Up to 10% of the population may present with heel pain over the course of their lives, which underscores the importance of practitioner familiarity with the diagnosis of plantar fasciitis and the associated risk factors, both intrinsic and extrinsic.
Plantar fasciitis is the most common cause of heel pain presenting to the outpatient clinic.1 Although thought of as an inflammatory process, plantar fasciitis is a disorder of degenerative changes in the fascia, and may be more accurately termed plantar fasciosis.2 Plantar fasciitis is diagnosed on the basis of a history of pain on taking the first few steps in the morning, worsening pain with weightbearing, and pain and tenderness to palpation over the medial calcaneal tubercle.1-5 Patients may have decreased ankle dorsiflexion secondary to a tight Achilles tendon, which may lead to a compensatory pronation of the foot.4 Up to one third of patients with plantar fasciitis will present with bilateral symptoms.6
On examination, plantar fasciitis must be distinguished from other causes of plantar heel pain. For example, fat-pad atrophy occurs in elderly patients with pain in the central heel. These patients usually do not complain of pain upon first weight bearing in the morning.7 Tarsal tunnel syndrome is described as burning pain along the area of the posterior tibial nerve inferior to the medial malleolus. Finally, a calcaneal stress fracture is confirmed on examination with use of the squeeze test, tenderness on mediolateral compression of the calcaneus.7
Etiology
Plantar fasciitis is multifactorial in etiology. Intrinsic factors include age, excessive foot pronation, obesity and limited ankle dorsiflexion;1,6,8-12 extrinsic factors include occupational prolonged weightbearing, inappropriate shoe wear, and rapid increases in activity level.1,8,12 These factors combine to create a pathologic overload of the plantar fascia at the calcaneal insertion, causing microtears in the fascia that subsequently lead to perifascial edema and increasing heel pad thickness.2,13,14 As microtears within the fascia increase in size, they may coalesce to form a large symptomatic mass that causes the increase in heel pad thickness and can be identified during surgery. These changes in fascial thickening, particularly in the proximal portion of the plantar fascia extending to the calcaneal insertion, and edema of the adjacent fat pad and underlying soft tissues can typically be seen on magnetic resonance imaging studies.15 Inflexibility of the posterior structures of the foot, combined with weakness of the plantar flexors during pushoff, alters the normal biomechanics of the foot, creating an environment of decreased efficiency of force absorption and production.14 The decrease in force absorption contributes to the overload of the plantar fascia and increasing degenerative changes, which include collagen necrosis, angiofibroblastic hyperplasia, chondroid metaplasia and matrix calcification.2 Plantar fasciitis can also be associated with various seronegative spondyloarthropathies, but in approximately 85% of cases there are no known systemic factors.1,15,16
In runners, plantar fasciitis is primarily believed to be an overuse injury combined with training errors, training surfaces, biomechanical alignment and muscle dysfunction and inflexibility. For example, excessive pronation of the foot leads to increased tension on the plantar fascia during the stance phase of running.18 In athletes who are just beginning their training programs, the lower limb muscles may have yet to develop the necessary strength and flexibility, and shock absorption can be negatively affected.17
Epidemiology
Plantar fasciitis is an important public health disorder as it is the most common cause of heel pain in the outpatient setting.1 Ten percent of people in the United States may present with heel pain over the course of their lives, with 83% of these patients being active working adults between the ages of 25 and 65 years old.3,4 Two large national data sets of ambulatory care data (excluding visits to podiatrists or federal, military, or Veterans Administrations facilities) from the Centers for Disease Control and Prevention’s National Center for Health Statistics found that plantar fasciitis accounts for an average of one million patient visits per year to medical doctors.4 Sixty-two percent of these visits were made to general medicine clinics, while 31% of patients were evaluated by orthopaedic or general surgeons. Additionally, a recent survey of members of the American Podiatric Medical Association revealed that plantar fasciitis/heel pain was the most prevalent condition being treated in podiatric clinics.19 Within the current literature, prevalence rates of plantar fasciitis among a population of runners have been shown to be between 4% and 22%.20,21
Rano et al11 found that the average age of the patients presenting to their facility with heel pain was almost 10 years higher than controls who presented for other reasons. Matheson et al’s retrospective review of 1407 patients from an outpatient sports medicine clinic, found that younger athletes had a lower prevalence of plantar fasciitis (2.5%) than older athletes (6.6%).17 The association of plantar fasciitis with increasing age is consistent with the histopathological findings of degenerative, rather than inflammatory, changes within the plantar fascia.2 These degenerative findings support the hypothesis that plantar fasciitis is secondary to repetitive microtrauma caused by prolonged weightbearing activities.13 The constant overload inhibits the normal repair process, resulting in collagen degeneration, which causes both structural changes and perifascial edema.15,22 These changes in turn lead to a thicker heel pad, which has been shown to be associated with pain in individuals with plantar fasciitis.12,13 Increasing heel pad thickness leads to a loss of heel pad elasticity; both of these factors are associated with increasing age and increasing BMI.23 The decrease in elasticity of the fascia seen with increasing age is associated with a decrease in shock absorbing capabilities,23 which may be a result of the degenerative fascia’s inability to resist normal tensile loads.22 It is this decrease in shock absorbing capability that is believed to cause the pain associated with plantar fasciitis.
The current literature is inconsistent regarding the association between sex and plantar fasciitis, with some studies showing an increased prevalence in men,18,24 while others show an increased prevalence in women.11,25 In a retrospective case-control study of running athletes, Taunton et al found a significant sex difference within their study population, as 54% of those affected were male and 46% were female. In contrast, a prospective study including athletes of varying skill levels by Rano et al11 found a higher percentage of women in the heel pain group than in the control group (66.1% compared with 42.6%; p = 0.015). There are no theories within the current literature hypothesizing the reason for a difference in the prevalence of plantar fasciitis between the two sexes, whether it be a function of different hormones or structural differences caused by genetic variations, as is suggested by the increased incidence of anterior cruciate ligament tears in women compared with men.
Increased body weight10 and increased body mass index (BMI)6,8,9,11 have been shown to be significant risk factors for plantar fasciitis, with a BMI of more than 30 kg/m2 having an odds ratio of 5.6 (95% confidence interval, 1.9 to 16.6; p < 0.01) compared with a BMI of less than 25 kg/m2. Frey and Zamora9 demonstrated a 1.4-fold increased probability of plantar fasciitis being diagnosed in an overweight or obese patient. Rome et al13 suggested that BMI is not related to plantar fasciitis pain in the athletic population, but other factors such as a low estrogen levels in female athletes leading to a reduction in the elasticity of collagen may predispose these patients to plantar fasciitis. Riddle et al8 hypothesized that reduced ankle dorsiflexion is the most important risk factor for the development of plantar fasciitis, as the greater the limitation in ankle dorsiflexion, the greater the amount of compensatory foot pronation and therefore the higher level of loading on the plantar fascia. A study by Scott et al26 found that older patients (mean age 80.2) had reduced ankle range of motion compared with younger patients (mean age 20.9). An exponential relationship between decreasing ankle dorsiflexion and the risk of developing plantar fasciitis has been found, with individuals who have 0o of dorsiflexion or less having an odds ratio of 23.3 (95% confidence interval, 4.3 to 124.4).8 Foot pronation alone, as measured by the Foot Posture Index,27 has also been shown to be significantly greater in patients with chronic plantar heel pain.6
In addition to these intrinsic factors, various extrinsic factors have been related to the development of plantar fasciitis. Several studies have shown an association between work-related prolonged weightbearing and plantar fasciitis.8,24,28,29 In their case series, Lapidus and Guidotti’s patient population included a predominance of occupations that necessitate continual standing or walking, such as waiters, maids, and kitchen workers. In addition, each heel strike during running causes compression of the heel pad up to 200% of body weight.30 Therefore, in individuals who may not have adequate muscle strength or flexibility, and therefore have decreased shock-absorbing capabilities, the initiation of a new training program can exacerbate overloading of the plantar fascia.30 Increases in tensile loading, seen with new increases in running intensity or frequency and changes in general footwear have been associated with overloads of the plantar fascia leading to microtears.14 In particular, firm footwear may exacerbate the developing plantar fasciitis in these patients.28 Additionally, plantar fasciitis has also been associated with young individuals engaging in sports involving jumping.15
In order to determine epidemiological risk factors and the current incidence of plantar fasciitis within a population of individuals with a high level of physical activity, Scher et al31 accessed a database from the United States Armed Forces. The United States Armed Forces represent a physically active population of ethnically diverse male and female service members with generally high occupational demands. They participate in daily, organized physical fitness training programs and are subject to the physical rigors of repeated combat deployments. The inability to meet these physical requirements secondary to a medical condition, such as plantar fasciitis, may necessitate a medical discharge from military service. In this population, the authors chose to look at various epidemiological risk factors in order to identify groups at high risk of developing plantar fasciitis. The authors used the Defense Medical Epidemiology Database, which compiles ICD-9 coding information for every patient encounter in a military treatment facility.
The overall incidence of plantar fasciitis in the military population was 10.55 per 1,000 person-years. Female sex; black race; junior enlisted, senior enlisted and senior officer rank groups; military service in the Army or Marines; and age greater than 24 years old were found to be significant risk factors for the development of incident plantar fasciitis when compared to male sex, white race, junior officers rank, service in the Air Force, and age 20 to 24, respectively. Female subjects, when compared with male subjects, had a significantly increased incidence rate ratio for plantar fasciitis of 1.95 (95% CI 1.93-1.98). These findings are based on incidence rates, but tend to correlate with prevalence data seen within the existing literature.
Summary
As 10% of the population may present with heel pain over the course of their lives, a familiarity with the diagnosis and risk factors for plantar fasciitis is important for both primary care and specialty practitioners. Obesity, decreased ankle dorsiflexion, a pronated foot, and increasing age are important intrinsic risk factors that have been associated with plantar fasciitis. The extrinsic risk factors include prolonged occupational weightbearing, increasing activity levels, and inappropriate shoe wear. With the knowledge of specific risk factors for the development of plantar fasciitis, the next step is to develop preventive measures, such as plantar-specific stretching programs and changes in footwear, to decrease the current incidence of this disorder.
by Capt. Danielle L. Scher, MD; Lt. Col. Philip J. Belmont, Jr., MD; and Maj. Brett D. Owens, MD
Monday, October 31, 2011
Sunday, October 30, 2011
Sleeping Difficulties Increase Risk of Eye Disease in People with Diabetes
People with Type 2 diabetes who have obstructive sleep apnea (OSA) are more at risk of losing their sight due to severe retinopathy, as well as foot problems and possible amputation because of neuropathy....
Researchers from the University of Birmingham looked at 231 people with Type 2 diabetes of whom 149 had OSA, a sleep disorder caused by disturbed breathing. They found there were twice as many people with severe retinopathy (48 percent) in the group with OSA compared to the group without OSA (20 percent).
In a separate study, the researchers found that OSA was also linked to neuropathy. They looked at 230 people with Type 2 diabetes of whom 148 had OSA. They found that 60 percent of the group with OSA had neuropathy compared to 22 percent in the group without OSA.
According to Dr. Iain Frame, Director of Research at Diabetes UK, said, "We already know that there is a high prevalence of OSA in people with Type 2 diabetes. However, this is the first time that the link between OSA and retinopathy, and neuropathy in people with Type 2 diabetes has been examined. This research suggests that if someone with Type 2 diabetes also has this sleeping disorder they are more at risk of developing these serious complications compared to someone with the condition who does not have OSA."
"As being overweight is a risk factor for both OSA and Type 2 diabetes, this is yet another reason to highlight the importance of good weight management through a healthy diet and regular physical activity. In people with Type 2 diabetes, the increasing severity of OSA is associated with poorer blood glucose control and the treatment of sleep disorders (in this case by losing weight) has the potential to improve diabetes control and energy levels."
In both studies, the association between OSA and the two diabetes complications in people with Type 2 diabetes was independent of age, gender, ethnicity, blood pressure, blood glucose levels, smoking and cholesterol.
"Our work highlights several important issues," stated Dr. Abd Tahrani, who led the research. "Our results emphasized what is already known -- that OSA is very common in patients with Type 2 diabetes, much higher than OSA prevalence in the general population. Furthermore, our results suggest that OSA is not an innocent bystander in patients with Type 2 diabetes and might contribute to morbidities associated with this condition. Whether OSA treatment has any impact on these complications will need to be determined."
Researchers from the University of Birmingham looked at 231 people with Type 2 diabetes of whom 149 had OSA, a sleep disorder caused by disturbed breathing. They found there were twice as many people with severe retinopathy (48 percent) in the group with OSA compared to the group without OSA (20 percent).
In a separate study, the researchers found that OSA was also linked to neuropathy. They looked at 230 people with Type 2 diabetes of whom 148 had OSA. They found that 60 percent of the group with OSA had neuropathy compared to 22 percent in the group without OSA.
According to Dr. Iain Frame, Director of Research at Diabetes UK, said, "We already know that there is a high prevalence of OSA in people with Type 2 diabetes. However, this is the first time that the link between OSA and retinopathy, and neuropathy in people with Type 2 diabetes has been examined. This research suggests that if someone with Type 2 diabetes also has this sleeping disorder they are more at risk of developing these serious complications compared to someone with the condition who does not have OSA."
"As being overweight is a risk factor for both OSA and Type 2 diabetes, this is yet another reason to highlight the importance of good weight management through a healthy diet and regular physical activity. In people with Type 2 diabetes, the increasing severity of OSA is associated with poorer blood glucose control and the treatment of sleep disorders (in this case by losing weight) has the potential to improve diabetes control and energy levels."
In both studies, the association between OSA and the two diabetes complications in people with Type 2 diabetes was independent of age, gender, ethnicity, blood pressure, blood glucose levels, smoking and cholesterol.
"Our work highlights several important issues," stated Dr. Abd Tahrani, who led the research. "Our results emphasized what is already known -- that OSA is very common in patients with Type 2 diabetes, much higher than OSA prevalence in the general population. Furthermore, our results suggest that OSA is not an innocent bystander in patients with Type 2 diabetes and might contribute to morbidities associated with this condition. Whether OSA treatment has any impact on these complications will need to be determined."
Friday, October 28, 2011
Killer pumps: Dangers of high heel shoes
Think you need a new pair of high-heeled bejeweled Louboutins? Think again. Many women are obsessed with high heels even if they are painful. Many of them think that high heels indicate higher status. However, this status is worthless if old age is filled with leg and back pain. Experts and doctors have been discussing the reasons why women should stop wearing heels and replace them with comfortable shoes.
Wearing heels brings your whole outfit together and makes your legs look taller and slimmer, but it also can make your ankle ache, says Dr. Nadia Saleh, an orthopedic doctor at Takhasusi Hospital in Riyadh. “Sprained ankles, hammertoes, nerve damage and even knee arthritis are other common problems linked to wearing high heels regularly,” she said.
Saleh says high heels are bad for the body, as they put pressure on one part of the body, requiring the rest of the body to adjust. “Wearing high-heeled shoes positions the foot downward, thus placing more pressure on the forefoot. This position lowers half of the body and makes it extend forward towards the toes. The chest also has to stretch backward to maintain balance, thus affecting the standard posture. As a result, many women who wear high heels often complain about back pain,” she explained.
In fact, wearing high heels can lead to the flattening of the lumbar vertebra (one of 5 vertebrae in the human vertebral column), adds Saleh. “The area in the lower back receives the most stress when wearing heels, especially since it gets pulled backward. This can cause a displacement of the thoracic spine, which is the area in the mid and upper back. Since the upper part of the body leans forward, the body tries to maintain its balance by decreasing the forward curve of the lower back. This position is unhealthy and it leads to lower back pain,” she said.
Wearing heels also affect your walk, she added. “Women tend to think that when it comes to heels, the higher they are, the better they look. This thought is completely wrong for high heels affect the walk. The whole body puts pressure on the forefoot, making legs unable to apply balanced strength on the ground when walking. This in turn puts pressure on the hips and muscles in the legs, making these muscles work harder to move the body forward. Also, since the knees remain bent, it affects the knee muscles as well.”
A British study published in the Journal of Experimental Biology stated that women who wear high heels on a daily basis had a 13% shortening of calf muscles and a noticeable thickening of the Achilles tendon, making it painful to stand on the ground barefoot.
Another study, which was presented in the annual meeting of the American Society of Biomechanics in 2010, stated that high heels increased the compression inside the knee, creating additional joint pain and strain.
“Wearing heels also altered the women's posture, forcing their ankles, knees and hips into unnatural positions that increased their risk for joint degeneration and osteoarthritis,” stated the study.
Arab News asked a number of women if they would switch shoes to save their feet. Eight out of 10 women said they would never give up their stilettos and switch to flats while two said they would go for stylish ballerinas and spare the heels for special occasions.
“We women know that heels are bad for our spine and bones, but it’s just like our bad eating habits and addiction to sugar; we can’t seem to kick the habit of high heels,” said 23-year-old graphic designer, Hawazen Jazzar. “I believe that heels make our outfits look complete and give it this feminine and girly touch even if we’re just wearing jeans and a T-Shirt.”
Knowing the effects of high heels by heart will not make women give up high heels, says Saleh. “I will not ask women to completely give up the idea of wearing high heels, I just ask them to wear them during special occasions. Wearing high heels repeatedly can cause chronic ailments, so I only recommend a heel with a height of 1.5 inches for daily purposes,” she added.
Wearing heels brings your whole outfit together and makes your legs look taller and slimmer, but it also can make your ankle ache, says Dr. Nadia Saleh, an orthopedic doctor at Takhasusi Hospital in Riyadh. “Sprained ankles, hammertoes, nerve damage and even knee arthritis are other common problems linked to wearing high heels regularly,” she said.
Saleh says high heels are bad for the body, as they put pressure on one part of the body, requiring the rest of the body to adjust. “Wearing high-heeled shoes positions the foot downward, thus placing more pressure on the forefoot. This position lowers half of the body and makes it extend forward towards the toes. The chest also has to stretch backward to maintain balance, thus affecting the standard posture. As a result, many women who wear high heels often complain about back pain,” she explained.
In fact, wearing high heels can lead to the flattening of the lumbar vertebra (one of 5 vertebrae in the human vertebral column), adds Saleh. “The area in the lower back receives the most stress when wearing heels, especially since it gets pulled backward. This can cause a displacement of the thoracic spine, which is the area in the mid and upper back. Since the upper part of the body leans forward, the body tries to maintain its balance by decreasing the forward curve of the lower back. This position is unhealthy and it leads to lower back pain,” she said.
Wearing heels also affect your walk, she added. “Women tend to think that when it comes to heels, the higher they are, the better they look. This thought is completely wrong for high heels affect the walk. The whole body puts pressure on the forefoot, making legs unable to apply balanced strength on the ground when walking. This in turn puts pressure on the hips and muscles in the legs, making these muscles work harder to move the body forward. Also, since the knees remain bent, it affects the knee muscles as well.”
A British study published in the Journal of Experimental Biology stated that women who wear high heels on a daily basis had a 13% shortening of calf muscles and a noticeable thickening of the Achilles tendon, making it painful to stand on the ground barefoot.
Another study, which was presented in the annual meeting of the American Society of Biomechanics in 2010, stated that high heels increased the compression inside the knee, creating additional joint pain and strain.
“Wearing heels also altered the women's posture, forcing their ankles, knees and hips into unnatural positions that increased their risk for joint degeneration and osteoarthritis,” stated the study.
Arab News asked a number of women if they would switch shoes to save their feet. Eight out of 10 women said they would never give up their stilettos and switch to flats while two said they would go for stylish ballerinas and spare the heels for special occasions.
“We women know that heels are bad for our spine and bones, but it’s just like our bad eating habits and addiction to sugar; we can’t seem to kick the habit of high heels,” said 23-year-old graphic designer, Hawazen Jazzar. “I believe that heels make our outfits look complete and give it this feminine and girly touch even if we’re just wearing jeans and a T-Shirt.”
Knowing the effects of high heels by heart will not make women give up high heels, says Saleh. “I will not ask women to completely give up the idea of wearing high heels, I just ask them to wear them during special occasions. Wearing high heels repeatedly can cause chronic ailments, so I only recommend a heel with a height of 1.5 inches for daily purposes,” she added.
Thursday, October 27, 2011
Michael Lohan Arrested Again, Tries to Flee Cops by Jumping Off Balcony
Michael Lohan’s in trouble with the law for the second time this week.
According to ABC affiliate WFTS, Tampa, Fla. police took the father of “Mean Girls” star Lindsay Lohan into custody early Thursday for violating the terms of his release. He was arrested Tuesday on a domestic abuse complaint.
Kate Major, Michael Lohan’s girlfriend who filed the original complaint, notified Tampa police to say that he had contacted her by phone. When they showed up at Major’s home, Lohan allegedly called Major again. Upon contacting the Hillsborough County State Attorney’s office, police were given the okay to arrest him.
Then things got hairy. Cops said Lohan tried to flee the scene by jumping off of a third floor balcony. He didn’t escape and was apprehended shortly thereafter. Paramedics initially determined that Lohan was not hurt from the jump, whereupon he was transported to the Hillsborough County Jail for booking. But once he arrived at the jail, deputies suspected Lohan might have broken his foot. Early this morning he headed to Tampa General Hospital for evaluation and is expected to go back to jail for processing after.
According to ABC affiliate WFTS, Tampa, Fla. police took the father of “Mean Girls” star Lindsay Lohan into custody early Thursday for violating the terms of his release. He was arrested Tuesday on a domestic abuse complaint.
Kate Major, Michael Lohan’s girlfriend who filed the original complaint, notified Tampa police to say that he had contacted her by phone. When they showed up at Major’s home, Lohan allegedly called Major again. Upon contacting the Hillsborough County State Attorney’s office, police were given the okay to arrest him.
Then things got hairy. Cops said Lohan tried to flee the scene by jumping off of a third floor balcony. He didn’t escape and was apprehended shortly thereafter. Paramedics initially determined that Lohan was not hurt from the jump, whereupon he was transported to the Hillsborough County Jail for booking. But once he arrived at the jail, deputies suspected Lohan might have broken his foot. Early this morning he headed to Tampa General Hospital for evaluation and is expected to go back to jail for processing after.
Killing the pain of killer heels
ECCENTRIC superstar Lady Gaga’s recent interview with TV’s Paul O’Grady may have drawn gasps from audiences for many different reasons.
Perhaps her bald head, bold lyrics or bright green wig might have been startling to some but, for me, it was the towering heels in which she tottered across the stage which caused the biggest surprise.
For many decades now celebrities have been setting the trend in the fashion for “killer heels” and a quick trip to high street shoe shops will prove the point that new shoe styles seem to becoming higher and more daring than ever before.
Iconic French designer Christian Louboutin even hit the headlines this week for creating a pair of his famous red-soled eight inch stilettos which will now be auctioned off to raise funds for the English National Ballet.
And although these shoes would probably only ever be attempted by a ballet dancer at best, a visit to most UK town centres on a Friday or Saturday night will prove that young women are still opting for killer heels which can leave them hobbling and limping home after a long evening out.
But what impact does the wearing of high heels really have on a person’s feet?
Podiatrist Kerri Money, who works at PhysioPlus in Kingsthorpe, said she believed only a section of 18 to 23-year-olds really attempt to wear super high heels, but those who wear them routinely should be aware of their biomechanical impact on the body.
She said: “When you are in a high heeled shoe, your body has been made unstable so the shoe will affect the way you stand and walk. Your back will be more arched, your pelvis pushed forward and your calf muscles will shorten so your muscles will not be working as they should be.
“If your calves are often flexed they will stay like that, if you are in them all the time and go to a lower heeled shoe you are asking them to be in a position they are not used to.
“In low heeled shoes you can absorb the shock from the ground. If you are not doing that you are pushing the foot forward to absorb the shock, which isn’t what it has been designed to do. In high heels the centre of gravity is pushed forward and the balls of the foot are absorbing the hit of the ground and you are pushing off with them. That is a lot of work and can make the balls of your foot hurt.”
She continued: “We all like to wear heels sometimes but my advice would be to wear them only for short periods. I call them ‘car to bar’ shoes. If you are going out, you should go for thicker soles, the thicker the better. The more sole, the more cushioning there will be to help with shock absorption.”
Other tips from Kerri include trying to vary the types of shoes worn and opting for footwear with more straps, which offer more support.
She said: “Rotate between different shoes. If you are rotating different heels your muscles will work in lots of different positions.
“With more straps you will have more stability.
“With narrow, pointed shoes and high heels that is two negatives. If someone has a bunion and they are in a high heel their centre of gravity will have been pushed forward and they will be putting weight on a problem area.”
According to the NHS, the occasional wearing of high heels will not be harmful but damage can be caused if they are worn often during a working week, particularly when a person has to do a lot of walking or standing.
And poor footwear can have an impact later in life.
Helen Harman, falls practitioner for NHS Northamptonshire, said: “The impact of falling later in life is probably not foremost in the mind of fashion conscious young ladies. However, one of the highest risk factors for falling in later life is related to feet. Poor balance which can lead to severe falls can be a result of poor feet, possibly caused by footwear in earlier years.
“The Northamptonshire Falls Service routinely assesses feet and footwear as part of identifying the possible causes of a fall and aim to minimise falls risks. Advice is given regarding wearing well fitting supportive shoes.
“The effect of poor footwear can cause problems such as a corn, ingrown toenails, a callus or bunions.
“Frequently money is spent on appearance such as facials/makeup/hair styles but, despite our feet walking many miles over the years and being vital to wellbeing, they are often neglected.”
Perhaps her bald head, bold lyrics or bright green wig might have been startling to some but, for me, it was the towering heels in which she tottered across the stage which caused the biggest surprise.
For many decades now celebrities have been setting the trend in the fashion for “killer heels” and a quick trip to high street shoe shops will prove the point that new shoe styles seem to becoming higher and more daring than ever before.
Iconic French designer Christian Louboutin even hit the headlines this week for creating a pair of his famous red-soled eight inch stilettos which will now be auctioned off to raise funds for the English National Ballet.
And although these shoes would probably only ever be attempted by a ballet dancer at best, a visit to most UK town centres on a Friday or Saturday night will prove that young women are still opting for killer heels which can leave them hobbling and limping home after a long evening out.
But what impact does the wearing of high heels really have on a person’s feet?
Podiatrist Kerri Money, who works at PhysioPlus in Kingsthorpe, said she believed only a section of 18 to 23-year-olds really attempt to wear super high heels, but those who wear them routinely should be aware of their biomechanical impact on the body.
She said: “When you are in a high heeled shoe, your body has been made unstable so the shoe will affect the way you stand and walk. Your back will be more arched, your pelvis pushed forward and your calf muscles will shorten so your muscles will not be working as they should be.
“If your calves are often flexed they will stay like that, if you are in them all the time and go to a lower heeled shoe you are asking them to be in a position they are not used to.
“In low heeled shoes you can absorb the shock from the ground. If you are not doing that you are pushing the foot forward to absorb the shock, which isn’t what it has been designed to do. In high heels the centre of gravity is pushed forward and the balls of the foot are absorbing the hit of the ground and you are pushing off with them. That is a lot of work and can make the balls of your foot hurt.”
She continued: “We all like to wear heels sometimes but my advice would be to wear them only for short periods. I call them ‘car to bar’ shoes. If you are going out, you should go for thicker soles, the thicker the better. The more sole, the more cushioning there will be to help with shock absorption.”
Other tips from Kerri include trying to vary the types of shoes worn and opting for footwear with more straps, which offer more support.
She said: “Rotate between different shoes. If you are rotating different heels your muscles will work in lots of different positions.
“With more straps you will have more stability.
“With narrow, pointed shoes and high heels that is two negatives. If someone has a bunion and they are in a high heel their centre of gravity will have been pushed forward and they will be putting weight on a problem area.”
According to the NHS, the occasional wearing of high heels will not be harmful but damage can be caused if they are worn often during a working week, particularly when a person has to do a lot of walking or standing.
And poor footwear can have an impact later in life.
Helen Harman, falls practitioner for NHS Northamptonshire, said: “The impact of falling later in life is probably not foremost in the mind of fashion conscious young ladies. However, one of the highest risk factors for falling in later life is related to feet. Poor balance which can lead to severe falls can be a result of poor feet, possibly caused by footwear in earlier years.
“The Northamptonshire Falls Service routinely assesses feet and footwear as part of identifying the possible causes of a fall and aim to minimise falls risks. Advice is given regarding wearing well fitting supportive shoes.
“The effect of poor footwear can cause problems such as a corn, ingrown toenails, a callus or bunions.
“Frequently money is spent on appearance such as facials/makeup/hair styles but, despite our feet walking many miles over the years and being vital to wellbeing, they are often neglected.”
Wednesday, October 26, 2011
Restaurant Calorie Counts Not Always Accurate
About 20% of meals tested by scientists pack at least 100 more calories than indicated on the menu, a study finds. Some foods are off by as much as 225 calories....
Dieters beware: offerings at popular restaurants may have more calories than what's stated on menus or company websites.
A team of scientists purchased items from 42 fast-food and sit-down eateries in Indiana, Arkansas and Massachusetts, and then measured the calories they contained. The list of stops on their calorie-busting tour included Burger King, Olive Garden, Outback Steakhouse, McDonald's, Taco Bell and Chuck E. Cheese's.
Susan Roberts, lead study author at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, stated that, only 7% of the 269 foods tested were within 10 calories of what the restaurants stated, the scientists found. And almost 20% packed at least 100 more calories than what was indicated. Over the course of a year, an extra 100 calories daily can add up to 10 to 15 pounds.
The biggest discrepancies occurred at sit-down restaurants, where the stated calorie information and what the researchers measured, was off by an average of 225 calories, according to the study. At fast-food restaurants, the average discrepancy was 134 calories per menu item.
The most variable foods included those that dieters are more likely to choose, such as an order of three pieces of dark chicken meat at Boston Market — listed as 358 calories but packing more than 500 in the study — and the cranberry pecan chicken salad at the Midwestern restaurant chain Bob Evans, listed as 841 calories but weighing in at over 1,100 calories — more than half of what an average adult should eat in a day.
The researchers later repurchased and retested 13 of the 17 menu selections with the greatest calorie discrepancies, and found that the items were often repeat offenders. For example, Chipotle Mexican Grill's burrito bowl, which is supposed to be 454 calories, was 703 calories on one occasion and 567 on the second. The 17 foods had more than 250 extra calories on average than what was stated.
It's too early to tell whether calorie information affects what types of foods people purchase, let alone obesity rates, experts said. A 2010 study showed that parents used calorie information to choose more healthful foods for their children -- but not themselves.
In New York City, Starbucks customers ordered 6% fewer calories after menu labeling laws went into effect in 2008, according to another 2010 study.
Restaurant food accounts for 35% of the calories Americans eat today, the authors noted.
Dieters beware: offerings at popular restaurants may have more calories than what's stated on menus or company websites.
A team of scientists purchased items from 42 fast-food and sit-down eateries in Indiana, Arkansas and Massachusetts, and then measured the calories they contained. The list of stops on their calorie-busting tour included Burger King, Olive Garden, Outback Steakhouse, McDonald's, Taco Bell and Chuck E. Cheese's.
Susan Roberts, lead study author at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, stated that, only 7% of the 269 foods tested were within 10 calories of what the restaurants stated, the scientists found. And almost 20% packed at least 100 more calories than what was indicated. Over the course of a year, an extra 100 calories daily can add up to 10 to 15 pounds.
The biggest discrepancies occurred at sit-down restaurants, where the stated calorie information and what the researchers measured, was off by an average of 225 calories, according to the study. At fast-food restaurants, the average discrepancy was 134 calories per menu item.
The most variable foods included those that dieters are more likely to choose, such as an order of three pieces of dark chicken meat at Boston Market — listed as 358 calories but packing more than 500 in the study — and the cranberry pecan chicken salad at the Midwestern restaurant chain Bob Evans, listed as 841 calories but weighing in at over 1,100 calories — more than half of what an average adult should eat in a day.
The researchers later repurchased and retested 13 of the 17 menu selections with the greatest calorie discrepancies, and found that the items were often repeat offenders. For example, Chipotle Mexican Grill's burrito bowl, which is supposed to be 454 calories, was 703 calories on one occasion and 567 on the second. The 17 foods had more than 250 extra calories on average than what was stated.
It's too early to tell whether calorie information affects what types of foods people purchase, let alone obesity rates, experts said. A 2010 study showed that parents used calorie information to choose more healthful foods for their children -- but not themselves.
In New York City, Starbucks customers ordered 6% fewer calories after menu labeling laws went into effect in 2008, according to another 2010 study.
Restaurant food accounts for 35% of the calories Americans eat today, the authors noted.
Thursday, October 20, 2011
6 Emergency Complications of Type 2 Diabetes
Uncontrolled diabetes can control your health. Help prevent these serious diabetes complications by learning the warning signs.
People with type 2 diabetes are at increased risk of many serious health problems, including heart attack, stroke, vision loss, and amputation. But by keeping your diabetes in check — that means maintaining good blood sugar control — and knowing how to recognize a problem and what to do about it should one occur, you can prevent many of these serious complications of diabetes.
Heart Attack
Heart disease and stroke are the top causes of death and disability in people with diabetes. If you experience any of the following heart attack warning signs, call 911 immediately:
-Chest discomfort that feels like pressure, squeezing, fullness, or pain in the center of your chest, lasting for a short time or going away and returning
-Pain elsewhere, including the back, jaw, stomach, or neck; or pain in one or both arms
•Shortness of breath
•Nausea or lightheadedness
Heart attack symptoms may appear suddenly or be subtle, with only mild pain and discomfort.
Stroke
Stroke warning signs may include:
Sudden numbness or weakness in the face, arm, or leg, especially if it occurs on one side of the body
-Feeling confused
-Difficulty walking and talking and lacking coordination
-Developing a severe headache for no apparent reason
If you suddenly experience any of these stroke symptoms, call 911 immediately. As with a heart attack, immediate treatment can be the difference between life and death.
Nerve Damage
People with diabetes are at increased risk of nerve damage, or diabetic neuropathy, due to uncontrolled high blood sugar. As a result, various foot and skin problems can occur, including:
•Foot problems. Nerve damage associated with type 2 diabetes can cause a loss of feeling in your feet, which makes you more vulnerable to injury and infection. You may get a blister or cut on your foot that you don't feel and, unless you check your feet regularly, an infection can develop. Untreated infections can result in gangrene (death of tissue) and ultimately amputation of the affected limb.
•Skin problems. Diabetes can make it more difficult for your body to fight infections, causing skin problems. Various skin conditions are linked to diabetes, and even the most minor cuts or sores can turn serious fast. Any bumps, cuts, or scrapes should be cleaned and treated with an antibiotic cream and monitored carefully.
If you notice any of the following symptoms, see your doctor:
•Inflammation and tenderness anywhere on your body
•Red, itchy rash surrounded by small blisters or scales
•Cuts, sores, or blisters on your feet that are slow to heal and are not as painful as you would expect
•Numbness, tingling, or burning sensations in your hands or feet, including your fingers and toes
•Sharp pain that gets worse at night
•Muscle weakness that makes walking difficult
•Bladder infections and problems with bladder control
•Bloating, stomach pain, constipation, nausea, vomiting, or diarrhea
•Erectile dysfunction in men and vaginal dryness in women
Kidney Disease
Type 2 diabetes increases your risk of kidney disease, or diabetic nephropathy, a condition in which the blood vessels in your kidneys are damaged to the point that they cannot filter out waste properly. If left untreated, dialysis (a treatment to filter out waste products from the blood) and ultimately a kidney transplant may be needed.
Typically, you won’t notice symptoms of kidney disease until it has advanced. However, if you experience any of the following symptoms, tell your doctor:
•Swelling in your ankles and legs
•Leg cramps
•A need to go to the bathroom more often at night
•A reduction in your need for insulin
•Nausea and vomiting
•Weakness and paleness
•Itching
The best way to prevent type 2 diabetes-related kidney problems is to have your urine, blood, and blood pressure monitored regularly and to keep your blood sugar and blood pressure under control.
Eye Problems
People with type 2 diabetes are at risk of several eye conditions, including diabetic retinopathy (which affects the blood vessels in the eye), glaucoma, and cataracts. If left untreated, these conditions can cause vision loss.
Call your doctor if you notice any of these warning signs:
•Blurry vision that lasts for more than two days
•Sudden loss of vision in one or both eyes
•Floaters, black or gray spots, cobwebs, or strings that move when you move your eyes
•A sensation of seeing "flashing lights"
•Pain or pressure in one or both eyes
Hyperglycemia
Hyperglycemia means you have too much sugar in your blood. High blood sugar doesn't always produce symptoms; therefore, it is important to check your blood sugar regularly, as indicated by your doctor. When symptoms of hyperglycemia occur, they may include:
•Frequent urination
•Extreme thirst
•Feeling tired and weak
•Blurry vision Feeling hungry even after eating
If you frequently have high blood sugar, tell your doctor. He or she may need to make changes to your medication and suggest diet and lifestyle modifications to help you gain and maintain better blood sugar control.
The key to preventing many of the complications of diabetes is to keep your blood sugar at a healthy level. To do this, eat right, exercise, monitor your blood sugar as recommended by your doctor, and don't smoke.
Report any unusual signs or symptoms to your doctor. Together you can work to prevent these diabetes-related health complications.
By Hedy Marks, MPH
Medically reviewed by Pat F. Bass III, MD, MPH
People with type 2 diabetes are at increased risk of many serious health problems, including heart attack, stroke, vision loss, and amputation. But by keeping your diabetes in check — that means maintaining good blood sugar control — and knowing how to recognize a problem and what to do about it should one occur, you can prevent many of these serious complications of diabetes.
Heart Attack
Heart disease and stroke are the top causes of death and disability in people with diabetes. If you experience any of the following heart attack warning signs, call 911 immediately:
-Chest discomfort that feels like pressure, squeezing, fullness, or pain in the center of your chest, lasting for a short time or going away and returning
-Pain elsewhere, including the back, jaw, stomach, or neck; or pain in one or both arms
•Shortness of breath
•Nausea or lightheadedness
Heart attack symptoms may appear suddenly or be subtle, with only mild pain and discomfort.
Stroke
Stroke warning signs may include:
Sudden numbness or weakness in the face, arm, or leg, especially if it occurs on one side of the body
-Feeling confused
-Difficulty walking and talking and lacking coordination
-Developing a severe headache for no apparent reason
If you suddenly experience any of these stroke symptoms, call 911 immediately. As with a heart attack, immediate treatment can be the difference between life and death.
Nerve Damage
People with diabetes are at increased risk of nerve damage, or diabetic neuropathy, due to uncontrolled high blood sugar. As a result, various foot and skin problems can occur, including:
•Foot problems. Nerve damage associated with type 2 diabetes can cause a loss of feeling in your feet, which makes you more vulnerable to injury and infection. You may get a blister or cut on your foot that you don't feel and, unless you check your feet regularly, an infection can develop. Untreated infections can result in gangrene (death of tissue) and ultimately amputation of the affected limb.
•Skin problems. Diabetes can make it more difficult for your body to fight infections, causing skin problems. Various skin conditions are linked to diabetes, and even the most minor cuts or sores can turn serious fast. Any bumps, cuts, or scrapes should be cleaned and treated with an antibiotic cream and monitored carefully.
If you notice any of the following symptoms, see your doctor:
•Inflammation and tenderness anywhere on your body
•Red, itchy rash surrounded by small blisters or scales
•Cuts, sores, or blisters on your feet that are slow to heal and are not as painful as you would expect
•Numbness, tingling, or burning sensations in your hands or feet, including your fingers and toes
•Sharp pain that gets worse at night
•Muscle weakness that makes walking difficult
•Bladder infections and problems with bladder control
•Bloating, stomach pain, constipation, nausea, vomiting, or diarrhea
•Erectile dysfunction in men and vaginal dryness in women
Kidney Disease
Type 2 diabetes increases your risk of kidney disease, or diabetic nephropathy, a condition in which the blood vessels in your kidneys are damaged to the point that they cannot filter out waste properly. If left untreated, dialysis (a treatment to filter out waste products from the blood) and ultimately a kidney transplant may be needed.
Typically, you won’t notice symptoms of kidney disease until it has advanced. However, if you experience any of the following symptoms, tell your doctor:
•Swelling in your ankles and legs
•Leg cramps
•A need to go to the bathroom more often at night
•A reduction in your need for insulin
•Nausea and vomiting
•Weakness and paleness
•Itching
The best way to prevent type 2 diabetes-related kidney problems is to have your urine, blood, and blood pressure monitored regularly and to keep your blood sugar and blood pressure under control.
Eye Problems
People with type 2 diabetes are at risk of several eye conditions, including diabetic retinopathy (which affects the blood vessels in the eye), glaucoma, and cataracts. If left untreated, these conditions can cause vision loss.
Call your doctor if you notice any of these warning signs:
•Blurry vision that lasts for more than two days
•Sudden loss of vision in one or both eyes
•Floaters, black or gray spots, cobwebs, or strings that move when you move your eyes
•A sensation of seeing "flashing lights"
•Pain or pressure in one or both eyes
Hyperglycemia
Hyperglycemia means you have too much sugar in your blood. High blood sugar doesn't always produce symptoms; therefore, it is important to check your blood sugar regularly, as indicated by your doctor. When symptoms of hyperglycemia occur, they may include:
•Frequent urination
•Extreme thirst
•Feeling tired and weak
•Blurry vision Feeling hungry even after eating
If you frequently have high blood sugar, tell your doctor. He or she may need to make changes to your medication and suggest diet and lifestyle modifications to help you gain and maintain better blood sugar control.
The key to preventing many of the complications of diabetes is to keep your blood sugar at a healthy level. To do this, eat right, exercise, monitor your blood sugar as recommended by your doctor, and don't smoke.
Report any unusual signs or symptoms to your doctor. Together you can work to prevent these diabetes-related health complications.
By Hedy Marks, MPH
Medically reviewed by Pat F. Bass III, MD, MPH
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