Diabetic Foot Care Guidelines

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• Inspect your feet daily. Check for cuts, blisters, redness, swelling, or nail problems. Use a magnifying hand mirror to look at the bottom of your feet. Call your Community Foot Specialist in Springfield and Dayton at 937-426-9500 if you notice anything
• Wash your feet in lukewarm (not hot!) water. Keep your feet clean by washing them daily. But only use lukewarm water—the temperature you’d use on a newborn baby.
• Be gentle when bathing your feet. Wash them using a soft washcloth or sponge. Dry by blotting or patting—and make sure to carefully dry between the toes.
• Moisturize your feet—but not between your toes. Use a moisturizer daily to keep dry skin from itching or cracking. But DON’T moisturize between the toes—this could encourage a fungal infection.
• Cut nails carefully—and straight across. Also, file the edges. Don’t cut them too short, since this could lead to ingrown toe nails.
• Never trim corns or calluses. No “bathroom surgery”—let your doctor do the job.
• Wear clean, dry socks. Change them daily.
• Avoid the wrong type of socks. Avoid tight elastic bands (they reduce circulation). Don’t wear thick or bulky socks (they can fit poorly and irritate the skin).
• Wear socks to bed. If your feet get cold at night, wear socks. NEVER use a heating pad or hot water bottle.
• Shake out your shoes and inspect the inside before wearing. Remember, you may not feel a pebble—so always shake out your shoes before putting them on.
• Keep your feet warm and dry. Don’t get your feet wet in snow or rain. Wear warm socks and shoes in winter.
• Never walk barefoot. Not even at home! You could step on something and get a scratch or cut.
• Take care of your diabetes. Keep your blood sugar levels under control.
• Don’t smoke. Smoking restricts blood flow in your feet.
• Get periodic foot exams. See your podiatric foot and ankle surgeon at Community Foot Specialists in Dayton and surrounding areas on a regular basis for an examination to help prevent the foot complications of diabetes. Call us today if you have any questions, 937-426-9500

Check out one of our podiatrists, Dr. Thomas at Community Foot Specialists talking more about diabetes and your feet!

Did you know we have a book on diabetes and how it affects your feet? Get your FREE copy today by clicking here. From your friends at the Community Foot Specialists!

Question of the Week: All About Shoe Comfort!

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By: Dr. Belinda M. Dotter

One of the most common questions asked in my Dayton area Podiatry office involves shoes.  What shoes are good?   How do I buy shoes? Am I doing the right thing about my shoe wear?

Shoes are near and dear to almost every woman's heart and many of us have at one time, preferred to be crippled but gorgeous, as opposed to comfortable but not-so-cute.  With these guidelines, perhaps we can find a happy medium.

•          Shoe sizes differ between manufacturers.  You can have your shoe size measured, but use it as a guideline.  Try half a size up or down your measurement.  Buy shoes later in the day, to accommodate for swelling.  Have your feet measured once per year, as age, pregnancy, and weight gain may increase shoe sizes.  If you lose weight, your feet also get smaller.  Not only will you need new clothing, but new shoes too (bonus!).  Do not buy tight shoes thinking that they will "break-in" later on.  Buy shoes that are comfortable from the start.
•          3 inch heel limit.  Stacked heels, wedges are vastly better than stiletto heels.  If you have "weak" ankles, or history of ankle sprains, strictly avoid stilettos as you will further injure your ankles.  Chronic stiletto heel wearers regularly develop achilles tendonitis and contraction of the achilles tendon, making it too tight and causing pain with every step.
•         Pick shoes with thicker soles.  More cushion, more support.  Constantly wearing flip-flops during the summer may cause many a foot pain.  Notice that when you wear them, your toes grip or flex, to try and hold the flip-flop in place.  You may develop plantar fasciitis (arch pain or heel pain) or hammertoes!
•          Limit wearing the same shoes every day.  It puts repeated pressure on identical areas of the foot, causing irritation and letting deformities further develop or worsen (such as bunions or hammertoes).  You may also re-infect your foot continually if you have athlete's foot!
•          Finally, orthotics.  There is a controversy about their increasing use, especially since custom orthotics cost hundreds of dollars and is not regularly covered by insurance.  Many foot problems are prevented and alleviated by orthotic wear, but some foot problems caused by overuse, overtraining, and being overweight won't be helped by them. Using orthotics heavily depends on the primary cause of your foot pain so discuss with your podiatrist how the orthotics will help you.
•        As a final note, Studies by Irene Davis, professor of physical therapy at the University of Delaware, found that "semi-custom" models (the lab uses a mold of the patient's feet to identify the best-fitting prefabricated insole) work as well as the totally customized, built-from-scratch kind.

If you are still having a hard time figuring out which shoes work best for you, stop by or call one of our six Dayton and Springfield Community Foot Specialists locations to speak with a podiatrist. We're here to get you (comfortably!) back on your feet! Call today, 937-426-9500

Everything You Need to Know about Warts

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By: Dr. Belinda M. Dotter

Plantar warts are noncancerous skin growths on the soles of your feet caused by the human papillomavirus (HPV), which enters your body through tiny cuts, breaks or other vulnerable sites on the skin of your feet.  Plantar warts often develop beneath pressure points in your feet, such as the heels or balls of your feet. This pressure also may cause a plantar wart to grow inward beneath a hard, thick layer of skin (callus).  Most plantar warts aren't a serious health concern and may not require treatment. However, plantar warts can be bothersome or painful so it's important to contact your Dayton/Springfield, Ohio Podiatrist at Community Foot Specialist so we can get you back on your feet. Call today for an appointment 937-426-9500

Signs and symptoms of plantar warts include:

• Small, fleshy, grainy lesions, or growths, on the soles of your feet
• Hard, thickened skin (callus) over a well-defined "spot" on the skin, where a wart has grown inwards
• Black pinpoints, which are commonly called "wart seeds" but are actually small, clotted blood vessels
• Lesions that interrupt the normal lines and ridges in the skin of your feet
• Pain or tenderness when walking or standing

Plantar warts are caused by an infection with the human papillomavirus (HPV) in the outer layer of skin on the sole of your feet.

There are more than 100 types of HPV, but only a few types are known to cause warts on your feet. Other types of HPV are more likely to cause warts on other areas of your skin or on mucous membranes.

Transmission of the virus
Each person's immune system responds differently to HPV, so not everyone who comes in contact with the virus develops warts. Even people in the same family react to the virus differently.

The HPV strains that cause plantar warts aren't highly contagious. Therefore, it isn't easily transmitted by direct contact from one person to another. However, the virus does thrive in warm, moist environments — such as shower floors, locker rooms and public swimming areas. Consequently, you may contract the virus by walking barefoot around pools or gyms.

The virus also needs to have a point of entry into the skin:

• Cracks in dry skin
• Cuts or scrapes
• Wet, softened, fragile skin from prolonged water exposure (macerated skin)

Multiple warts
If the virus spreads from the original site of infection, multiple warts may appear. These may include:

• Several individual warts at different sites on the foot
• "Kissing warts," a pair of warts that appear where two parts of the foot touch, such as a point of contact between two toes or between a toe and the ball of foot
• Mosaics, clusters of warts that essentially form a large, single lesion

Treatment options include the following:

• Freezing (cryotherapy). Application of liquid nitrogen with a spray canister or cotton-tipped applicator to freeze and destroy your wart. The chemical causes a blister to form around your wart, and the dead tissue sloughs off within a week or so. The application itself can be painful, and cryotherapy can result in painful or tender blisters that resolve on their own.
• Cantharidin. Application of cantharidin — a substance extracted from the blister beetle — on your plantar warts. Typically, the extract is paired with salicylic acid, applied to the plantar wart and covered with a bandage. The initial application is painless, but the subsequent blister that forms may be painful. The dead part of the wart is clipped off in about a week.
• Immunotherapy. This therapy attempts to harness your body's immune system to remove tough-to-treat warts. This can be accomplished in a couple of ways. Injection on your warts with interferon, a medication that boosts your immune system's instinct to reject warts. Or injection of your warts with a foreign substance (antigen) that stimulates your immune system. Often, mumps antigens are used, because many people are immunized against mumps. As a result, the antigen sets off an immune reaction that may fight off warts. Interferon treatment may result in flu-like symptoms for a few hours after treatment. Both treatments may cause pain.
• Imiquimod (Aldara). This prescription cream applied directly to a wart is an immunotherapy medication that encourages your body to release immune system proteins (cytokines) to attack HPV. This treatment can result in severe inflammation near the site and damage to the tissues beyond the wart. If this occurs, the treatment is dropped. The drug may also result in flu-like symptoms that may lessen with a lower dosage.
• Minor surgery. This involves cutting away the wart or destroying the wart by using an electric needle in a process called electrodesiccation and curettage. Anesthesizing your skin before this procedure is required. This treatment is avoided if possible with plantar warts because of the risk of scarring.
• Laser treatment. A type of laser treatment called pulse dye laser treatment burns closed (cauterizes) tiny blood vessels. The infected tissue eventually dies, and the wart falls off. This treatment can cause pain and scarring.

To reduce your risk of plantar warts:

• Avoid direct contact with warts. This includes your own warts.
• Keep your feet clean and dry. Change your shoes and socks daily.
• Don't go barefoot in public areas. Wear sandals or flip-flops in public pools and locker rooms.
• Don't pick at warts. Picking may spread the virus.
• Don't use the same file, pumice stone or nail clipper on your warts as you use on your healthy skin and nails.
• Wash your hands carefully after touching your warts.

If you or you know someone who may be experiencing any of these painful plantar wart symptoms, call your local Springfield/Dayton, Ohio Podiatrist at Community Foot Specialist so we can find the best treatment option for you. Call and schedule your appointment today with any of our 6 conveniently located Greater Dayton offices. 937-426-9500

What are Corns and Calluses?

What are Corns and Calluses?

Calluses and corns are areas of thick, hardened, dead skin. They form to protect the skin and structures under the skin from pressure, friction, and injury. They may appear grayish or yellowish, be less sensitive to the touch than surrounding skin, and feel bumpy. Calluses on the hands and feet of an active person are normal. Calluses and corns become a problem when they grow large enough to cause pain.
Calluses on the feet generally form on the ball of the foot, the heel, and the underside of the big toe. They often form where the foot and the beginning of the toe meet (under the end of the metatarsal bone).Corns generally are found where toes rub together. Corns have an inner core that can be soft or hard. A soft corn is found between toes (usually the fourth and fifth toes). A hard corn is often found over a bony part of a toe (usually the fifth toe).
What Causes Corns and Calluses?
Calluses and corns are caused over a period of time by repeated pressure or friction on an area of skin. The pressure causes the skin to die and form a hard, protective surface. A soft corn is formed in the same way, except that when perspiration is trapped where the corn develops, the hard core softens. This generally occurs between toes. Calluses and corns are not caused by a virus and are not contagious. There are many reasons why Corns and Calluses form on the feet here are a few:
Tight shoes squeeze the foot.
High-heeled shoes squeeze the front part of the foot.
Loose shoes may cause your foot to slide and rub against the shoe.
Shoes with a thin sole can create more pressure on the ball of the foot when walking than do thicker-soled shoes.
Wearing sandals and shoes without socks can lead to increased friction.
The foot may rub against a seam or stitch inside the shoe. Socks that don't fit may result in pressure where a sock bunches up.
 How Are Corns and Calluses Diagnosed?
Calluses and corns generally are diagnosed during a physical exam. Your doctor may also ask you questions about your work, your hobbies, or the types of shoes you wear. An X-ray of the foot may be done if your doctor suspects a problem with the bones.
How Are Corns and Calluses Treated?
If you have diabetes, peripheral arterial disease, peripheral neuropathy, or other conditions that cause circulatory problems or numbness, talk to your doctor before you try any treatment for calluses or corns.
Calluses and corns do not need treatment unless they cause pain. If they do cause pain, the treatment goal is to remove the pressure or friction that is causing the callus or corn, to give it time to heal. This is done by wearing footwear that fits properly and using doughnut-shaped pads (such as moleskin) or other protective padding to cushion the callus or corn. Some other types of padding include toe separators, toe crest pads, and toe caps and toe sleeves. Also, the callus or corn can be softened and the dead skin can be removed by using products such as salicylic acid.
Your doctor may use a small knife to pare (trim) the callus or corn. You may reduce the size of the callus or corn yourself by soaking your foot in warm water and then using a pumice stone to rub the dead skin away. Never cut the corn or callus yourself, especially if you have diabetes or other conditions that cause circulatory problems or numbness. In some cases, surgery may be done to remove the callus or corn or to change the bone structure beneath the callus or corn.
How Common Are Corns and Calluses?
Most people get calluses and corns. They are seen more frequently in people who have bony feet and in women, probably because women often wear shoes that create friction on the feet, such as high-heeled or thin-soled shoes.

Why are my nails thick?

There are several contributing factors to nail disorders.  Skin conditions, trauma to the nail from shoes rubbing, or dropping something on the toes can all contribute to the thickness.  After there is damage to the nail a fungal infection is easily acquired.  Resolving the fungus is difficult because it has a cell structure similar to our own so we can't kill them like we can bacteria.  We will be working with a lab to identify the infection and help guide treatment.  Treatments include periodic trimming to reduce pain, oral Lamisil therapy, and soon to come is a safe laser therapy.  Recurrence is always a concern so treating your shoes and using antifungal skin creams are also important.  Diabetics should always try to reduce damage from fungal infections to protect the skin integrity and prevent open sores.  All the more reason to have your feet evaluated by the doctors at Community Foot Specialists.
Contact us at DaytonFeet.com