Bunions Painful?

Prolonged changes to normal foot patterns can lead to the formation of bony protrusions commonly known as bunions.

Typically caused by tight fitting footwear, a bunion can be an eyesore, although the real sore is experienced on the great toe and sometimes the fifth toe (Tailor's Bunion). For early stages, preventing the bunion from enlargement is important.

Prevention can be achieved with orthotics that relieves pressure on the bunion.
Orthotics may be semi-rigid to rigid to meet the accommodations each person needs who are suffering from bunions. Orthotics are devices worn in your shoes that provide correction to your feet, helping them to function more efficiently.

Prescription orthotics may help relieve your pain by realigning and stabilizing the bones in your feet, restoring your natural walking pattern. They will also help alleviate pain from rubbing, which often leads to enlargement of the protrusion.

Patients should be advised to wear comfortable shoes that help support their feet. Taking preventative measures in the initial stages of the bunion’s existence is a great way to slow its growth.

Be sure to come by and see Dr. Weaver about getting your custom orthotics today and stop the unsightly growth of your bunion. The key to better health could be right under your toes.

Thermometer to save diabetics losing limbs

A new handheld device could greatly reduce the number of ulcers and limb ­amputations in people with diabetes.

The device provides early ­warning of complications which, if left untreated, can lead to the limb becoming so ­damaged it needs to be removed.

Around 100 Britons a week undergo an amputation as a result of diabetes. The disease can cause significant ­damage to the nerves and blood vessels — possibly because they are exposed to such high levels of blood sugar.

Nerve damage: Red areas highlight possible inflammation

Nerve damage can lead to loss of feeling in the feet, meaning sufferers might not feel a cut, blister or sore. Left untreated, such injuries can develop into serious ulcers and infections.

Poor circulation exacerbates the problem — reduced blood and oxygen supply to the area makes healing difficult.

Four out of ten people with diabetes are thought to have lost some feeling in their feet, and nearly half will suffer a foot wound or ulceration in their lifetime.

In some cases, wounds can remain open for months or even years, vastly increasing the risk of life-threatening infection.

If an infection sets in deeply, or affects the bone, antibiotics alone might not be enough. Gangrene can set in and amputation might be the only course of action.

Even if patients don’t end up so drastically affected, they can still suffer from ulcerations, infections and the foot can become deformed.

Diabetes affects 2.8 million people in the UK, with more than one ­million thought to be undiagnosed. It is caused by too much sugar — glucose — in the blood. There are two variants of the condition, type one and type two.

Type one can be present from birth and is caused by the destruction of insulin-producing cells.

However, around 90 per cent of those who suffer with diabetes have type two, which is triggered by ­obesity.

In this case, the body is unable to ­produce enough insulin. The ­condition can be controlled by ­following a healthy lifestyle.

The new device — a ­battery-­powered thermometer — has been developed by U.S.-based Dibetica Solutions to be used at home by people with ­diabetes and some existing nerve damage.

It uses infrared light to measure changes in foot temperature — a rise in temperature is a sign of inflammation and damage. The readings can help alert a patient that a sore or ulcer is ­developing, before it even breaks the surface of the skin. They can then seek medical attention.

The gadget is designed to be used daily — the patient measures six sites on each foot and ­compares the temperatures.

If this temperature ­difference is more than four degrees Fahrenheit (2C), for two days or more, a problem might be ­brewing and they need to ­contact their doctor.

Previous studies have shown the device cut ulcer rates by a third, compared to ­people who didn’t use the gadget.

Now a larger, ­clinical trial is under way at Oslo University ­Hospital, in Norway, to see whether the device can ­prevent future foot ulcers in patients who have previously ­suffered with this complaint.

Cathy Moulton, clinical adviser at the charity Diabetes UK, says the device could be ­successful as long as patients are vigilant in ­taking their temperature every morning: ‘There is ­evidence ­showing that temperature changes could identify signs of neuropathy (nerve damage).

‘To reduce the risk of ulcers which could lead to ­amputations, ­Diabetes UK ­recommends that people with ­diabetes regularly check their feet looking for discolouration, damage to the skin, swollen areas, and if the foot feels very hot or cold.

‘If there are any changes such as these, they should see their ­doctor as soon as possible.

‘It is also vital that people with diabetes have access to a ­podiatrist and specialist care if any foot ­problems do develop.’

Does Medicare Cover Therapeutic Shoes?

Yes, Medicare will cover the cost of one pair of therapeutic shoes (diabetic shoes) and inserts for people with diabetes if you have a medical need for them. The Medicare payment for therapeutic shoes is subject to the requirement that they are necessary and reasonable for protection of insensitive feet or neuropathy (nerve damage in the feet). To ensure that Medicare pays for your shoes, you must follow the steps below:

Your treating doctor must complete a certificate of medical necessity for the therapeutic shoes and document the need in your medical records. So, do not order anything until you have visited your doctor - no matter what the sales person tells you.

The shoes and inserts must be prescribed by a podiatrist or other qualified doctor and provided by a podiatrist, orthotist, prosthetist, or pedorthist.

The supplier must receive the order before Medicare is billed and must keep it on file.

If you receive your Medicare through a Medicare Advantage Plan (like a HMO, PPO) it is likely you will have to follow the plan's steps for approval and purchase. Make a point of calling your plan's customer service number and ask about their steps for coverage of diabetic shoes.

Medicare will cover one of the following per calendar year:
One pair of depth-inlay shoes and three pairs of inserts or;
One pair of custom molded shoes (including inserts) and two additional pairs of inserts. This option is only available if you cannot wear depth-inlay shoes due to a foot deformity.

In certain cases, Medicare may also cover separate inserts or shoe modifications instead of inserts.

Medicare will not cover deluxe features: A deluxe feature is one that does not contribute to the shoe's therapeutic function - for example, a custom style, color or custom material.

Surgical site infection risk in patients with diabetes

Surgical procedures are often unavoidable in patients with diabetes, and can even help reduce future risk of ulceration. But high postoperative infection rates in this patient population pose additional challenges to practitioners.

With 7.8% of the United States population (~23.6 million people) estimated to be diabetic, one can see how diabetes has become an increasing challenge for the medical community. It has been estimated that nearly a third of these patients are unaware of being diabetic. This prevalence will rise, as nearly 25% of adults over 60 are diabetic and there are increasing numbers being diagnosed in younger patients. Approximately 366 million people will have diabetes worldwide by the year 2030, most of these in developing countries. Foot disorders such as ulcers, infection, Charcot neuroarthropathy and peripheral arterial disease (PAD) are the most common causes of hospital admissions in diabetics. As diabetes mellitus is considered a lifelong condition, one can see the true impact on the healthcare system overall.

Peripheral neuropathy is one of the most common complications found in diabetics, prevalent in anywhere from 14-60% of the diabetic population. Peripheral neuropathy leads to sensory, motor and autonomic dysfunction, and this loss of protective sensation often causes these patients to fail to seek timely medical care for their conditions.

Foot surgery in patients with DM can be elective or preventative. Due to concerns with increased infection rates and slow healing of skin and bony structures in diabetics, elective surgery is performed with extreme caution. Prophylactic or preventative surgery is performed in those diabetics with pre-ulcerative areas, bony prominences and stable, non-infected ulcers. The purpose is to prevent ulcerations due to these bony prominences or to assist in healing of current ulcerations. Multiple types of surgeries can be performed based on the underlying bony deformity found, including hammertoe repair, bunion repair, metatarsal osteotomies, bone resections, Achilles tendon lengthenings for ulcers in the forefoot area and many more. Fracture repair is often required in diabetic patients. Those patients with Charcot foot deformity not treatable with bracing may require surgical intervention also.

It has been noted that diabetic patients without neuropathy can be treated with standard surgical technique and post-op care, but those who are neuropathic should have more fixation, be seen more often and remain non-weightbearing for approximately double the time period.

Peripheral arterial disease can also complicate the surgical site in diabetics, especially those with an insensate foot. Lack of blood flow to the surgical site not only affects the patient’s ability to heal the site quickly, but can also lead to an inability to fight off potential infection at the surgical site in the diabetic patient. Surgical site infections are infections that occur with 30 days of a surgical procedure, or within 1 year if an implant was inserted and is related to the surgery. One study found that by controlling factors such as hypothermia, blood glucose levels, removing hair from the surgical site and administering procedure-specific pre-operative antibiotics for an appropriate time frame, infection risk can be decreased.

One study showed a post-op infection rate of 6.7% in diabetic patients with neuropathy but no open wound undergoing forefoot surgery. A recent study was performed to examine wound infection rates involving 57,183 patients with ankle fractures undergoing repair. This study showed that non-diabetic patients had an infection rate of 1.4% after surgery. Diabetics without neuropathy or other comorbidities had a rate of 3.55% and diabetics with neuropathy or other comorbidities had an infection rate of 7.71%. Other reviews have found similar percentages, indicating that there is an obvious increased risk of infection in diabetics undergoing foot and ankle surgery. This implies that foot and ankle surgeons must have appropriate protocols in place to lessen these infection rates in their patients. First and foremost, comorbidities such as peripheral neuropathy and peripheral arterial disease must be diagnosed and managed prior to preventative surgery.