop some fruit into a pitcher and let it sit a few minutes -- lemons, oranges, watermelon, and berries all work well. Or let an herbal or flavored green tea bag steep in unheated water to accent the taste.
You'll be less apt to get sick
Why: Hydration keeps your mucus membranes in top working order -- they're gatekeepers to the natural defense system that helps keep out germs such as cold and flu viruses. When these tissues dry out, germs can more easily penetrate to the nasopharynx, where the nasal passages and mouth meet. And if you catch a bug anyway, the severity of your illness is more likely to be lower if you've been drinking a lot of water.
Water is an especially smart health move when you're traveling. Most commercial planes fly at elevations between 30,000 and 35,000 feet, where humidity is 10 percent or lower. That means you're breathing dry air in a tight space filled with germs from dozens of people. Water keeps your mucus membranes moist -- and your defenses high -- even in that challenging situation.
Water-drinking tip: Bring an empty water bottle with you to the airport that you can fill for free once you're past security. Or buy the biggest bottle you can right before you board, and aim to finish it by flight's end. Don't hesitate to ask the flight attendant for refills while you're in the air.
Water, the Drink of Longevity
You'll be more comfortable
Why: It doesn't matter if the water you sip is hot or ice-cold. The act of drinking it will keep you warmer on a cold day -- and cool you off on a hot one.
"Your internal thermostat works better when you're well hydrated," Duke nutritionist Beth Reardon says. "Water helps regulate body temperature."
The body's temperature-regulating system, governed by the hypothalamus in the brain, is constantly picking up information that allows it to make adjustments to maintain a fairly steady core temperature. Hot sun? You'll sweat to cool down. Hatless in snow? The hypothalamus will know you're losing heat through your head and work to produce extra energy, such as shivering.
But these mechanisms work less well if you're dehydrated – and dehydration is a common risk for people of all ages, in winter as well as summer. In cold weather, for example, you lose water vapor through your breath. And many people tend to drink less water in cold weather because they don't think they need it as much as on hot, sunny days.
Water-drinking tip: Start by swapping out one soda, cup of coffee, or high-calorie hot chocolate a day with an equal amount of water. Carry a bottle of water with you all day long as a visual reminder to pause and sip. Sip more when you're physically active, whether in water, snow, or any weather condition.
It will help regulate your blood pressure
Why: In 2010, the American Red Cross discovered that when blood donors were given 16 ounces of water to drink before giving blood, there was a 20 percent drop in fainting after the procedure. That was an important finding for them, given that many of those who faint then chalk blood donation up as a bad experience and never return to give again.
It's not entirely clear what mechanism is at work. But the Red Cross was inspired to conduct a study after researchers at Vanderbilt University noticed that drinking water activated the parasympathetic nervous system -- related to the "fight or flight" system that makes you more alert, elevates blood pressure momentarily, and boosts energy. Fainting after donating blood is often connected to a drop in blood pressure, and they theorized that the water would counter that effect.
(Not drinking enough water on a regular basis can also raise blood pressure. That's because dehydration causes blood vessels to constrict as the body strives to conserve water that it loses through perspiration, urination, and breathing. When blood vessels constrict, however, the heart pumps harder, bringing blood pressure up.)
Water-drinking tip: Start your day with a glass of water for a simple energy boost that remedies any dehydration that may have occurred overnight. Keep a filled glass or bottle on your nightstand or an empty one next to the bathroom sink.
Saturday, February 4, 2012
Striking a balance: Foot orthoses in DPN (Diabetic Peripheral Neuropathy)
Preliminary research suggests that impaired balance in patients with diabetic peripheral neuropathy (DPN) may improve with proprioceptive stimulation from foot orthoses.
Postural instability is common in patients with diabetic neuropathy, said David Levine, DPM, CPed, who is in private practice in Frederick, MD.
“Balance issues occur as we age, but add in diabetes and other medical conditions and balance becomes even more of an issue,” he said.
There have been concerns that the soft materials used in orthoses often prescribed for patients with DPN may reduce somatosensory input on the foot’s plantar surface and reduce postural stability. But a study from the Netherlands suggests this concern may be unwarranted.
In the September 2007 Prosthetics and Orthotics International, researchers from the University of Groningen in the Netherlands published a study assessing 30 patients with DPN (aged 37-82 years) and 10 healthy controls (aged 27-51 years).
Postural stability was evaluated in a shoe without insoles, a shoe plus flat insole with a low Shore A value (15°), and a shoe plus flat insole with a higher Shore A value (30°). Researchers performed assessments in four conditions: eyes open, eyes closed, and these conditions with and without a dual task (mental arithmetic).
Patients had significantly increased postural instability compared with controls (p < 0.05) and with eyes closed compared with eyes open (p < 0.05); the latter finding was more pronounced in patients with DPN. No significant effects were found for insoles or dual tasks for the total group or for insoles in the DPN group.
Another study from the same institution published in the July 2008 Journal of Rehabilitation Research & Development investigated the effects of vibrating insoles on standing balance in 17 patients with DPN and 15 individuals without diabetes or impaired sensation.
Participants stood for 60 seconds on vibrating insoles placed on a force plate. Vibrations were not perceptible to participants. Investigators assessed effects of the insoles under four conditions: eyes open, eyes closed, and these conditions with and without a dual task.
Vibrating insoles improved standing balance in subjects with neuropathy when attention was distracted, the condition most often associated with impaired balance and falls in real-world settings. Researchers found no effects of vibration on balance in healthy participants.
A 2006 Boston University study published in the Annals of Neurology found that vibrating insoles significantly reduced postural sway in 15 patients with diabetic neuropathy, 15 patients with stroke, and 15 healthy elderly control subjects.
The evidence is still preliminary, however, a point noted in a review published in July in the Journal of Geriatric Physical Therapy. Researchers at Children’s Hospitals and Clinics of Minnesota reviewed six articles on interventions, including vibrating insoles, used to minimize balance dysfunction in people with DPN. Apart from lower extremity strengthening exercises, which received a fair recommendation, all interventions lacked evidence to either support or disprove their effect on balance in DPN.
Some practitioners aren’t sure that the value of orthoses for patients with DPN involves balance, which, in addition to reduced proprioception, can be affected by vision problems, weakness, or medication side effects.
“I see orthoses as more of an aid for protection, cushioning, and prevention of diabetic foot complications rather than for helping balance,” said Dennis Janisse, CPed, president and CEO of National Pedorthic Services in Milwaukee, WI.
Orthopedic issues may also be balance mediators that can be addressed orthotically.
“Combinations of leg length discrepancy and peripheral neuropathy are issues that shouldn’t be overlooked. Many of these patients may also have had a joint replacement, which quickly adds a lot of factors that can make ambulating even a short distance a challenge,” Levine said.
Footwear selection, he noted, can also affect balance.
“Assessing footwear is an important step to take before starting to think about orthotics,” Levine said. “Prescribing a shoe with a wider base of support might be all that’s necessary. If an orthotic device is made for a poorly supportive shoe or a shoe that doesn’t fit well, the orthotic won’t help. The shoe, after all, is the ultimate orthotic.”
Postural instability is common in patients with diabetic neuropathy, said David Levine, DPM, CPed, who is in private practice in Frederick, MD.
“Balance issues occur as we age, but add in diabetes and other medical conditions and balance becomes even more of an issue,” he said.
There have been concerns that the soft materials used in orthoses often prescribed for patients with DPN may reduce somatosensory input on the foot’s plantar surface and reduce postural stability. But a study from the Netherlands suggests this concern may be unwarranted.
In the September 2007 Prosthetics and Orthotics International, researchers from the University of Groningen in the Netherlands published a study assessing 30 patients with DPN (aged 37-82 years) and 10 healthy controls (aged 27-51 years).
Postural stability was evaluated in a shoe without insoles, a shoe plus flat insole with a low Shore A value (15°), and a shoe plus flat insole with a higher Shore A value (30°). Researchers performed assessments in four conditions: eyes open, eyes closed, and these conditions with and without a dual task (mental arithmetic).
Patients had significantly increased postural instability compared with controls (p < 0.05) and with eyes closed compared with eyes open (p < 0.05); the latter finding was more pronounced in patients with DPN. No significant effects were found for insoles or dual tasks for the total group or for insoles in the DPN group.
Another study from the same institution published in the July 2008 Journal of Rehabilitation Research & Development investigated the effects of vibrating insoles on standing balance in 17 patients with DPN and 15 individuals without diabetes or impaired sensation.
Participants stood for 60 seconds on vibrating insoles placed on a force plate. Vibrations were not perceptible to participants. Investigators assessed effects of the insoles under four conditions: eyes open, eyes closed, and these conditions with and without a dual task.
Vibrating insoles improved standing balance in subjects with neuropathy when attention was distracted, the condition most often associated with impaired balance and falls in real-world settings. Researchers found no effects of vibration on balance in healthy participants.
A 2006 Boston University study published in the Annals of Neurology found that vibrating insoles significantly reduced postural sway in 15 patients with diabetic neuropathy, 15 patients with stroke, and 15 healthy elderly control subjects.
The evidence is still preliminary, however, a point noted in a review published in July in the Journal of Geriatric Physical Therapy. Researchers at Children’s Hospitals and Clinics of Minnesota reviewed six articles on interventions, including vibrating insoles, used to minimize balance dysfunction in people with DPN. Apart from lower extremity strengthening exercises, which received a fair recommendation, all interventions lacked evidence to either support or disprove their effect on balance in DPN.
Some practitioners aren’t sure that the value of orthoses for patients with DPN involves balance, which, in addition to reduced proprioception, can be affected by vision problems, weakness, or medication side effects.
“I see orthoses as more of an aid for protection, cushioning, and prevention of diabetic foot complications rather than for helping balance,” said Dennis Janisse, CPed, president and CEO of National Pedorthic Services in Milwaukee, WI.
Orthopedic issues may also be balance mediators that can be addressed orthotically.
“Combinations of leg length discrepancy and peripheral neuropathy are issues that shouldn’t be overlooked. Many of these patients may also have had a joint replacement, which quickly adds a lot of factors that can make ambulating even a short distance a challenge,” Levine said.
Footwear selection, he noted, can also affect balance.
“Assessing footwear is an important step to take before starting to think about orthotics,” Levine said. “Prescribing a shoe with a wider base of support might be all that’s necessary. If an orthotic device is made for a poorly supportive shoe or a shoe that doesn’t fit well, the orthotic won’t help. The shoe, after all, is the ultimate orthotic.”
Friday, February 3, 2012
Debunking myths: Compression hosiery
Myths abound in discussions about healthcare (just think chicken soup). But when it comes to the use of compression hosiery, some tales can be debunked easily.
The benefits of compression hosiery include improved blood circulation for patients with varicose veins, or achy swollen feet—especially helpful for those with diabetes.
Traditionally, home medical equipment (HME) and durable medical equipment (DME) companies have dispatched representatives to practitioners’ offices to educate them about the availability of products. Typically, these reps leave behind a locally printed prescription pad for physicians, a scenario that leads to the first big myth.
Myth 1: Compression stockings require a prescription.
By law, no prescription is required. Practically speaking, though, many pharmacies require a prescription for higher-level compression hosiery. Compression levels range from 10 to 30 mm Hg and above; compression above 10 to 15 mm Hg falls into the higher range.
“Most pharmacies won’t dispense higher-level compression hosiery without a prescription,” said Marybeth Crane, DPM, of Foot and Ankle Associates of North Texas, in Grapevine, TX.
Patients, however, can get lower-level compression hose that work very well without a prescription, said Bill Meanwell, CPed, of the International School of Pedorthics in Broken Arrow, OK.
Most patients can use 10- or 15-mm Hg hosiery without a problem, but using higher levels of compression requires more knowledge on the part of the patient, said Bret Ribotsky, DPM, a podiatrist in private practice in Boca Raton, FL, and founder of www.PodiatricSuccess.com, a website featuring audio interviews with prominent podiatrists. If 10 to 15 mm Hg is not effective, patients should see a practitioner for further guidance, Ribotsky added.
“It’s a good idea to have a physician to pick out the compression level,” he said.
Myth 2: Compression stockings are appropriate only for certain patients.
“The only people who don’t need compression stockings are giraffes,” Ribotsky said. “Gravity is your enemy, so you might as well use the stockings.”
Almost all individuals can benefit from compression, said Crane, especially patients with diabetes, as long as they have adequate arterial circulation.
“I wear compression stockings in the operating room to help with leg fatigue,” she said.
Professional athletes are taking advantage of compression wear to improve performance and recover faster from injuries, according to Crane and Meanwell.
“If you have absolutely zero edema, and you have an excellent venous system, well, maybe the compression hose aren’t necessary,” Meanwell said.
Myth 3: The risks of compression hosiery outweigh the benefits.
“Ridiculous,” Crane said. “A patient with severe vascular disease should not use compression wear, but otherwise it’s not dangerous.”
In fact, said Meanwell, “the risk of not wearing them and developing a blood clot or pooling of blood in the foot is definitely a major risk.”
There are no risks if the hose are properly fitted, he added.
“The compression hose must be properly and professionally fitted and professionally selected [probably by the specialist at the pharmacy],” he said, adding that it’s best to measure the legs in the morning before they expand and swell.
Myth 4: Your patients can’t afford compression stockings.
“I think it’s all about making them a must rather than a should,” Ribostsky said. “You have to tell a compelling story. You might ask, ‘Do you want to take your grandkids to Disney World without your legs hurting?’”
Myth 5: Your patients won’t wear compression hosiery even if you prescribe them.
It’s true that compression hose can be intimidating to patients, Meanwell said.
“It’s like a wrestling match with yourself,” he said. “If you’re not a flexible person by nature, you would be worried that you’d find yourself in a video on YouTube putting on these hose. They can be quite taxing.”
But these issues can be addressed through patient education and the use of assistive devices to help with donning and doffing.
“If you need the strong compression but can’t get them on, then start with the light compression,” Ribotsky said. “A little compression is better than nothing
The benefits of compression hosiery include improved blood circulation for patients with varicose veins, or achy swollen feet—especially helpful for those with diabetes.
Traditionally, home medical equipment (HME) and durable medical equipment (DME) companies have dispatched representatives to practitioners’ offices to educate them about the availability of products. Typically, these reps leave behind a locally printed prescription pad for physicians, a scenario that leads to the first big myth.
Myth 1: Compression stockings require a prescription.
By law, no prescription is required. Practically speaking, though, many pharmacies require a prescription for higher-level compression hosiery. Compression levels range from 10 to 30 mm Hg and above; compression above 10 to 15 mm Hg falls into the higher range.
“Most pharmacies won’t dispense higher-level compression hosiery without a prescription,” said Marybeth Crane, DPM, of Foot and Ankle Associates of North Texas, in Grapevine, TX.
Patients, however, can get lower-level compression hose that work very well without a prescription, said Bill Meanwell, CPed, of the International School of Pedorthics in Broken Arrow, OK.
Most patients can use 10- or 15-mm Hg hosiery without a problem, but using higher levels of compression requires more knowledge on the part of the patient, said Bret Ribotsky, DPM, a podiatrist in private practice in Boca Raton, FL, and founder of www.PodiatricSuccess.com, a website featuring audio interviews with prominent podiatrists. If 10 to 15 mm Hg is not effective, patients should see a practitioner for further guidance, Ribotsky added.
“It’s a good idea to have a physician to pick out the compression level,” he said.
Myth 2: Compression stockings are appropriate only for certain patients.
“The only people who don’t need compression stockings are giraffes,” Ribotsky said. “Gravity is your enemy, so you might as well use the stockings.”
Almost all individuals can benefit from compression, said Crane, especially patients with diabetes, as long as they have adequate arterial circulation.
“I wear compression stockings in the operating room to help with leg fatigue,” she said.
Professional athletes are taking advantage of compression wear to improve performance and recover faster from injuries, according to Crane and Meanwell.
“If you have absolutely zero edema, and you have an excellent venous system, well, maybe the compression hose aren’t necessary,” Meanwell said.
Myth 3: The risks of compression hosiery outweigh the benefits.
“Ridiculous,” Crane said. “A patient with severe vascular disease should not use compression wear, but otherwise it’s not dangerous.”
In fact, said Meanwell, “the risk of not wearing them and developing a blood clot or pooling of blood in the foot is definitely a major risk.”
There are no risks if the hose are properly fitted, he added.
“The compression hose must be properly and professionally fitted and professionally selected [probably by the specialist at the pharmacy],” he said, adding that it’s best to measure the legs in the morning before they expand and swell.
Myth 4: Your patients can’t afford compression stockings.
“I think it’s all about making them a must rather than a should,” Ribostsky said. “You have to tell a compelling story. You might ask, ‘Do you want to take your grandkids to Disney World without your legs hurting?’”
Myth 5: Your patients won’t wear compression hosiery even if you prescribe them.
It’s true that compression hose can be intimidating to patients, Meanwell said.
“It’s like a wrestling match with yourself,” he said. “If you’re not a flexible person by nature, you would be worried that you’d find yourself in a video on YouTube putting on these hose. They can be quite taxing.”
But these issues can be addressed through patient education and the use of assistive devices to help with donning and doffing.
“If you need the strong compression but can’t get them on, then start with the light compression,” Ribotsky said. “A little compression is better than nothing
Wednesday, February 1, 2012
Have high-heel hangover? Here's help
High heels push the pelvis forward, shifting body weight and loading the small bones and tissues of the forefoot. Hello bunions, fasciitis and hammer toes.
Photograph by: Wayne Cuddington, PNG Merlin Files, Vancouver Sun
We often talk about the post-holiday hangover: the sluggish feeling we get from all the food and drink consumed. But there is another hangover many women experience. It starts in the feet and works it's way up. We're talking about the high-heel hangover.
We all know that high heels are bad for our feet, but there are so many fabulous heels out there and they sure can dress up an outfit and make our legs look great. So we often ignore the obvious and pretend that a well made, well fitting pair of heels is the answer.
Maybe we don't wear them every day, but during the holiday season, with parties every other day, we donned them more often than usual.
And now we are suffering the high-heel hangover.
"Foot health is a really big issue for people over the age of 40, to the point where one in four can't really walk without foot pain," says U.S.-based bio-mechanics expert Katy Bowman, author of Every Woman's Guide to Foot Pain Relief.
According to Bowman, who is also the director of the Restorative Exercise Institute in California, foot pain is the canary in the coal mine of human health. Jimmy Choos and Manolo Blahniks are the poison.
"Your foot pain is like an early indicator of the state of everything," she says. "Every other ailment of the body, from your body composition to even something like depression, all of those ailments are affected by physical mobility. But more than that, foot pain tells us that our knees, hips and back are at risk.
Most of us totally ignore our feet. We may exercise all the other parts of our bodies, but do nothing south of the ankle. Many of us can't spread our toes, fewer still can lift each toe individually.
That is where the problem begins, says Bowman. "The feet are just breaking down under the weight of the body because there is no muscle to resist it."
Then we mess with our posture by wearing high heels.
If we are standing with perfect posture, our pelvis is in the middle of a vertical line from our head to our heels, which as the densest structure of the foot are the best equipped to take our weight, says Bowman.
But when we wear heels, we push the pelvis forward positioning our weight over the front of the feet and loading the small bones and tissues of the forefoot. Hello bunions, fasciitis and hammer toes.
Wearing heels also causes the calf muscle to shorten, which in turn causes a cascade of problems, including knee and hip osteo arthritis. Research has shown people who have worn high heels regularly for more than 20 years have calves 13-per-cent shorter than everyone else.
"That is what causes the knee osteo arthritis, because the calf muscle attaches above the knee joint so the tighter the muscle the less joint space your knee has."
Even low heels can do the damage, says Bowman, adding there is no such thing as a sensible heel, except "in same way as there is a sensible cigarette." If we must wear heels, we should treat them like we treat dessert, she says.
"There is a consequence that comes with eating a lot of desserts and there are steps you can take to mitigate the effects. The same thing goes with high heels.
"If you are going to wear them, instead of trying to come up with a healthier way to do so, you want to come up with another daily habit or habit you cultivate every time you wear them that undoes some of the permanent tissue changes so that you don't have to deal with the full effects of wearing them."
These habits should include stretching, strengthening and wearing flat, flexible footwear or bare feet the rest of the time. Fifteen minutes of exercise a day is enough to protect your feet, says Bowman, and no fancy equipment is needed.
So avoid the hangover. Limit your time in heels and mitigate the damage they do. Here are four basic exercises that anyone can do, even as they watch TV or work at their desk.
Calf Stretch: Put your hands on a wall, place one foot in front of the other and keeping both heels on the ground, bend the front knee until you can feel the stretch in your back calf. Hold 30 seconds. A second calf stretch can be done on stairs; hang one heel off the stair until you can feel the stretch. Hold 30 seconds. Switch.
"A calf stretch is what anyone who wears any shoes should do, because even your general athletic shoe is technically 1½-2 inches (3.8-5 cm) in the heel, so that is a high heel, too," says Bowman. "So calf stretch, calf stretch, calf stretch."
Toe spread: Sit in a chair and rest your feet on an ottoman or low table. Spread your toes so that there is a space between each one. Repeat. (if you can't do this, start with wearing pedicure spacers).
Toe lift: Standing straight, lift your big toes off the ground while keeping all the other toes on the ground. Then lift the other toes one by one.
Tennis ball massage: While seated, roll a tennis ball under your feet to stretch your plantar fascia. If your feet are inflamed or tired, roll your foot over a bottle of water that has been frozen.
Photograph by: Wayne Cuddington, PNG Merlin Files, Vancouver Sun
We often talk about the post-holiday hangover: the sluggish feeling we get from all the food and drink consumed. But there is another hangover many women experience. It starts in the feet and works it's way up. We're talking about the high-heel hangover.
We all know that high heels are bad for our feet, but there are so many fabulous heels out there and they sure can dress up an outfit and make our legs look great. So we often ignore the obvious and pretend that a well made, well fitting pair of heels is the answer.
Maybe we don't wear them every day, but during the holiday season, with parties every other day, we donned them more often than usual.
And now we are suffering the high-heel hangover.
"Foot health is a really big issue for people over the age of 40, to the point where one in four can't really walk without foot pain," says U.S.-based bio-mechanics expert Katy Bowman, author of Every Woman's Guide to Foot Pain Relief.
According to Bowman, who is also the director of the Restorative Exercise Institute in California, foot pain is the canary in the coal mine of human health. Jimmy Choos and Manolo Blahniks are the poison.
"Your foot pain is like an early indicator of the state of everything," she says. "Every other ailment of the body, from your body composition to even something like depression, all of those ailments are affected by physical mobility. But more than that, foot pain tells us that our knees, hips and back are at risk.
Most of us totally ignore our feet. We may exercise all the other parts of our bodies, but do nothing south of the ankle. Many of us can't spread our toes, fewer still can lift each toe individually.
That is where the problem begins, says Bowman. "The feet are just breaking down under the weight of the body because there is no muscle to resist it."
Then we mess with our posture by wearing high heels.
If we are standing with perfect posture, our pelvis is in the middle of a vertical line from our head to our heels, which as the densest structure of the foot are the best equipped to take our weight, says Bowman.
But when we wear heels, we push the pelvis forward positioning our weight over the front of the feet and loading the small bones and tissues of the forefoot. Hello bunions, fasciitis and hammer toes.
Wearing heels also causes the calf muscle to shorten, which in turn causes a cascade of problems, including knee and hip osteo arthritis. Research has shown people who have worn high heels regularly for more than 20 years have calves 13-per-cent shorter than everyone else.
"That is what causes the knee osteo arthritis, because the calf muscle attaches above the knee joint so the tighter the muscle the less joint space your knee has."
Even low heels can do the damage, says Bowman, adding there is no such thing as a sensible heel, except "in same way as there is a sensible cigarette." If we must wear heels, we should treat them like we treat dessert, she says.
"There is a consequence that comes with eating a lot of desserts and there are steps you can take to mitigate the effects. The same thing goes with high heels.
"If you are going to wear them, instead of trying to come up with a healthier way to do so, you want to come up with another daily habit or habit you cultivate every time you wear them that undoes some of the permanent tissue changes so that you don't have to deal with the full effects of wearing them."
These habits should include stretching, strengthening and wearing flat, flexible footwear or bare feet the rest of the time. Fifteen minutes of exercise a day is enough to protect your feet, says Bowman, and no fancy equipment is needed.
So avoid the hangover. Limit your time in heels and mitigate the damage they do. Here are four basic exercises that anyone can do, even as they watch TV or work at their desk.
Calf Stretch: Put your hands on a wall, place one foot in front of the other and keeping both heels on the ground, bend the front knee until you can feel the stretch in your back calf. Hold 30 seconds. A second calf stretch can be done on stairs; hang one heel off the stair until you can feel the stretch. Hold 30 seconds. Switch.
"A calf stretch is what anyone who wears any shoes should do, because even your general athletic shoe is technically 1½-2 inches (3.8-5 cm) in the heel, so that is a high heel, too," says Bowman. "So calf stretch, calf stretch, calf stretch."
Toe spread: Sit in a chair and rest your feet on an ottoman or low table. Spread your toes so that there is a space between each one. Repeat. (if you can't do this, start with wearing pedicure spacers).
Toe lift: Standing straight, lift your big toes off the ground while keeping all the other toes on the ground. Then lift the other toes one by one.
Tennis ball massage: While seated, roll a tennis ball under your feet to stretch your plantar fascia. If your feet are inflamed or tired, roll your foot over a bottle of water that has been frozen.
Tuesday, January 31, 2012
Stretching out plantar fasciitis
Tight hamstrings play an important role in plantar fasciitis, according to a study published in the June issue of Foot and Ankle Specialist.
“These findings show that while we always consider the tightness of the gastrocnemius/soleus complex and the subsequent restricted ankle motion from this equinus, we also need to consider the role of the hamstrings,” said Jonathan Labovitz, DPM, lead author and associate professor at Western University of Health Sciences, Pomona, CA.
The prospective cohort study included 105 participants (210 feet); 79 had plantar fasciitis, which researchers assessed with palpation, who measured popliteal angle with a tractograph and diagnosed hamstring tightness when the popliteal angle ≤160°.
Without controlling for covariates, body mass index (BMI), tightness in the hamstring, gastrocnemius/soleus, and gastrocnemius, and the presence of a calcaneal spur all had statistically significant associations with plantar fasciitis.
After controlling for covariates, participants (86 of 210 feet) with hamstring tightness were 8.7 times as likely to experience plantar fasciitis (p < .0001) as participants without hamstring tightness. Patients with a BMI >35 were 2.4 times as likely as those with a BMI <35 to have plantar fasciitis.
Researchers at Cappagh Orthopedic Hospital in Dublin, Ireland, first linked hamstring tightness with plantar fasciitis in a study published in the December 2005 issue of Foot & Ankle International. The Western University researchers now suggest that an increase in hamstring tightness may induce prolonged forefoot loading and, through the windlass mechanism, may be a factor that increases repetitive plantar fascia injury.
Triceps surae tightness was not included in the Western University covariate analysis, raising the possibility that hamstring tightness was not actually the cause of plantar fasciitis in patients wth tightness in both areas.
“People who have tight hamstrings are more than likely going to have a tight triceps surae,” said Michael T. Gross, PT, PhD, a professor in the Division of Physical Therapy at the University of North Carolina in Chapel Hill. “The investigators of this study admitted that 96% of subjects who had tight hamstrings also had tight triceps surae. Now there’s a cause and effect. If you can’t get dorsiflexion at your talo-crural joint, this often drives dorsiflexion at other joints and that is going to cause collapse of the longitudinal arch of the foot, loading the plantar fascia with increased tensile stress.”
In people with hamstring and triceps surae tightness and plantar fasciitis it’s not known whether the ankle equinus from a tight triceps surae causes hamstring tightness or vice versa, Labovitz said.
“There is no question that the tightness of the triceps surae will cause flattening of the arch and increase tensile stress on the plantar fascia,” Labovitz said. “The question becomes, are the hamstrings involved in this and, if so, to what effect?”
The timing of plantar fascia loading and hip kinematics during gait raise additional questions about possible hamstring involvement, Gross said.
“When loading is taking place at the plantar fascia, it’s mid to late stance. At mid to late stance, the hip is in extension and even hyperextension. Even though the knee is extended, extension/hyperextension at the hip will limit the amount of passive tension that could be developed in the hamstrings, so it is a mystery to me how tight hamstrings would cause trouble for the plantar fascia,“ he said.
Labovitz suggested, however, that a little hamstring tightness might go a long way in influencing the plantar fascia.
“The practical application is that since the hamstrings have been shown to be involved and possibly have more influence than equinus due to the longer lever arm, showing greater effect on the flattening of the foot and plantar fasciitis, less restriction is necessary to have the same effect as equinus,” he said.
The researchers suggest that treatment of plantar fasciitis should address hamstring tightness along with equinus and obesity. Night splints, orthoses, and gait retraining have been shown to be effective for managing plantar fasciitis pain but will not address hamstring flexibility, Labovitz noted.
“The hamstrings should be examined and treated,” Labovitz said. “Stretching is the best treatment for increasing flexibility.”
“These findings show that while we always consider the tightness of the gastrocnemius/soleus complex and the subsequent restricted ankle motion from this equinus, we also need to consider the role of the hamstrings,” said Jonathan Labovitz, DPM, lead author and associate professor at Western University of Health Sciences, Pomona, CA.
The prospective cohort study included 105 participants (210 feet); 79 had plantar fasciitis, which researchers assessed with palpation, who measured popliteal angle with a tractograph and diagnosed hamstring tightness when the popliteal angle ≤160°.
Without controlling for covariates, body mass index (BMI), tightness in the hamstring, gastrocnemius/soleus, and gastrocnemius, and the presence of a calcaneal spur all had statistically significant associations with plantar fasciitis.
After controlling for covariates, participants (86 of 210 feet) with hamstring tightness were 8.7 times as likely to experience plantar fasciitis (p < .0001) as participants without hamstring tightness. Patients with a BMI >35 were 2.4 times as likely as those with a BMI <35 to have plantar fasciitis.
Researchers at Cappagh Orthopedic Hospital in Dublin, Ireland, first linked hamstring tightness with plantar fasciitis in a study published in the December 2005 issue of Foot & Ankle International. The Western University researchers now suggest that an increase in hamstring tightness may induce prolonged forefoot loading and, through the windlass mechanism, may be a factor that increases repetitive plantar fascia injury.
Triceps surae tightness was not included in the Western University covariate analysis, raising the possibility that hamstring tightness was not actually the cause of plantar fasciitis in patients wth tightness in both areas.
“People who have tight hamstrings are more than likely going to have a tight triceps surae,” said Michael T. Gross, PT, PhD, a professor in the Division of Physical Therapy at the University of North Carolina in Chapel Hill. “The investigators of this study admitted that 96% of subjects who had tight hamstrings also had tight triceps surae. Now there’s a cause and effect. If you can’t get dorsiflexion at your talo-crural joint, this often drives dorsiflexion at other joints and that is going to cause collapse of the longitudinal arch of the foot, loading the plantar fascia with increased tensile stress.”
In people with hamstring and triceps surae tightness and plantar fasciitis it’s not known whether the ankle equinus from a tight triceps surae causes hamstring tightness or vice versa, Labovitz said.
“There is no question that the tightness of the triceps surae will cause flattening of the arch and increase tensile stress on the plantar fascia,” Labovitz said. “The question becomes, are the hamstrings involved in this and, if so, to what effect?”
The timing of plantar fascia loading and hip kinematics during gait raise additional questions about possible hamstring involvement, Gross said.
“When loading is taking place at the plantar fascia, it’s mid to late stance. At mid to late stance, the hip is in extension and even hyperextension. Even though the knee is extended, extension/hyperextension at the hip will limit the amount of passive tension that could be developed in the hamstrings, so it is a mystery to me how tight hamstrings would cause trouble for the plantar fascia,“ he said.
Labovitz suggested, however, that a little hamstring tightness might go a long way in influencing the plantar fascia.
“The practical application is that since the hamstrings have been shown to be involved and possibly have more influence than equinus due to the longer lever arm, showing greater effect on the flattening of the foot and plantar fasciitis, less restriction is necessary to have the same effect as equinus,” he said.
The researchers suggest that treatment of plantar fasciitis should address hamstring tightness along with equinus and obesity. Night splints, orthoses, and gait retraining have been shown to be effective for managing plantar fasciitis pain but will not address hamstring flexibility, Labovitz noted.
“The hamstrings should be examined and treated,” Labovitz said. “Stretching is the best treatment for increasing flexibility.”
Monday, January 30, 2012
Shoe stiffness and pressure patterns
Pressure measurement technology can differentiate between the impact forces of a stability shoe and a flexible shoe during gait, according to a preliminary study presented in August at the annual meeting of the American Society of Biomechanics in Long Beach, CA.
Researchers from Indiana’s Valparaiso University found that walking in a flexible shoe was associated with increased duration of contact at the heel compared with a stability shoe.
“Shoes that are overly flexible in the midfoot region may delay the off-weighting or dorsiflexion of the calcaneus. This can have potential detrimental effects on foot and lower extremity function,” said Bruce Williams, DPM, one of the researchers and a podiatrist in private practice in Merrillville, IN.
The preliminary study of one 21-year-old man compared the impact force profiles produced throughout gait with two different running shoes from the same shoe company.
The flexible shoe featured flexion near the midfoot region of the shoe, while the stability shoe flexed closer to the ball of the shoe. An in-shoe pressure measurement system was used to map the force versus time profile for each shoe type as the participant walked 30 feet.
“In-shoe pressure had not been used to differentiate potential differences in function from shoes of these types and their potential effects on foot function,” Williams said.
In order to evaluate the transition between the heel and ball of the foot, force measurements were recorded for the heel, the ball, and the entire sole of the foot. Three trials for each shoe type were undertaken. To compare force profiles across trials, heel strike to toe off (one period) was truncated and normalized to the time associated with that period.
Force versus time was analyzed for the heel and the ball in order to observe slope variation and compare periods in which impact force was constant. This dwell in the gait cycle represents prolonged ground contact.
The results indicate a significantly longer dwell period in the heel region for the flexible shoe compared with the stability shoe (p < 0.05), at 0.1663 seconds compared with 0.0959 seconds. There were no significant dwell periods in the ball region for either shoe.
Prolonged pronation associated with a lack of midfoot support in the flexible shoe explains this dwell period, according to the researchers. They suggest this may be compensatory pronation in response to a lack of ankle joint dorsiflexion. Although no dwell period was evident for the ball of the foot, the researchers suggested this may not be the case in future studies with additional participants.
There is a definite clinical usage for the pressure measurement technology used in this study, said Williams. The technology holds potential for identifying effects of different shoe construction features on lower extremity mechanics and how those changes can result in pain and impaired function, he said.
The researchers plan to collect further data from a variety of subjects with varying foot types, gender, age, and weight.
“These studies may help design better shoes and help match the shoe construction to activity or foot type,” said Smita Rao, PhD, PT, assistant professor of physical therapy at New York University.
There are a number of questions that remain unanswered with regard to shoe stiffness and pressure patterns.
“Stability and flexible shoes may alter load distribution patterns. This may contribute to the user’s perceived comfort,” Rao said. “Differences in magnitude of regional loading are not discussed [in the pilot study]. It would be helpful if the authors related their findings to specific features of the shoes.”
Further trial data are being examined, said Williams. “Such data have the potential to clarify unanswered questions, such as ‘What other sporting shoe types potentially have an impact like this?’” he said.
Researchers from Indiana’s Valparaiso University found that walking in a flexible shoe was associated with increased duration of contact at the heel compared with a stability shoe.
“Shoes that are overly flexible in the midfoot region may delay the off-weighting or dorsiflexion of the calcaneus. This can have potential detrimental effects on foot and lower extremity function,” said Bruce Williams, DPM, one of the researchers and a podiatrist in private practice in Merrillville, IN.
The preliminary study of one 21-year-old man compared the impact force profiles produced throughout gait with two different running shoes from the same shoe company.
The flexible shoe featured flexion near the midfoot region of the shoe, while the stability shoe flexed closer to the ball of the shoe. An in-shoe pressure measurement system was used to map the force versus time profile for each shoe type as the participant walked 30 feet.
“In-shoe pressure had not been used to differentiate potential differences in function from shoes of these types and their potential effects on foot function,” Williams said.
In order to evaluate the transition between the heel and ball of the foot, force measurements were recorded for the heel, the ball, and the entire sole of the foot. Three trials for each shoe type were undertaken. To compare force profiles across trials, heel strike to toe off (one period) was truncated and normalized to the time associated with that period.
Force versus time was analyzed for the heel and the ball in order to observe slope variation and compare periods in which impact force was constant. This dwell in the gait cycle represents prolonged ground contact.
The results indicate a significantly longer dwell period in the heel region for the flexible shoe compared with the stability shoe (p < 0.05), at 0.1663 seconds compared with 0.0959 seconds. There were no significant dwell periods in the ball region for either shoe.
Prolonged pronation associated with a lack of midfoot support in the flexible shoe explains this dwell period, according to the researchers. They suggest this may be compensatory pronation in response to a lack of ankle joint dorsiflexion. Although no dwell period was evident for the ball of the foot, the researchers suggested this may not be the case in future studies with additional participants.
There is a definite clinical usage for the pressure measurement technology used in this study, said Williams. The technology holds potential for identifying effects of different shoe construction features on lower extremity mechanics and how those changes can result in pain and impaired function, he said.
The researchers plan to collect further data from a variety of subjects with varying foot types, gender, age, and weight.
“These studies may help design better shoes and help match the shoe construction to activity or foot type,” said Smita Rao, PhD, PT, assistant professor of physical therapy at New York University.
There are a number of questions that remain unanswered with regard to shoe stiffness and pressure patterns.
“Stability and flexible shoes may alter load distribution patterns. This may contribute to the user’s perceived comfort,” Rao said. “Differences in magnitude of regional loading are not discussed [in the pilot study]. It would be helpful if the authors related their findings to specific features of the shoes.”
Further trial data are being examined, said Williams. “Such data have the potential to clarify unanswered questions, such as ‘What other sporting shoe types potentially have an impact like this?’” he said.
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