Saints' Drew Brees day-to-day with torn plantar fascia

Saints quarterback Drew Brees became the fourth quarterback in NFL history with 60,000 passing yards on Monday night, but his ability to continue up the ladder in 2015 will be complicated by a foot injury.

After the loss to the Lions, Brees said that he would have an MRI on his right foot due to an injury suffered during the game that left him wearing a protective boot. Ed Werder of ESPN reports that the test showed a torn plantar fascia and that Brees wants to play in the final two games, but is still waiting an evaluation from Charlotte-based foot specialist Dr. Robert Anderson.

If the report is accurate, that would mean two of the four passers with more than 60,000 yards would be in contact with Anderson about similar injuries. Broncos quarterback Peyton Manning is dealing with a partially torn plantar fascia and may need surgery to repair the issue.

Injuries affect different people in different ways, but Manning’s been out for several weeks so there’s some chance that Brees may have played his last down for the Saints this season. With talk about Sean Payton’s future, or lack thereof, in New Orleans a background topic for much of the year and Brees carrying a huge cap number for a team that needs help at many positions this off season, some will likely wonder if he’ll play any for them next season.

Charles Woodson, Donald Driver suffer injuries, but Super Bowl XLV victory helps ease the pain

ARLINGTON, Tex. - Charles Woodson waited eight long years to get a second chance to win a Super Bowl and he hated having to stand on the sidelines and watch it happen. "It was very hard to watch," Woodson said afterward. "But not anymore."

The agony of injuries was replaced by the unrestrained joy of a long-awaited championship for the 34-year-old Woodson and 36-year-old Donald Driver, both of whom were knocked out of Super Bowl XLV in the first half. Woodson broke his collarbone. Driver suffered a high ankle sprain.

Both of them were standing helplessly on the sidelines when the Packers finally put away the Steelers, 31-25.

"It was very hard," Driver said. "I went in at halftime and the doctor told me that we were going to try to tape it up and see if I could go. I couldn't jump on it anymore and he told me I was done, even though I felt like I could still go. He said, 'No good.'

"Sometimes you have to follow what the doctor says. I followed the doctor's orders."

While Driver, the Packers' receiver, was trying to finagle his way back onto the field, Woodson already knew he was out. So the cornerback and captain instead delivered some inspirational words.

"I told the guys before they went back out, they understand how much I wanted it," Woodson said. "I was pretty emotional so I didn't get a whole lot out, but just to tell them to get it done. And they did."

Woodson was still in pain after the game, but he said, "I'm a champ, so it doesn't matter. World champion. That's what it's all about."

RINGING IT IN
How confident were the Packers? On Saturday, coach Mike McCarthy had the team fitted for its championship rings.

"It's a pretty quiet process," Packers guard Daryn Colledge said. "It's a ring fitting like you probably did for your own wedding ring. I think it just sets that mental mind-set that you've got to go out there and you've got something to accomplish."

BAD IDEA
Before Rashard Mendenhall's fourth-quarter fumble swung the momentum back to the Packers, Steelers coach Mike Tomlin nearly did so when he decided to have Shaun Suisham try a 52-yard field goal with 4:29 left in the third quarter and the Steelers trailing 21-17.

He missed badly, wide left, giving the Packers the ball near midfield. The Steelers dodged the bullet when the Packers were forced to punt. "That was a terrible decision by me in hindsight," Tomlin admitted. "That wasn't even close."

NUMBERS GAME
The NFL announced the attendance as 91,060, including those outside the stadium in the Party Plaza. It also took the unusual step of announcing there were 12,159 "credentialed" people at the game, including media, workers and league officials. That brought the "total" to 103,219.

No word on whether that included the 400 unlucky people who bought $800 tickets to the game, but were left without seats because several sections of temporary seating weren't completed in time.

PACK GETS THE JUMP
The Packers have scored first in all five Super Bowl appearances.... The Packers had 50 rushing yards - second-fewest ever for a Super Bowl-winning team. The St. Louis Rams had just 29 in Super Bowl XXIV. ... Had the Steelers rallied from a 21-3 deficit, it would've been the largest comeback in Super Bowl history. The record is 10 points, twice, including by the New Orleans Saints last year.

PAIN REIGNS
Steelers rookie wide receiver Emmanuel Sanders was carted off the field in the second quarter with a foot injury. He was placed in a walking boot and didn't return. Pittsburgh cornerback Bryant McFadden (hip) and right tackle Flozell Adams (left shoulder) left the game for a short time in the first half before returning.

HAVING THEIR PHIL
In what is fast becoming a ritual for the Steelers, Mike Tomlin had his team listen to a CD of Phil Collins' "In the Air Tonight" on Saturday night to visualize its goals, as Tomlin had before the AFC title game. Asked about Tomlin's message, one player told the NFL Network, "Nothing much actually. Phil Collins runs the meeting."

The Packers, on the other hand, had motivational speaker Kevin Elko address them on Saturday night.

Foot Care Is Essential With Diabetes

From inspecting your feet for sores to keeping your skin dry, proper foot care is essential when you have diabetes. Practice these tips to reduce the risk of infection and protect your feet.

You may think of diabetes as a blood sugar problem, and it is. But the nerve and blood vessel damage caused by diabetes can also become a problem for your feet if you develop neuropathy and lose feeling in your feet or hands or get an infection. To ensure the best possible foot health, follow these 11 easy tips to avoid injury, and your feet will be healthy longer.

Nerve damage is a complication of diabetes that makes it hard to feel when you have sores or cracks in your feet. “Patients with diabetes are looking for any changes in color, sores, or dry, cracked skin,” says podiatrist Steven Tiller, MD, of Portland, Ore. Place a mirror on the floor to see under your feet or ask a friend or relative for help if you can’t see all parts of your feet clearly.

When people with diabetes develop nerve damage or neuropathy, it’s hard to tell if the bath water is too hot. “They won’t realize they are actually scalding their skin,” explains Dr. Tillet. Stepping into a bath before checking the temperature can cause serious damage to your feet, and burns and blisters are open doors to infection. Use your elbow to check the water temperature before getting into the tub or shower.

Shoe shopping for people with diabetes requires a little more attention to detail than you may be used to. Tillet advises looking for shoes with more depth in the toe box, good coverage of both top and bottom, and without seams inside the shoe that can rub on your foot. Likewise, seek socks without seams, preferably socks that are padded and made from cotton or another material that controls moisture.

Wearing shoes with good coverage outside to protect your feet makes sense to most people, but even inside your house, puttering around without shoes puts your feet at risk for small cuts, scrapes, and penetration by splinters, glass shards, and the misplaced sewing needle or thumbtack. If you have neuropathy, you might not notice these dangerous damages until they become infected. It’s best to wear shoes at all times, even in the house.

Make sure that drying your feet is part of your hygiene routine. “The space between the toes is very airtight,” says Tillet. “Skin gets moist and breaks down, leading to infection.” Prevent this by toweling off thoroughly after washing your feet and by removing wet or sweaty socks or shoes immediately. You can still use moisturizer to prevent dry, cracked skin — just avoid putting it between your toes.

Attend to bunions, calluses, corns, hammertoes, and other aggravations promptly, so they don’t lead to infection due to pressure sores and uneven rubbing. Even seemingly harmless calluses may become problems if you ignore them, notes Tillet. See a podiatrist, a doctor who specializes in foot care, instead of heading to the pharmacy for an over-the-counter product for feet — some products are irritating to your skin and can actually increase the risk of infection even while they treat the bunion, callus, or corn on your foot.

Because wearing the correct shoes is so important, orthotic footwear is a great investment in protection and comfort. Shoes made especially for people with diabetes are available at specialty stores and through catalogs, or you can visit your podiatrist for advice. Medicare will cover one pair of diabetic shoes a year, with the addition of three inserts to reduce pressure on your feet. Your doctor may recommend this type of diabetic shoe if you have an ulcer or sore that is not healing.

People with diabetes benefit from exercise, but you still must go easy on your feet. Many fitness classes and aerobics programs include bouncing, jumping, and leaping, which may not be the best activities for your feet, especially if you have neuropathy. Instead, look into programs, such as walking, that don’t put too much pressure on your feet. Just make sure you have the right shoe for whatever activity you choose.

The dangers of smoking run from your head to your feet. “The nicotine in a cigarette can decrease the circulation in the skin by 70 percent,” says Tillet. So if you smoke, you are depriving your feet of the nutrient- and oxygen-rich blood that helps keep them healthy and fights infection. “Diabetic patients already have risk factors that compromise their blood vessels. It’s never too late to stop smoking,” says Tillet.

“There’s a direct relationship between blood sugar level and damage to the nerve cells,” says Tillet. Out-of-control blood sugar leads to neuropathy, which will make it hard to know when your feet are at risk or being damaged. The better you are at controlling your blood sugar, the healthier your feet will be over the long term. Finally, if you already have an infection, high blood sugar levels can make it hard for your body to fight it.

Your doctor and your diabetes team are great sources of information if you need ideas and inspiration for taking care of your feet, quitting smoking, or staying on top of your “numbers” — your weight, blood sugar, and other measures of health, such as blood pressure. Of course, if you notice any changes in your feet that concern you, it’s a good idea to see your doctor before your next regularly scheduled check-up.

Can DPMs Have An Impact On The Multidisciplinary Team For Patients With Diabetes?

When treating at-risk patients with diabetes, a multidisciplinary team can be invaluable in averting complications such as lower extremity amputation. A recent study in the Journal of the American Podiatric Medical Association says early identification and referral to a podiatric limb preservation team can improve the survival rate of at-risk patients with diabetes.

In a retrospective cohort study involving 485 patients with diabetes, researchers collected data on ulcer status and surgical outcomes for five years in patients who received specialty podiatric medical care (311 patients) and those who did not (174 patients).

The study found the proportion of “minor” amputations was significantly higher in the group receiving advanced multidisciplinary podiatric care (67.3 percent) versus the group that did not receive advanced multidisciplinary podiatric care (33.7 percent). Additionally, authors noted that during the study, 19.5 percent of non-specialty care patients died in comparison with 7.7 percent of patients in the podiatric limb preservation group.

The study authors conclude that decreased rates of proximal amputations and increased rates of survival may result in patients with diabetes when there is early identification of those at risk for ulcerations and subsequent referral to advanced multidisciplinary podiatric medical specialty care.

Educating Patients On The Importance Of Foot Screenings

The most effective method of preventing ulcerations and amputations is a careful and frequent inspection of the diabetic foot, according to lead study author Vickie Driver, DPM, MS. She says one should assess and document abnormalities, whether they are age-related, structural or pathological.

Dr. Driver cites the American Diabetes Association’s 2004 recommendation that patients with diabetes undergo a comprehensive annual foot examination, including a patient history. Dr. Driver and Peter Blume, DPM, cite the importance of the Semmes Weinstein 5.07 monofilament to test for diabetic neuropathy and palpating for pedal pulses.

If patients do not have pedal complications of diabetes, annual screenings are sufficient, according to Dr. Blume, an Assistant Clinical Professor of Surgery in the Anesthesia and Orthopedics and Rehabilitation Department at the Yale School of Medicine. However, if patients do have disease affecting the foot, Dr. Blume says routine foot care is “extremely important” every two to three months along with offloading, education and strict glucose control.

Dr. Driver supports giving patients specific instruction on foot care as well as insights on selecting proper footwear and breaking in shoes in order to help prevent blisters and ulcers.

“It is imperative that patients understand the importance of daily foot exams, the implication of losing their protective sensation and proper foot care,” notes Dr. Driver, an Associate Professor of Surgery and the Director of Clinical Research, Foot Care at the Boston University School of Medicine.

Emphasizing The Role Of DPMs

In addition, Dr. Driver emphasizes that DPMs should spread the word to primary care physicians about their efficacy in treating high-risk patients with diabetes.

“The data now shows that we are cost effective providers to help treat these patients,” maintains Dr. Driver, a Fellow of the American College of Foot and Ankle Surgeons. “We need to present at medical meetings where PCPs attend. This will help them understand how and when to consult us.”

Barefoot Running

Have you seen the alien shoes spotted on celebrities recently? Matthew McConaughey and girlfriend Camila Alves wear them to work out, actor Channing Tatum runs in them, and Heisman Trophy winner Eddie George sports them for beach football.

Just what are these funky, rubber glove toe socks? They’re Vibram FiveFingers—shoes that are meant to mimic the experience of running without shoes, yet protect your feet from dirt and debris. Why would people want to run without their cushy trainers? Running without shoes can strengthen your feet, ankles, and lower legs and improve balance. Some say modern running shoes are to blame for injuries. And one man wrote an immensely popular book that concluded as much.

The 10 laws of injury prevention

Vibram started making the five-toed shoes in 2006, but the trend really picked up steam last year, following the publication of Christopher McDougall's book “Born to Run.” The book describes how Mexico’s Tarahumara Indians have become some of the greatest long-distance runners in the world despite running barefoot or in sandals fashioned from tire rubber. McDougall chronicles an ultramarathon race in Mexico’s Copper Canyons attended by a group of Americans including “Barefoot Ted” McDonald, who either ran sans shoes or in FiveFingers, in case of sharp rocks. The author argues that we’d be better off without the souped-up shoes marketed to us by giants like Nike and Adidas, which he says have done nothing to prevent injuries. The book made “The New York Times” bestseller list, and now TMZ is photographing celebrities in their very own lizard shoes.

According to CNN, the FiveFingers have become so popular that the company is having a hard time keeping them in stock—and stopping counterfeiters from selling knock-offs online.

Your ultimate guide to fall running shoes

Some barefoot devotees simply like the sensation of feeling the surface they’re running on while others swear up and down that ditching traditional running shoes has helped them prevent injuries. While there’s no scientific evidence to support the latter claim, we do know that running barefoot or in barefoot-style shoes like the FiveFingers or Nike Free changes one’s running mechanics. When runners aren’t wearing shoes with built-up soles, they tend to land in the middle or toward the front of their feet rather than on their heel and researchers believe that such midfoot or forefoot striking results in less impact on the body. But as Susan Paul, M.S., exercise physiologist and program director for the Orlando Track Shack Foundation says, “To date, there are no studies indicating that running shoes contribute to injury or, conversely, that barefoot running reduces injury or makes you run faster.”

The mechanics of barefoot running
If you’re thinking about shedding your shoes, consider these guidelines:

1. Barefoot training is not for people who are just starting to run or returning from a long layoff—it’s something to slowly incorporate into an existing running regimen.

2. If you have persistent or serious foot problems, consult your podiatrist first.

3. Ease in slowly. Paul advises starting with a few minutes on a flat, relatively forgiving surface once a week. Grassy fields, smooth roads, and soft trails qualify. Running on sand might be tempting, but barefooting newbies should stick to wet sand at first as the unstable soft stuff puts a lot of torque on your joints and is much harder to run on.

4. Listen to your body. “Barefoot Ken Bob” Saxton, founder of runningbarefoot.org and finisher of more than 70 barefoot marathons, says, “Luckily, your feet are sensitive, which is a good thing. Listen to them and they'll keep you from doing something stupid.”

Has anyone run barefoot or in minimalist shoes like Vibrams? What did you think? If not, would you ever try it? Why or why not?

A head-to-heel guide to running
Susan Rinkunas is an associate editor at Runner’s World, a magazine (and website) that informs, advises, and motivates runners of all ages and abilities—and we mean it. Her blog on Yahoo! Shine offers tips on running technique, nutrition and weight loss, shoes and apparel, and balancing fitness and life.

Diabetes Patients NEED More Prevention Services

It has been found that there is a distinct lack of appropriate prevention programmes for foot ulcers and amputations for patients that are suffering from type 2 diabetes, and it has been recommended that improved prevention services could significantly improve the high rate of amputation for diabetes patients.

Researchers have used information taken from electronic medical records to identify 150 patients on dialysis and 150 patients with a previous foot ulceration or amputation from 2000 to 2006. Factors such as patient education, podiatry care and the use of therapeutic shoes and insoles were monitored over a 30-month period. Despite 92.3 per cent of the overall population of the study having type 2 diabetes, only two patients in the dialysis group and none in the ulcer group were reported to be offered formal diabetes education.

In the study, 65 per cent of patients were seen by a podiatrist, of whom 70 per cent received care after developing a foot ulcer. This is compared with 42 per cent of patients in the dialysis group, and only 18 per cent of patients in the ulcer group received preventive care from a podiatrist.

It was noted that "Prevention services for the diabetic foot are simple to establish and can be made easily accessible through organized multidisciplinary care. These data provide further evidence that preventative foot care is not regularly provided, even among patients with the highest risk for lower limb complications. It also highlights an opportunity to improve prevention services for the diabetic foot with simple protocols for evaluation and referral."

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.

New Study Demonstrates Dramatic Impact of Podiatric Care

Patients with diabetes who receive medical and surgical care provided by a podiatrist are less likely to suffer hospitalization or amputation than patients who do not receive care from a podiatrist, according to a new study from Thomson Reuters. Thomson Reuters is an internationally respected research firm with expertise in the health-care market.

The study, sponsored by APMA, examined records for more than 32,000 patients with diabetes under 65 and matched health and risk factors for those who had podiatry visits to those who did not. Care by a podiatric physician, defined as at least one pre-ulcer visit, was associated with lower risk of hospitalization and amputation. James Wrobel, DPM, presented the results at the American Diabetes Association Scientific Sessions this weekend in Orlando, Florida.

"The dramatic results of the study demonstrate the important role of today's podiatrist," said APMA President Kathleen Stone, DPM. "As a profession, we make a significant impact on patient outcomes and health-care costs. As more diabetic patients receive high-quality medical care by podiatrists prior to developing ulcers, we will see even greater reductions in cost and improvements in patients' quality of life. The next step is to confirm these findings with prospective pilot programs that identify high-risk patients and provide preventive foot care services by podiatrists."

Comprehensive Diabetic Foot Exam

The American Diabetes Association's "2010 Standards of Medical Care in Diabetes" statement on diabetic foot care and the newly established Physician Quality Reporting Initative (PQRI) for the treatment of feet of patients with diabetes now requires an annual comprehensive diabetic foot examination to assess all lower extremity risk factors. We are requesting all of our patients with diabetes to schedule a Comprehensive Diabetic Foot Exam (CDFE) appointment if you have not already done so. This appointment should only take about 15 minutes of your time and will allow us to perform the necessary testing and examination to meet this new requirement. The exam may include the treatment of your nails, calluses, or corns.

THANK YOU Father H and Setter Foundation...

Your VERY GENEROUS $1000 donation has helped start CKPA Sock Tree 2010 on its way!! We are able to purchase several hundred pairs of brand new socks for all ages. We are asking everyone that has brand new socks that you may have laying around, or got for your Birthday, Christmas or just because to please donate them to CKPA Sock Tree 2010. Please donate them to US because we have many people right here in Wichita who need these socks. Our goal is 5000 pairs of socks to accompany every pair of shoes we give to charity. Come by and hang your BRAND NEW SOCKS on CKPA Sock Tree. We have decided to start 2010 on the right foot and what better way then with socks. All you have to do is bring us your new socks to our office at 933 N. Topeka. You can pick where you would like to hang the socks or we can do it for you. We welcome single pairs of socks and bulk packages. The socks can be your choice of style, color and age group but please just bring those brand new socks to us.

Mildred discusses Kansas Podiatrist Dr. Weaver's Diabetic Foot Care

Mildred has had lots of foot problems due to diabetes. She wanted you to know how great Dr. Ben Weaver's care has been. Take a look!