Regular trips to a podiatrist will help keep you on your toes

It's all too easy to take healthy feet for granted — they take you where you want to go without complaint and don't ask for much in return. But, over time, those puppies can really start barking due to corns, calluses, bunions and other assorted ailments.

Many people are surprised to learn that the normal aging process affects feet as much as any other body part. Feet become wider and flatter, the protective fat pads on the soles thin out and circulation throughout the feet can decrease, all of which can lead to foot pain and damage. But you don't have to suffer alone. You — and your feet — need an ally. That's where a podiatrist comes in.

Doctors of podiatric medicine focus their practices entirely on the foot, ankle and lower leg. Their medical education and training includes four years of undergraduate education, four years of graduate education at an accredited podiatric medical college and two or three years of hospital residency training. Each state requires podiatrists to be licensed to practice there.

"We're primary physicians and specialists for the foot and ankle," says Dr. Marlene Reid, president of the Illinois Podiatric Medical Association. "That's all we do, which means it's best to go to a podiatrist for any foot or ankle condition, large or small."

Unlike many familiar screening guidelines, like getting your first mammogram at age 40 or your first colonoscopy at age 50, there is no definite rule about when to start seeing a podiatrist. "I always suggest coming in for an initial look once you're past your 30s," says Dr. Kirk Contento of Contento Foot & Ankle Center in Palos Heights and Chicago. "We're all about preventing little problems from developing into something major later."

Here are three common foot conditions that become all the more common as we age, and here's what to do about them.

1. Toenail fungus - Podiatrists suggest seeing a podiatrist whenever a nail thickens or becomes discolored. "The doctor can thin the nail, then medicate topically or orally and get the patient started on a good home treatment regimen," Contento says. "Fungal infections often thicken the nail, which can lead to a secondary problem of an ingrown nail." Lasers are also an emerging new treatment for this common problem.

2.Arch strain and heel pain - One word here: Orthotics. Either custom or over-the-counter are fine, as long as you receive adequate arch support. "The tendon that supports the foot's arches weakens over time due to decreased blood flow, which means your arch drops," says Reid. "It usually starts as a vague feeling of weakness or muscle strain and is often misdiagnosed as plantar fasciitis. People tend to ignore it but it can cause the tendon to rupture, which may require surgical repair."

3. Arthritis - People tend to think about big-toe bunions when they think about arthritis in the foot, as arthritis often follows when bunions develop. But Reid, who practices in Naperville, says arthritis can develop in any joint. "Older people often develop arthritis across the top of the foot or in the instep, and it's quite painful," she says. "This is another instance where proper orthotics early on can make a big difference."

One last caveat: If you have diabetes, put your podiatrist on speed-dial because you'll be seeing a lot of each other. "Diabetes is a multi-organ disease that requires constant vigilance because decreased blood flow and neuropathy magnifies everything that happens in the feet," says Contento. "I want to see all my diabetic patients twice a year if they are not having problems and every 2 to 3 months if they are. Diabetics literally should not even be cutting their own toenails due to the risk of infection."

Fortunately, Medicare should cover nail trims every 60 days for people with diabetes. "That's a good interval," Contento says. "It lets me check the feet's skin, neurological status and circulation on a regular basis."

According to Reid, at a certain point, even people 55+ without diabetes should plan on leaving the regular foot care to a pro: "Once reaching or seeing your toes becomes a problem, plan on coming in every few months. An office visit charge of $40-$60 is well worth the peace of mind."

Copyright © 2011, Chicago Tribune

To Bandage or Not to Bandage

Q: What is the best way to treat diabetic ulcers on the legs? I have new ones every day and it's hard to decide if they should be bandaged or not. They are always seeping. Please send some advice.

A: Leg ulcers can indeed be difficult and frustrating to treat, and they usually take a long time to heal. Treatment recommendations have changed over the years; it's confusing to decide what to do. Unfortunately, the treatment of leg ulcers is not simple. Specific therapy depends on the cause, size and depth, location and duration of the ulcer. That's why there is not just one answer to the question. What Dr. Benjamin Weaver suggests is to work with your doctor to develop the best treatment plan for your specific situation.

How Should a Diabetic Foot Ulcer Be Treated?

The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing, the less chance for an infection.

There are several key factors in the appropriate treatment of a diabetic foot ulcer:
Prevention of infection.
Taking the pressure off the area, called "off-loading."
Removing dead skin and tissue, called "debridement."
Applying medication or dressings to the ulcer.
Managing blood glucose and other health problems.
Not all ulcers are infected; however if the physician diagnoses an infection, a treatment program of antibiotics, wound care, and possibly hospitalization will be necessary.

There are several important factors to keep an ulcer from becoming infected:

Keep blood glucose levels under tight control.
Keep the ulcer clean and bandaged.
Cleanse the wound daily, using a wound dressing or bandage.
Do not walk barefoot.
For optimum healing, ulcers, especially those on the bottom of the foot, must be "off-loaded." Patients may be asked to wear special footgear, or a brace, specialized castings, or use a wheelchair or crutches. These devices will reduce the pressure and irritation to the ulcer area and help to speed the healing process.

The science of wound care has advanced significantly over the past ten years. The old thought of "let the air get at it" is now known to be harmful to healing. We know that wounds and ulcers heal faster, with a lower risk of infection, if they are kept covered and moist. The use of full strength betadine, peroxide, whirlpools and soaking are not recommended, as this could lead to further complications.

Appropriate wound management includes the use of dressings and topically-applied medications. These range from normal saline to advanced products, such as growth factors, ulcer dressings, and skin substitutes that have been shown to be highly effective in healing foot ulcers.

For a wound to heal there must be adequate circulation to the ulcerated area. The physician can determine circulation levels with noninvasive tests.