Richard Egan, CPED, LPED, Pedorthist

Managing your Diabetes and Taking Care of Your Feet:

We have all heard the saying “an ounce of prevention is worth a pound of cure”. That is so with managing Diabetes. By the year 2030, a third of the population will have diabetes. This disease affects the entire body. Many complications occur in the eyes, kidneys and the feet as a result of neuropathy. By getting the patients in proper fitting footwear with inserts that help offload pressure in problem areas, many times we can prevent foot ulcers and amputation. In the United States, infected foot ulcers are the most frequent admitting diagnosis for hospitalization of patients with diabetes. The cost to treat these problems is in the Billions of dollars.

As a Pedorthist, we are part of the allied health community, working to help prevent complications of the foot. Patients with diabetes should check their feet regularly to make sure they aren’t getting callusing or red spots on their feet. They need to have their toe nails trimmed properly to prevent infection and wear socks that do not bind or cut off circulation of the feet. By being pro-active, many problems can be avoided.

With the introduction of the Therapeutic shoes bill more than ten years ago, vendors were quick to jump on the bandwagon, producing shoes that were not only functional but stylish as well. A diabetic shoe that is billable with Medicare must meet Medicare’s guidelines and be coded. The shoe must have an extra 3/16th depth to accommodate heated or custom molded inserts. The shoe must come in 3 widths and have tie or Velcro closure. Many of the shoes have reinforced medial counters and rocker soles to help the patient with stability offloading pressure in the ball of the foot. We are seeing many styles,in the diabetic shoe line, to accommodate a multitude of foot problems We now have shoes made out of stretchable Lycra that help reduce pressure on the bunion and bunion areas. Shoes are being made that have a deeper opening to allow the patient with edema and swelling problems ease in putting on the shoes. Shoes are now available with different colors of Lycra to choose from. It is no longer black, black, or black! Some shoes have Velcro closures on the medial side to help the person who has arthritis in the hands and has trouble gripping.

Medicare will cover three pairs of either heat molded or custom molded inserts that help with shear and relieving pressure on the plantar surface of the foot. Inserts are made of plastazote and poron. Custom molded inserts made from a mold of the patients foot seem to be the Gold Standard. Custom molded inserts allow the technician making them to add additional metatarsal support, posting and other modifications to accommodate callusing and help offload pressure in sensitive areas that are prone to ulceration. Heat molded inserts are heated to 225 degrees and then shaped to the patients foot.

Every foot is different and what works for one patient may not be the best choice for everyone. One of the biggest problems in fitting shoes is to get the patient to realize that prevention of foot problems is our goal. Although style is important, function is our main goal.

Alan Kravet, Chief Pharmacist

The word arthritis means “joint inflammation” and is one of the body’s natural reactions to injury or disease and includes pain, swelling and stiffness. Inflammation that lasts for a long time or is recurring, as in arthritis, can lead to tissue damage.

Arthritis appears normally in joints. A joint is where two or more bones come together, such as the hip or knee. The bones of a joint are covered by a smooth, spongy material called cartilage, which cushions the bones and allows the joint to move without pain. The joint is lined with a thin film of tissue called the synovium. The synovium’s lining produces a slippery fluid called synovial fluid that nourishes the joint and helps reduce friction. Ligaments connect the bones and help keep the joint stable. Muscles and tendons also support the joints and enable you to move.
With arthritis, an area in or around a joint becomes inflamed, causing pain, stiffness, and difficulty when moving. Some types of arthritis also affect other parts of the body, such as skin and internal organs.

Some of the more common types include:

Osteoarthritis, the most common type. It occurs when the cartilage covering the end of the bones gradually wears away. Without the protection of the cartilage, the bones begin to rub against each other and the resulting friction leads to pain and swelling. It can occur in any joint, but most often in the hands and knees, hips and spine. Osteoarthritis often occurs as the cartilage breaks down or degenerates with age. Therefore it is sometimes also called degenerative joint disease.

Rheumatoid Arthritis:

Rheumatoid arthritis is a long lasting disease that can affect joints in any part of the body but mostly in the hands, knees and wrists. With rheumatoid arthritis, the immune system mistakenly attacks itself and causes the joint lining to swell. The inflammation then spreads to the surrounding tissues and can eventually damage cartilage and bone. In more severe cases it can also affect skin, nerves and eyes.

Gout:

Gout is a painful condition that occurs when the body can’t eliminate a natural substance called uric acid. The excess uric acid forms needle-like crystals in the joints that cause swelling and severe pain. Gout most often affects the big toe, knee and wrist joints.

What Are the Symptoms of Arthritis:

Different types have different symptoms and they vary in severity from person to person. Osteoarthritis does not generally cause any symptoms outside the joint. Symptoms of other kinds of arthritis may include fatique, fever, a rash and joint inflammation, including:
Pain, Swelling, Stiffness, Tenderness, Redness, Warmth

Arthritis Treatment Options:

It generally includes occupational or physical therapy, exercise, drugs and sometimes surgery to correct joint damage. Treatments can help relieve pain and stiffness, but the disease may continue to progress. Treatments for Rheumatoid Arthritis in recent years have been able to stop or slow progression of joint damage.
In the case of localized pain, stiffness and immobility, the typical three stage treatment consists of medication to relieve pain and inflammation, rest to let injured tissues heal themselves, and exercise to rebuild mobility and strength.
Learning to protect your joints is an important part of the treatment. Avoid positions that strain your joints, use stronger joints and muscles while sparing weaker ones, wearing braces or supports for certain joints, and using grab bars, modified door knobs, walkers, etc.

Tiffany Rodriquez, Pain Relief and ED Professional

Lower Back Pain:

What is lower back pain? It can affect the back anyplace below the ribs and above the legs. The lower back is the connection between the
upper and lower body and it bears most of your weight. Therefore it can easily be injured when you lift, reach or twist. Most of the time lower back pain goes away by itself after a few weeks. If it doesn’t, make sure to see your doctor. It’s caused by overuse, strain or injury, like a car crash.
Also, aging plays a part. Your bones and muscles tend to lose strength, which increases your risk of injury. The spongy disc between the vertebrae (bones of the spine) tends to wear down and won’t provide enough cushions between the bones. A bulging or herniated disc can press on nerves and cause pain. Arthritis and osteoporosis are also contributors to back pain.
Depending on the cause, the pain may be dull, burning, sharp, at a single point, over a broad area, come on gradually or suddenly, occur with muscle spasms or stiffness and can also involve leg pain, caused by pressure on a nerve leading to the leg. Back pain can be classified as “acute” if it lasts less then three months, “recurrent” if the symptoms come back or “chronic” if it lasts more then three months.
Treatments for back pain: Because back pain stems from a variety of causes, treatment goals are pain relief and restored movement. The basic treatment is rest. An ice pack and anti-inflammatory drugs will help to reduce pain and inflammation. After the inflammation subsides, applying heat can sooth muscles and tissue. Physician prescribed physical therapy may consist of massage, ultrasound, whirlpool baths, applied heat and exercise programs. The strengthening of the abdominal and back muscles helps to stabilize the spine. Also helpful are over-the-counter drugs like Tylenol, Aspirin, Ibuprofen or, in severe cases, prescription drugs like Vicodin, Percocet or muscle relaxants.

TENS Unit:

This treatment is covered by Medicare and most Insurance Companies.
The most common form of electrical stimulation used for back pain is “transcutaneous electrical nerve stimulation”, or TENS therapy which provides short term pain relief. In TENS therapy, a small, battery operated device, delivers low-voltage electrical current through the skin via electrode patches that are placed near the pain area. The electricity stimulates nerves in the affected area and sends signals to the brain that scramble normal pain perception. TENS is not painful.

Moist/Dry Heating Pad:

Heat therapy works by stimulating the body’s own healing force. It dilates the blood vessels, stimulates circulation and reduces muscle spasms. You can use dry or moist heat.

Back Brace:

A lower back brace may help relieve lower back pain by stabilizing the inflamed or painful area. Back braces provide compression to the affected areas. A good back brace can also help correct posture.