Diabetic Blisters

Blisters can be potentially very dangerous in patients who suffer with Diabetes. Normally treatment in a healthy patient would be to lance the blister and leave the flap of skin attached to offer protection to the soft tissue underneath also to apply Tinc Benzoin or other healing agents to speedily heel up the site together with a sterile dressing and follow up appointments. As a preventative measure avoid pressure blister points the use of orthotics/ Padding to help the patient of load pressure that may be causing the problem in the first place.

Podiatry Expert Witness

Podiatry expert witness, what is it? It is a Podiatrist that gives legal testimony before a court.Usually expert are called upon by lawyers and are able also to provide them with a medico Lego report to help resolve matters in professional matters.

However this kind of work that Podiatrists are called to undertake is usually very demanding and has to be tried and tested over many years, so any report writing must be able to stand the test of time.

There are specialized organizations that are able to assist lawyers when choosing a Podiatrist expert witness, one of the leading firms that specialize in this work are known as the Round Table http://www.roundtablegroup.com/about/areasofexpertise/

We at The Stephen Kite Practice UK are pleased to be a part of their portfolio of Podiatry experts.

Other well established expert witness firms include Society of expert witnesses,also the society of chiropodists and podiatrists have a list of experts.

The Academy of Experts are also a good place to find a Podiatrist expert Witness.

This kind of work that podiatrists can undertake though can be rigorous and can involve having to present your finding in a court of law and having to be cross examined with questions from top barristers, so it isn't for the faint hearted .

There are courses however that can train the podiatrists in court room techniques and if you are planning to take up such work it would be well advised to go on one of these courses.

Can vitamins replace diabetic drugs?

GRAND RAPIDS -- The pain in Rosemary Sousley's feet had gotten so bad she could barely walk into the next room.

Knowing it was caused by her diabetes and perhaps the chemotherapy she underwent for breast cancer a few years ago didn't help. Neither did the eight Tylenol she was taking every day.

So when her podiatrist, Dr. Michael David, invited her to join a study to determine if a formula of vitamins and minerals could reduce diabetes-related pain, the 68-year-old Middleville woman agreed. 

Within two weeks, the pain in her feet had subsided enough she began cutting back on the Tylenol. Within a month, she was down to one Tylenol a day, and "now I'm at the point of taking two or three a week."

The pain is virtually gone, Sousley said. "It's a warm awareness," she said, "but it's not painful."

Self-heal bandage helps diabetics

Self-healing bandages, which use patients' own cells, could help treat diabetic ulcers, their makers say.

The bandage is being developed by CellTran, a company linked to the University of Sheffield.

Currently, diabetics have to attend clinics over months or even years to have their wounds dressed.

Trials of the bandage have shown it can help these difficult-to-treat wounds to heal in an average of eight weeks. It is already used to treat burns victims.

osteoporosis

Annual treatment for osteoporosis :

A once-a-year treatment significantly cuts the risk of broken bones caused by osteoporosis in post-menopausal women, international research has shown. 

Compared with a dummy pill, an infusion of Aclasta cut the risk of broken hips by 41% and of spinal breaks by 70%. 

The condition accounts for 60,000 hip and 120,000 spinal fractures a year in the UK, mostly among post-menopausal women - and numbers are rising. 

The study features in the New England Journal of Medicine.

Full Story here: http://news.bbc.co.uk/1/hi/health/6615725.stm

National Osteoporosis Society have a lot of useful information. 

www.stephenkitepractice.co.uk 

How to maintain 'happy feet'

The human foot is a marvel of biomechanical engineering that most people take for granted until the system breaks down. The average person will walk the equivalent of twice around the world in a lifetime. 

Podiatrists in the UCLA Medical Group offer the following tips for maintaining healthy feet: 

+Inspect feet regularly and pay attention to changes in color, texture or appearance. 

+Maintain good foot hygiene, including washing and drying between the toes. 

+Hydrate the skin. Southern California weather and open shoes can cause rapid loss of moisture from the skin and may result in cracking or the formation of fissures. It is helpful to replace the moisture content by using lotions or creams on a regular basis. 

+Buy shoes that fit properly. A person may not wear the same size in shoes made by different manufacturers. Purchase new shoes late in the day when feet tend to be at their largest. Always buy the shoes that feel the best. 

+Don't ignore foot pain. Symptoms that increase or do not resolve within a reasonable period of time need evaluation by a podiatrist. 

+Cut toenails straight across. Never cut into the corners- this could cause an ingrown toenail. Gently file away sharp corners or rough edges with an emery board. 

+Exercise. Walking is a great way to keep weight under control and is an excellent conditioner for the feet. Wear appropriate athletic shoes when exercising. 

+Alternate shoes each day. Since the feet have sweat glands, shoes will absorb moisture from feet. It's important to allow shoes to dry out completely. 

+Avoid walking barefoot to help protect feet from injury and infection. 

+Put sunblock on feet while wearing sandals during the day to avoid sunburn. 

Reference Source: UCLA News. 

Diabetes Advice for Patients

Below is some useful advice for Diabetic Patients here in the UK and around the World.

More and more people are developing Diabetes, it is an epidemic due to our lifestyles and diet. The feet can play an important role in ageing successfully and regular exercise together with a healthy diet is a start in the right direction.

Regular check up at the Podiatrist is most important and many Diabetic Clinics in Bournemouth, Dorset have regular out patient departments whereby patients can receive the best of advice and the Diabetic Nurses there know that one of the most important things a diabetic patient should do is to have regular foot care from an HPC Registered Podiatrist

Below is some useful advice from our collegues. You can also visit www.stephenkitepractice.co.uk for free information regarding Diabetic Footcare. 

http://www.aofas.org/files/public/DiabeticFootCareEnglishTranslation.pdf 

The British Influence

A brief history of Chiropody

In the UK . The profession of Chiropody has been established in the UK for approaching 100 years. Some countries like the USA have changed the word traditional Chiropody and have relaced it with Podiatrist in the last 50 years(1967 ) and the term chiropody there is now non existent there. The term "chiropodist" and the profession of chiropody is British in origin and the royal family helped initially to make the profession popular with regular visits to Chiropodists. It has been traditionally used to describe an individual who treats feet in various ways, and up until the 1950's and earlier, there were chiropodists in both the U.S. and Canada based on that British standard. Here in the UK now it is changing too; In 1993 the Society of Chiropodists added the name 'Podiatrists' to its title reflecting the use of this term throughout the English speaking world and with the objective of securing protection of this title for the State Registered profession. 

Although it was the Egyptians who first treated foot conditions and in the bible there are references to treating feet there also, but it was a British man whose name was David Low who invented the word back in the 1700's. There is also written documentation in an Egyptian papyrus of 1500 B.C. outlining a treatment for corns. Hippocrates advocated a sensible approach to corns (thick, hard skin which usually forms on the knuckles of the toes). He recommended a simple operative technique and getting rid of the cause (probably tight sandals or boots). There are records of the King of France employing a personal podiatrist, as did Napoleon. In the United States of America, President Abraham Lincoln suffered greatly with his feet and chose a Chiropodist named Isachar Zacharie, who not only cared for the president’s feet, but also was sent by President Lincoln on confidential missions to confer with leaders of the Confederacy during the U.S. Civil War.

Some Common Mistakes

The word Chiro ( Cheir ) the is relative to the hand, wherby, Pody is the foot hence the word Chiropody. The pronunciation of the word is actually Cheiropody ( Chiropody )with the K being more strongly pronounced than the ch sound. The word Chiropody has been wrongly pronounced . I often say to patients who wrongly mis pronounce this word by comparing it to Christmas, you wouldn't say Shristmas , now would you!

The new word for Chiropody today is now Podiatry & Podiatrist less chance of this word being mis pronounced or spelt incorrectly.

Podiatrist comes from the Greek Word Greek podos, "foot," and iatros, "doctor.

Turf Toe Syndrome

What is Turf Toe?

Turf toe can occur after a very vigorous upward bending of the big toe. It got it's name due to the fact that it occurs frequently in people who play games on artificial surfaces. The shoe grips hard on the surface and sticks causing bodyweight to go forward and so bending the toe up. It is also common in martial arts. You are more at risk if you have increased range of motion in the ankle and / or wear soft flexible shoes.

When the toe is bent upwards this causes damage to the ligaments which can become stretched. In addition the surfaces of the bones at the joint can become damaged. You should really have an X-ray to check if a bone has not been broken. 

Symptoms of turf toe include: 

Swelling and pain at the joint of the big toe and metatarsal bone in the foot. 

Pain and tenderness on bending the toe or pulling (stretching) it upwards. 

What can the athlete doto prevent turf toe?

Ice the injury immediately. 

Apply a compression bandage. 

See a sports injury professional for advice. 

Rest, which might include crutches to take the weight off the toe. 

Use a brace to protect the toe - or at the very least wear a shoe that has a firm sole that will not allow bending. 

What can a Podiatrist/Sports Therapist do?

X-ray to check for a fracture. 

Apply ultrasound or other electrotherapy treatment. 

After 2 to 4 days the athlete may be able to weight bear again. 

Tape the toe to prevent movement. 

Advise on a rehabilitation programme. 

Recovery of this injury can take three to four weeks depending on how bad the sprain is. If the athlete does not look after this injury then it may develop into Hallux Limitus! This is a decreased range of motion due to arthritis around the joint.

Reference Sports Injury Clinic

15 Ways To Keep Cool When it’s Hot

As temperatures reach record highs in the UK (England) in july 2006 it is time to review some sound advice to keep safe in the sun. 

Try some of these tips:

1: Alter your pattern of outdoor exercise to take advantage of cooler times (early morning or late evening). If you can’t change the time of your workout, scale it down by doing fewer minutes, walking instead or running, or decreasing your level of exertion. 

2: Wear loose-fitting clothing, preferably of a light color. 

3: Cotton clothing will keep you cooler than many synthetics.

4: Fill a spray bottle with water and keep it in the refrigerator for a quick refreshing spray to your face after being outdoors. 

5: Fans can help circulate air and make you feel cooler even in an air-conditioned house. 

6: Try storing lotions or cosmetic toners in the refrigerator to use on hot, overtired feet. 

7: Keep plastic bottles of water in the freezer; grab one when you’re ready to go outside. As the ice melts, you’ll have a supply of cold water with you. 

8: Take frequent baths or showers with cool or tepid water.

9: Combat dehydration by drinking plenty of water along with sports drinks or other sources of electrolytes.

10: Some people swear by small, portable, battery-powered fans. At an outdoor event I even saw a version that attaches to a water bottle that sprays a cooling mist. 

11: Pour a bit of ice cold water into the hat, then quickly invert it and place on your head. 

12: Avoid caffeine and alcohol as these will promote dehydration. 

13: Instead of hot foods, try lighter summer fare including frequent small meals or snacks containing cold fruit or low fat dairy products. As an added benefit, you won’t have to cook next to a hot stove. 

14: If you don’t have air-conditioning, arrange to spend at least parts of the day in a shopping mall, public library, movie theater, or other public space that is cool. Many cities have cooling centers that are open to the public on sweltering days. 

15: Finally, use common sense. If the heat is intolerable, stay indoors when you can and avoid activities in direct sunlight or on hot asphalt surfaces. Pay special attention to the elderly, infants, and anyone with a chronic illness, as they may dehydrate easily and be more susceptible to heat-related illnesses. Don’t forget that pets also need protection from dehydration and heat-related illnesses too. 

Reference Source: Medicinenet.com

Chamomile

The chamomiles (or camomiles) have long been used and cultivated by Europeans and Americans. There is hardly one western herbal published in the past 500 years that does not include this group of plants. Tyler (1993) notes that the Germans refer to it as alles zutraut (capable of anything), equating its reputation (though not uses) as a popular European herb with the status afforded ginseng in other cultures.

Soccer helps men express their feelings -study

LONDON - Soccer gives men a way to express their innermost thoughts and feelings, according to a pre World Cup survey.

Almost two-thirds of men (64%) believe that while watching or playing soccer, they are more willing to share their feelings with other men than when doing other activities.

Three quarters said they would not be embarrassed to hug their mates while watching a match.

"Football does have positive effects on people's psychological well-being," said Sandy Wolfson, Head of Psychology at Northumbria University.

"It gives people a ready-made topic of conversation where opinions on team selection, strategy, and players' skills are enjoyable topics for debate," he added.

The survey was carried out by the Mental Health Research Foundation, an independent organization devoted to helping people across the UK maintain good mental health. It was conducted online, with 500 male participants ranging from ages 18-70.

"It is encouraging that football makes it easier for men to talk about their feelings as traditionally, men are far less likely than women to share their innermost thoughts," said Andrew McCulloch, chairman of the foundation.

Along with hugging their friends, 70 percent of men admitted that a match can make them upset while 58 percent said that what happens over the course of a football match can make them aggressive.

However, the ability of football to bring out a man's emotions does have its limits -- three-quarters of men polled said they had never cried over the outcome of a match.

© Reuters 2006. All Rights Reserved.

Are Boots To Blame For England Football Injuries?

The current question among England football fans after star player, Wayne Rooney, broke the fourth metatarsal bone on his right foot, is whether the boots are to blame for the number of injuries experienced by English footballers.

If Rooney makes a swift recovery he may be able to play in some of the World Cup matches. Whether he will be fighting fit is doubtful.

Rooney was wearing Nike Total 90 Supremacy boots. He wore them for the first time on the day he had the injury. Nike denies its boots are linked to a higher risk of injury.

Tom Docherty, who used to manage Manchester United, Rooney's current team, said to the Manchester Evening news that his wife, a physiotherapist, thinks the boots are to blame.

Docherty said that when he was a professional football player in the 1950s it used to take six weeks to break a pair of boots in. Players used to have to put them in a bucket of water. He added that balls are much lighter now and the pitches are in much better condition. Docherty believes the modern boot does not support the foot properly.

Rooney broke a metatarsal in 2004. David Beckham, Gary Neville and Roy Keane have all suffered a broken metatarsal.

When football pitches were not so good in the 70s and 80s hernias were the most common injuries.

Some ex-footballers say modern boots are like slippers.

Tony Book, an ex-professional footballer, told the Manchester Evening News he believes the name of the injury has changed. He believes the old ‘broken toe' injury is now reported as ‘fractured/broken metatarsal'.

Others say it is the media attention, or the faster pace of modern football.

The most common comments made by England fans and commentators are:

1. The boots.
2. Players are not getting enough rest.

There Are 5 Metatarsal Bones (in the foot)

-- The First Metatarsal Bone
Os metatarsale I; metatarsal bone of the great toe
The thickest and shortest one.

-- The Second Metatarsal Bone
Os metatarsale II
The longest one
David Beckham's injury in 2002

-- The third metatarsal bone
Os metatarsale III

-- The fourth metatarsal bone
Os metatarsale IV
Wayne Rooney's current injury

-- The fifth metatarsal bone
Os metatarsale V
Wayne Rooney's injury in 2004

Click Here To See Illustrations - Wikipedia

Written by: Christian Nordqvist
Editor: Medical News Today

Did you Know? There are more than 300 types of foot ailments

There are more than 300 types of foot ailment, with some resulting from genetic factors. However, for the elderly, most such ailments are caused by habitual neglect or accumulated damage. With just a little effort, people can avoid much harm. But if you are in pain, be sure to get medical treatment without delay.

What is Cyro Surgery?

Cryosurgery is the specialized field of using extremely low temperatures to destroy pathological tissues. Cryosurgery is not a new concept in the elimination of pain. Hippocrates recognized the analgesic and anti inflammatory properties of ice on injuries in the year 430BC.

In the past few decades, cryo-technology has been used in the treatment of malignant tumors of the prostrate, liver and other organs. Moreover, cryosurgery is gaining acceptance in dermatology, plastic surgery, urology, pain management and podiatry.

WHAT ARE THE BEST ORTHOTICS FOR PLANTAR FASCIITIS?

Plantar fasciitis (heel spur syndrome) is a common foot problem in athletes and accounts for approximately 7 percent of the injuries to the lower extremity. With each running step, the athlete subjects the plantar fascia to tremendous cyclic loading. In some athletes, this produces a mechanical irritation to the plantar fascia, resulting in an inflammatory response and pain.

The irritation is the result of biomechanical deformities such as limb length discrepancy, gastrocsoleus equinus, and excessive foot or leg varus, producing midtarsal and subtalar hyperpronation. In turn, this pronation produces a stretch of the plantar fascia as well as unwanted pulling on the origin of the fascia (the medial calcaneal tubercle).

FOOT PUSH UP TEST

Take this simple test to check how well your arches are performing their important functions.

1: In bare feet, stand facing a kitchen counter.

2: Place your palms on the counter with slight pressure.

3: Stand with your back straight, and lift one foot off the floor.

4: Slowly lift the heel of other foot, placing all of your weight onto the ball of your foot.

5: Slowly lower your heel back to the floor.

6: Do 10 foot push-ups.

Repeat steps 1 - 6 with the other foot.

FROSTBITE PRACTICAL SUGGESTIONS

Frostbite means that skin and underlying tissue actually freeze. This condition rarely occurs in still air above -10°C but may do so at higher temperatures in high winds due to the wind chill effect). It cannot be emphasised strongly enough that frostbite need not happen even at extremes of altitude, temperature and fatigue: frequently a degree of carelessness is the chief cause.

Recognition

Below minus 10°C, any tissue that feels numb for more than a few minutes may become frostbitten. Although all climbers are well aware of having suffered from numb cold feet or hands for hours at a time with no ill effects, it is important to realise that while being frost-bitten the subject is senses no more than this familiar numbness. It is wise therefore to have some idea of the temperatures in unfamiliar terrain: many miniature portable thermometers are available, so clip one on your sack or outer jacket zipper tab. If you feel the numbness and the temperature is particularly low it's time to act - flexing the fingers and toes, stamping the feet, clapping your hands or placing them in the armpits or groin should all bring back some sensation. If not, assume some degree of frostbite (probably frostnip) and perform more specific re-warming with warm water as below.

In early (superficial) frostbite in the unthawed state, the skin is yellow-grey, painless, numb and leathery to the touch - pain (lots of it!) occurs as re-warming takes place. In deep frostbite, the tissue is hard, white and obviously frozen like a piece of chicken from a freezer, and medical advice must be sought as soon as possible.

Emergency treatment

For all but trivial frostbite (e.g. a cheek, a fingertip) evacuation to a place of safety is essential. If the feet are frostbitten the difficult decision has to be made about the patient moving on foot. There are no absolute rules but in general, it is better to move for six hours with frozen feet to a place of safety than to thaw the feet at a high camp. Walking on vulnerable inflamed unfrozen tissue can cause further injury.

Once safe, re-warming should begin immediately. Avoid smoking (nicotine contracts blood vessels), but alcohol may be helpful (it dilates blood vessels) - however only provided hypothermia does not co-exist. If possible, immerse the frostbitten area in a saucepan of hand hot water - 39-42°C is optimal. If you have no thermometer heat the water until it is "really quite hot" to the touch, about as hot as your elbow can stand: take great care not to scald the patient! Immerse for periods of 20 minutes, moving fingers and toes if possible, but do not knock or rub the frozen tissue.

Thawing may be extremely painful, but perseverance is the key! After thawing, wrap gently in clean bandages, separating fingers and toes. The victim must use thawed tissue as little as possible - this may require them being nursed, fed and helped at the lavatory by colleagues. If a hot water container is not available, warm the affected parts in a warm sleeping bag (or on the abdomen, groin or armpits) for several hours. Above 5500m, oxygen should be given if it is available.

Further progress of frostbite

A few hours after thawing the tissue swells and during the first two days giant blisters form. Try not to break them, these blisters will settle during the first week albeit to leave tissue hideously discoloured, and if gangrenous, shrunken and black. This carapace, or shell separates in several weeks. If the frostbite is superficial, pink new skin will appear beneath the carapace, if deep, the end of a toe or finger will gradually separate off - an unsightly but usually painless process.

By far the most important emergency treatment after re-warming is to keep the skin as clean as possible to avoid any infection.

Risks and implications of frostbite

The disability caused by frostbite often leads to increased risks in descending difficult ground and usually means abandoning a climb. Anything more than very trivial frostbite means the end of climbing for the patient for a few months at least. It is wise to warn newcomers to cold conditions of these implications - adequate clothing, spare gloves and dry socks should always be carried; boots should not be too tight and if using plastic boots, consider carrying spare inners.

Long term management

There are widely disparate views on the use of drugs in frostbite, a tacit admission that few are really effective. It is imperative to keep damaged tissue free of infection: antibiotics may be necessary, and tetanus toxoid prophylaxis is often recommended.

It is extremely difficult to predict the outcome in the first few weeks after frostbite, and remarkable recoveries occur. Surgery is usually best avoided for several weeks or even months, until it is clear that there is no other alternative.

Summary

Frostbite on a climb is a major emergency, yet with competent nursing care most cases can be looked after in the field, e.g. at a Himalayan base camp. Frostbite can frequently be avoided, but when it does occur, it increases the risks both to the sufferer and their colleagues. Rapid re-warming is recommended and strict adherence to hygiene, but surgery is usually best delayed for at least several weeks, or months.

The UIAA Mountain Medicine Centre is supported by:

Mount Everest FoundationFoundation of Sport and the ArtsBritish Mountaineering Council.

Reference: UIAA Mountain Medicine Centre

FOOT INJURIES

The body's foundation originates with the feet, which support the body weight in a myriad of positions and function over a multitude of surfaces and contours. Most athletic activity begins with and is dependent on the feet. As such, the feet continually bear the brunt of physical stresses and rapidly changing forces thrust on them from all directions.

Injuries involving an athlete's feet are often magnified in severity because the feet are weight bearing structures. A relatively minor injury of the foot can impair an athlete's performance as dramatically as a major injury to another body area. Proper and adequate care should be given all injuries and athletic related conditions of the feet, no matter how minor they appear. 

THE FEET CAN MEASURE THE HEIGHT ( Forensics )

The bones of the feet can tell a lot about a person. What do feet reveal about a person's height? Forensic anthropologists team up with law enforcers to help solve crimes.

Bones of the feet can reveal an interesting fact about an individual. Let's combine math with forensics to see how.

Create a spreadsheet.

List the individuals name, height, and foot length.

Have some adults remove their shoes and measure their height.

Measure the length of the adult's left foot from the wall to the tip of the big toe.

Examine the numbers. Do you see a pattern?

Divide the length of each person's left foot by his/her height. Multiply the quotient by 100. What do you get? You may also want to use the calculator on a computer for this activity.

The results of your calculations should be about 15, illustrating that the length of a person's foot is approximately 15 percent of his or her height.

Find out the approximate height of each of your classmates by measuring their foot and charting it on a spreadsheet. Use this proporation for your calculations: 15/100 = Length of Foot/x (person's height)

When a forensic scientist has the length of a foot, the forensic scientist will be able to approximate the height of the individual. This works best on a full grown individual for the ratio of body parts is slightly different in growing children.

Reference Cyberbee