Episode 9: The Big Four
Let’s talk about the association between The Big Four problems:
Haglund’s deformity is a bony enlargement on the back of the calcaneus/heel bone. There is soft tissue bursa surrounding the insertion of Achilles tendon; it can become irritated when area by the bony enlargement rubs against shoes. This often leads to painful bursitis. Long-term equinus and irritation at the insertion of the Achilles tendon and lead to small bone spurs which form at that back of the heel and have involvement with the Achilles tendon itself.
Episode 7: When to Keep Wounds Moist or Dry?
When should you air out your wound? When wounds are kept exposed to the air they will dry and form a scab. The purpose of the scab is to protect the wound from environmental contamination. But, at the same time, scabbing has some disadvantages.A scab forms a barrier to the generation of new tissue.
Exposed wounds run the risk of infection, which is complicated when patients have diabetes and vascular disease (PVD or PAD). Moist wound healing is considered the ideal environment for optimal wound healing. The development of a scab is no longer necessary, we use advanced wound care dressings that enhances the body’s natural defenses and healing processes to improve healing outcomes and contributes to improved patient comfort.
Episode 5: Toenail Fungus
Nail Fungus: A fungus is an organism that lives in warm moist areas. Fungus of the toenails is a common problem that can affect people of all ages, although it most commonly affects individuals who are older.
Treatment Options: The most common treatment for nail fungus is debridement or nail trimming. Topical antifungals need to be applied around the cuticles and skin. Oral antifungal treatments benefit from a daily clean routine. The most common medication is Lamisil. It is taken for 3 months once daily.
Nail Care: Discontinue harsh nail products; switch to gentle or children’s nail polish. Make sure your nail instruments are sanitary. Consider buying your own. Purchase cheap emery board for the infected nail and use ½ of the board, and then throw away. Do not infect your other nails with a dirty file.
Episode 4: Annual Foot Screen
What is ANNUAL FOOT SCREEN? Your annual foot screen is a comprehensive exam in which Dr. Pulapaka and her team update/overhaul your chart, check your Medicare compliance, and perform simple & basic tests to the lower extremity as part of her Lower Extremity Amputation Prevention (LEAP) program.
Who might have an ANNUAL FOOT SCREEN? Foot Screens should be performed annually on patients with at least one of these factors:
· every diabetic patient
· every patient over 60 years old
· current or former smokers over 50 years old
· history of foot and/or leg ulcers
· history of heart attack, stroke, TIAs, PAD
· history of vascular surgery, angioplasty, open heart surgery
· neuropathy, Hansen’s disease, spinal trauma, polio, etc.
· motor loss to the legs,
Why do it? It is simple. Our comprehensive program follows guidelines adopted by U.S. Department of Health and Human Services, to dramatically reduce lower extremity amputations in individuals with a loss of sensation or other diseases that can cause breakdown in the feet. Foot Screens also helps document qualifying criteria for medical necessity with Medicare in the treatment and maintenance of mycotic nails or callus care and diabetic shoes programs.
Episode 3: Diabetic Foot Care
The importance of diabetic foot care and some Do’s & Don’ts.
Washing your feet with warm or tepid water and soap every day keeps them clean and gives you a good chance to do that daily inspection.
Applying a moisturizing lotion to your feet once or twice a day can also help keep your skin healthy and moist.
Even with the best foot care, it would be hard to go through life without developing a callus or corn on your feet.
The drugstore is a good place to pick up two first-aid essentials: antibiotic ointment and adhesive bandages (such as Band-Aids). If you see no appreciable improvement within 24 hours, call your doctor immediately.
For many people, the regular toenail trimmers or clippers sold at the drugstore are safe for home use. Toenails should be cut straight across or following the natural curve of the toe.
You can do a lot to keep your feet healthy. In addition to protecting the skin on your feet by making smart drugstore purchases, you can extend their life by maintaining blood glucose control, following a heart-healthy diet, getting regular exercise, and wearing properly fitted diabetic shoes.
Episode 2: PLANTAR FASCIITIS
Anatomy - The plantar fascia is made up of 3 distinct parts: the medial, central, and lateral bands on the bottom of the foot.
There are many treatment options when patient experience heel pain.
Rest and activity modification, although helpful may not be practical, particularly for more active individuals and for those whose jobs require standing.
Physical Therapy or home stretching is the initial physical treatment for plantar fasciitis that emphasizes stretching of the calf and foot.
NSAIDs or Corticosteroids (anti-inflammatory medications) are frequently used to treat plantar fasciitis. Corticosteroids can be administered either orally or via injections.
Orthotics help support the arch and limit the motion the foot experiences.
A fasciotomy in some cases surgery may be required. A plantar fascia release provides significantly improved outcomes for patients with severe symptoms.
This is dedicated to my Grandmother Evelyn Trache, she passed away a few years ago at the age of 95. Her life and spirit were inspiring for me, so this series is dedicated to her. So join in with the discussions.
PODIATRY DOC TALK
As I read the latest journal article on antibiotic resistance on diabetic ulcers, I realize they failed to ask the difficult question.
Antibiotic resistance is a real issue. All chronic wounds contain bacteria; it is the determination between contaminated & colonized and critical colonization & infection. Each wound will behave differently.
The FDA has approved only two systemic antibiotics in the past five years, almost a 90% drop-off from 1985.
Inappropriate overuse of antibiotics leads to resistance with profound ramifications.
Why did the article failed to ask physicians for an honest answer in determining their treatment decisions?