Diabetic Foot Care Advice

The aim of this blog is to help members of the public to understand their feet better. However the information on this blog should never be regarded as medical advice. Readers with foot problems are strongly encouraged to visit their GP if not the podiatrist for further medical assessment and treatment.

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Monday, December 31, 2007


Clubfoot is a congenital birth defect that affects the alignment of the foot. Newborns with clubfoot have feet that point down and inwards. If the condition is severe, the infant’s feet are rigidly stuck in the misaligned position. Clubfoot is more prevalent among males and those with a family history of the disorder. It may be a symptom of another disorder such as spina bifida. Clubfoot is not the result of behavior or nutrition of the mother during pregnancy.

The physiological cause of the deformity is that some of the tendons of the foot are too short. This restricts the range of movement and keeps the foot in an unnatural position. Milder foot problems that are common in newborns are often misidentified as clubfoot. The treatment for clubfoot is called the Ponseti method. This treatment begins soon after birth.

The Ponseti method involves repeatedly putting casts on the feet the force the stretching of the tendons and realignment of the feet. The casts are changed every week. Each time the feet are put into casts, it brings the foot into more natural alignment. After the series of casts, the child will need to wear braces during the night, usually until the child is two years old. The Ponseti method is sufficient to correct clubfoot in about half of the cases.

If the Ponseti method fails to correct the condition, surgical intervention may be required. Surgical correction of clubfoot involves the release or loosening of the Achilles tendon. This allows the foot to assume its natural position. If left untreated, clubfoot will cause the child to develop an abnormal gait. Someone with uncorrected clubfoot will walk on the outsides of their feet. This can adversely affect the joints and cause other foot problems including skin problems on the surface of the foot on which the person walks.

Friday, December 28, 2007

Choosing Shoes For Foot Health

Foot health should be a major factor to consider when purchasing shoes. Here are a few tips to selecting shoes that will not jeopardize foot health.

Try on shoes before you buy. It is best to go shopping for shoes in the late afternoon or evening. This is because feet naturally expand throughout the day. When first waking in the morning, the feet had been relaxed during the night. The pressure exerted on the feet while walking will slightly expand the feet. Shoes should be bought to fit at the time of day when feet are at their largest.

Choose shoes with wide toe boxes. Shoes that are too narrow should be avoided. Even if the shoes fit, if they cause pressure on the toes or any other part of the foot, it can cause problems. When trying shoes on, pay attention to any friction caused by the shoe.

If heels are desired, choose a moderate to low heel. High heels can cause a variety of problems including hammertoes, corns, tight heel cords, and metatarsalagia. High-heeled shoes can also worsen bunions and bunionettes.

Shoes should provide proper support. Flimsy soles do not provide the support needed. Sandals often lack even minimal support. If sandals are to be used for any significant length of time, look for sandals that provide some cushioning and substantial soles.

The back of the shoe should not be overly stiff. It should yield to the movement of the foot. Hard backs to heels and other shoes can irritate the back of the foot. Friction from stiff shoe backs can lead to the development of Haglund’s deformity, otherwise known as “pump bump.” Haglund’s deformity is the formation of a bony lump on the back of the foot accompanied by irritation and pain.

Everyone buying shoes should try on both shoes. Taking the shortcut of only trying on one of the shoes can cause problems since it is common for one foot to be slightly larger than the other. Sometimes people buy shoes that are too tight thinking that they will be “broken in.” This practice should be avoided. With a little care and common sense, shoes can be supportive of good foot health.

Sunday, December 23, 2007

The Dangers Of High Heels

Wearing high-heeled shoes too often can compromise the health of your feet. Almost all high heels have narrow toe boxes. A toe box is the front portion of the shoe. Couple the narrow toe box with the added pressure caused by the elevation of the heel and it sets the conditions that can cause a number of foot problems.

Forcing the toes into a narrow toe box can cause misalignment of the toes. High heels can lead to the development of hammertoes. Hammertoes are an unnatural bending of the toe joints. After repeated pressure from unhealthy footware, such as high heels, the joints of the toes can become deformed by remaining rigidly bent. The bending of the first joint of a hammertoe can cause the toe to rub against the shoe. This can be painful and can cause corns.

Corns are small calluses that are caused by pressure and friction. If the toes rub against the shoe, as is common with high heels, the skin on the toe becomes hard and thick in the area that is experiencing the pressure. Wearing high heels can worsen bunions or bunionettes. A bunion is a bony bump along the side of the big toe that can be made worse by wearing tight-fitting shoes. A bunionette is a small bunion that forms on the smallest toe.

Toenails are often under pressure during the time that high heels are worn. This pressure can cause nail problems such as nail fungus and ingrown toenails. Wearing high heels frequently can interfere with the natural state of the Achilles tendon. High heels prevent the heel of the foot from coming in contact with the ground. Therefore, the Achilles tendon is not stretched while walking. The Achilles tendon can become tightened and shortened.

Excessive use of high heels can cause stress fractures in the foot. Stress fractures are tiny cracks in the bone caused by pressure and strain on the bone. Metatarsalgia is a condition of pain in the foot. High heels cause extreme pressure on the ball of the foot. This pressure can lead to strain and pain in the ball of the foot.

Haglund’s deformity, also called “pump bump,” is a small, bony irritation that occurs on the back of the foot due to pressure from straps and the rigid backs of high heels. This causes redness, irritation, and pain in the area of the pump bump. Neuromas can also be called by wearing tight-fitting shoes. Neuromas are growths of the nerves of the foot. Neuromas cause sharp pain or numbness in the ball of the foot and the toes.

Thursday, December 20, 2007

Intractable Plantar Keretosis (IPK)

An intractable plantar keretosis, or IPK, is a think, deep callus on the bottom of the foot. It is a painful condition caused by the misalignment of a metatarsal bone. The misaligned metatarsal increases pressure in the bottom of the foot. The misaligned metatarsal is referred to as a dropped metatarsal. When someone with a misaligned metatarsal takes a step, the misaligned bone comes in contact with the ground first. This creates tremendous pressure which causes extreme pain.

The least invasive treatment option for an IPK is for a doctor to trim it and pad it. The padding helps support the dropped metatarsal. Orthotics and metatarsal bars may be used to support the dropped metatarsal and alleviate the pressure it causes. A metatarsal bar is padding that fits into the shoe. It is used to reduce the pressure on the ball of the foot. Taping or strapping the foot may be used for pain relief.

Removal of the intractable plantar keretosis may be necessary or medically preferred. A doctor may use chemical or laser treatment to remove the IPK. Cantharone is the chemical used to remove an IPK. It is a painless procedure. However, the chemical causes the IPK to blister, so the area may be tender or painful for several days after treatment. The only post care instructions for chemical removal of a IPK is to keep the blister covered with a band aid. The laser treatment is also relatively painless. The doctor administers an injection of a local anesthetic, which is perhaps the most painful part of the procedure.

If the pain is persistent or if the IPK is caused by a bone deformity, surgery may be necessary. A doctor will be able to discuss the various treatment options and help the individual decide on the best treatment plan.

Monday, December 17, 2007

Raynaud's Phenomenon

Raynaud’s phenomenon is a condition that compromises the circulatory system’s ability to supply blood to the toes. This condition can affect the small blood vessels in the fingers, ears, lips, and nose. Raynaud’s phenomenon causes the toes and other effected body parts to be oversensitive to exposure to cold temperatures. It is also called Raynaud’s disease.

Often, the first symptom that emerges is skin discoloration after cold exposure. The skin may appear white, red, or bluish purple due to the abnormal constriction of the blood vessels. Skin turns white is the arteries in the effected body part have collapsed. Blue or purple discoloration Is caused by the body parts lack of oxygenated blood. The body part may also feel cold or numb. The body part may turn red as the blood flow is restored after an attack of Raynaud’s phenomenon. Some people with Raynaud’s disease experience all three discolorations at different phases of the disorder.

Attacks of Raynaud’s phenomenon can be triggered by cold temperatures or emotional stress. Raynaud’s can occur alone or can be caused by another disease. When Raynaud’s disease has an onset that is not due to another disease, it is called primary Raynaud’s. The cause for primary Raynaud’s is unknown. Lupus, rheumatoid arthritis, and athosclerosis are examples of diseases that can cause Raynaud’s phenomenon. When Raynaud’s phenomenon develops as the result of a disease or other causes, such as excessive use of vibrating power tools, having frostbite, or smoking, it is called secondary Raynaud’s phenomenon.

A nailfold capillaroscopy is the diagnostic test doctors use to diagnose Raynaud’s phenomenon. This test allows doctors to microscopically examine the capillaries. Only secondary Raynaud’s phenomenon yields a positive test result.

When people with Raynaud’s phenomenon experience an attack, they should immediately warm their toes and other effected body parts with warm water. It is preferable for people with Raynaud’s disease to stay indoors in times of cold weather. If they must go outside in the cold, wearing several layers of warm clothing is strongly recommended. Stress-triggered attacks may be avoided or their occurrence lessened by avoiding stressful situations and using relaxation exercises or biofeedback. The doctor may prescribe medication to help prevent attacks.

Wednesday, December 12, 2007


Corns are circular, cone-shaped areas of toughened skin on the feet usually due to repeated pressure and friction from ill-fitting footware. Corns commonly occur on the tops of the toes. Unlike a callus, a corn has a central, thickened area. A callus is a more diverse thickening of the skin. A corn can form under a callus or be surrounded by one.

Someone may be at an increased risk for corns if they have another foot problem such as hammertoes. A deforming condition such as hammertoes can cause the skin on the top of the effected toe to rub against shoes. If a corn forms, a doctor should be consulted to check for possible underlying causes, such as bone spurs.

To prevent corns, shoes should be selected for optimal foot health. Shoes should have a wide toe box. Narrow toe boxes as are common in shoes with pointed toes can cause undue pressure on the surfaces of the feet, especially the toes. Heels should be low or moderate in height. High heels place more pressure on the toes and the ball of the foot. Shoes should have adequate support and cushioning.

There are several treatment options for corns. Over-the-counter treatment options for corns include corn pads, foot baths, pumice stones, lotions, and callus removers. If a corn becomes painful, medical treatment is suggested. A doctor can recommend the best treatment for the corn. If the corn is removed but the underlying cause of the corn is not corrected, the condition may recur. Severe cases may require surgery.

Corns that are left untreated or are improperly cared for may get infected. If someone with a corn continues to wear ill-fitting shoes, the constant pressure will not allow the corn to heal. If a person tries to remove the corn by cutting it, the area becomes prone to infection. When dealing with corns, it is best to seek medical advice.

Friday, December 7, 2007

Home Remedies For Cracked Heels

Cracked heels are called by excessively dry skin. It can be worsened by the presence of thick calluses on the heels. Though cracked heels are often merely a cosmetic problem, deep cracks can cause pain and bleeding. Cracked heels are sometimes referred to as heel fissures.

Cracked heels can make standing and walking painful. This condition is caused by excessive pressure on the bottom of the heel without proper support. Working a job that requires a lot of standing, wearing open-backed shoes or sandals, and some medical conditions such as diabetes or eczema can make the individual prone to cracked heels. Being overweight can also be a contributing factor.

The heels that have become cracked should be kept well moisturized. One common home remedy is to apply an ample amount of petroleum jelly to the feet and covering them with socks before going to bed. Over-the-counter moisturizers may also be used instead of petroleum jelly. Some over-the-counter moisturizers are specially marketed as remedies for cracked heels. Beauty supply stores often carry a variety of creams and moisturizers for the treatment of cracked heels. Lanolin is a common home remedy for severely dry skin, including cracked heels. Lanolin is sold as nipple cream for nursing mothers.

For a natural home remedy, mash a piece of papaya and apply to the cracked heel. Papaya contains a plant enzyme that promotes healing. I received a moisturizing tip from my dermatologist. He suggests applying regular shortening to the skin after showering. This acts as a barrier to trap moisture in the skin.

If calluses are a contributing factor for the cracked heels as they often are, the moisturizing treatments will be most effective if the calluses are also treated. A home remedy suggests soaking the feet in a basin of warm water with three tablespoons of baking soda before rubbing the callus with a pumice stone.

Thursday, December 6, 2007

Accessory Navicular Syndrome

Accessory navicular syndrome is a painful condition caused by the presence of a small extra bone or piece of cartilage on the inside of the foot. The extra bone is commonly located just above the arch of the foot. The extra bone is called an accessory navicular. An accessory navicular is a congenital defect. This extra bone does not ossify until about age nine. For about half of those born with an accessory navicular, the extra bone will fuse with the normal navicular bone of the foot.

About ten percent of the population has an accessory navicular. For most people with the extra bone, it never poses any problems. Therefore, they may never even know they have an extra bone. Some people with this extra bone develop accessory navicular syndrome.

This condition causes pain and may cause redness and swelling. The development of accessory navicular syndrome occurs when the bone or tendon becomes aggravated. This can happen due to an injury, overuse, or irritation from footwear.

To diagnose this condition, the physician will manipulate the foot and feel for the extra bone. An x-ray will show the presence of an accessory navicular. The doctor may suggest the use of anti-inflammatory pain relievers. Applying ice to the area may help reduce swelling. The doctor may use of a cast or walking boot to immobilize the area in order to allow it to heal without further aggravation. Physical therapy may be used to strengthen the muscles. If non-invasive methods fail to provide relief, the extra bone may be surgically removed.

Children with flat feet are at risk for accessory navicular syndrome. After non-surgical treatment, the doctor is likely to prescribe the use of orthotics to support the arch and help prevent future occurrences of accessory navicular syndrome. Though adolescence is usually the time when accessory navicular syndrome develops, it can occur in childhood and adulthood.

Tuesday, December 4, 2007


A bending of one or both joints of one or more toes is commonly called hammertoe. It does not affect the big toe. This abnormal bending of the small toes can cause difficulty with footwear. This condition can cause pain when shoes are worn. It can also cause calluses or corns to build up on the effected toes. If the condition has caused the bones to become dislocated, it can cause persistent pain.

If left untreated, hammertoes can become rigid and therefore be resistant to non-invasive treatment. The underlying cause of hammertoe is an imbalance of the muscles and tendons. Ill-fitting shoes can further aggravate the condition.

Hammertoes can arise from a congenital defect. This condition can also occur after an injury, such as a broken toe. Sometimes, wearing proper footwear is enough to provide relief from pain. Shoes should have wide, deep toe boxes. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help alleviate pain.

If corns or calluses have developed, they can be trimmed by a physician. Over-the-counter corn pads may provide temporary relief by protecting the corn from being irritated from footwear.

The doctor may prescribe the use of orthotic devices, splints, or straps. Orthotics may be used to try to correct the imbalance of the muscles and tendons. Splints or straps may be used to realign the effected toe.

If the hammertoe does not respond to non-invasive methods of treatments, surgery may be necessary One surgical method is called arthroplasty. This surgery involves removing a small portion of bone.

Arthrodesis is a surgical treatment for severe cases of hammertoe. During arthrodesis, the joint of the toe is fused in a straight position. A surgical pin may be used to hold the bones of the toe in position as it heals. The muscles and tendons could also be adjusted during a surgical procedure for hammertoe.

Monday, December 3, 2007

Toenail Fungus

Nail fungus can develop and flourish under toenails since the growth of the fungus is encouraged by warm, damp places such as shower floors and sweaty shoes. The infection may begin as a white or yellow spot under the toenail. As the fungus spreads, the nail may become completely yellowed, thick, and brittle. The fungus may cause an odor. Eventually, effected nails can separate from the nail bed.

Nail fungus is usually caused by a class of fungi called dermatophytes. It can also be caused by types of yeast and mold. Fingernails can also develop fungus. Toenails are more susceptible, not only because they can be in contact with damp surfaces such as shower floors, but also because the circulation is poorer in toes than in fingers. The lack of circulation interferes with the body’s immune system ability to fight the infection.

Older adults are at greater risk for nail fungus due to the poor circulation of the feet. Diabetes or a compromised immune system increases a person’s risk. Heavily perspiring or working in moist environments can put someone at greater risk. Repeated exposure to common sources of the fungi, such as swimming pools and public showers, increases the individual’s risk.

The doctor may prescribe an oral antifungal medication to treat the nail fungus. These medications prevent the fungus from infecting new nails growth. As the new, infection-free nails grow, the old infected nail can be periodically trimmed until the nail has been replaced by healthy nails.

An antifungal nail polish may be prescribed for cases that are not severe. This antifungal lacquer is not very effective in most cases. Topical medications may be prescribed instead, however they are not often effective on their own. Their use may be prescribed in for use in combination of oral antifungal medication. The doctor may determine that the nail needs to be removed.

Saturday, December 1, 2007

Achilles Tendonitis

Achilles tendonitis is a common injury to the Achilles tendon which is located along the back of the foot. The Achilles tendon is directly above the back of the heel. Those with Achilles tendonitis experience pain or tenderness in the tendon.

Achilles tendonitis is caused by overuse of the tendon. It is exasperated by an increase in repetitive activity. This type of sudden increase in activity puts too much strain on the tendon. If Achilles tendonitis is left untreated, Achilles tendonosis can develop. In Achilles tendonosis, the constitution of the tendon has been altered by microscopic tears in the tendon.

Athletes are at greater risk for developing Achilles tendonitis due to repetitive stress on the tendon. People whose careers involve repetitive pressure on their ankles and feet are also at an increased risk. People with flat feet or fallen arches are at risk for Achilles tendonitis since the Achilles tendon is at greater demand while they walk.

A doctor can diagnose Achilles tendonitis by manipulating the foot and judging the range of motion. Typical treatment for this condition involve pain relief and preventing further stress on the tendon while it heals. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help with pain relief. It can also minimize the inflammation associated with the early stages of the condition.

The doctor may suggest the use of ice packs. Applying ice packs can help reduce swelling and inflammation after the injury occurs. The doctor may prescribe the use of a walking boot, cast, or other supportive measure to immobilize the area of the injured tendon. Rest and immobilization promotes healing of Achilles tendonitis.

Physical therapy may be recommended to improve the strength of the Achilles tendon and safely increase range of motion. In severe cases, surgery to repair the Achilles tendon may be necessary. After treatment, the doctor or physical therapist may instruct the patient to conduct daily stretching and strengthening exercises.

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