Why are my toes tingling?

I see many diabetics in my practice, and many are very well informed about their process, and prognosis. However when we speak about foot problems and complications, frequently patients ask why their toes are tingling, burning, or sometimes feel numb. Other complaints include the complete opposite, such as hypersensitivity. Very often the answer to these questions is diabetic peripheral neuropathy (DPN).

DPN is one of the most common side effects of diabetes. The longer a person has diabetes, the more the risk of developing neuropathy. Some recent studies have shown that up to 60% of diabetics have neuropathy. What causes it? Elevated blood sugar causes chemical changes in the nerves. These changes do not allow the nerves to transmit signals effectively, causing decreased feeling, imbalance and instability of gait with increased risk in falling, and the ability to feel sensations different in different parts of the body, especially in your feet and toes.

In order to treat the symptoms, it is important for proper diagnosis. Ways your podiatrist can diagnose diabetic peripheral neuropathy include a monofilament test, nerve conduction studies, nerve biopsies, and quantitative sensory testing.

Treatment may include blood sugar control, oral prescription medications, topical medications, and even a product called Neuremedy which can be dispensed right in our office. Speak to one of our podiatrist to find out if this supplement is appropriate for you.

By seeing a podiatrist and getting a thorough exam, you can get help with diagnosing and treating diabetic peripheral neuropathy. Visit us at elmhurstfootdoc.com or stop in our office in Elmhurst, IL and speak to Dr. Arain or Dr. McNeill. Your tingling toes will thank you!

Diabetes and Chocolate?

With the Easter holiday upon us, everywhere you turn its candy, candy, candy... especially chocolate. Many of my patients ask me, can diabetes and chocolate mix?

With so many consumers suffering from diabetes, there has been a great deal of discussion about which foods are OK and which ones are forbidden. As with all simple sugars, those patients with diabetes may enjoy an occasional chocolate treat if they exercise restraint and moderation. According to dieticians, the sugar in chocolate is absorbed more slowly than that found in many often consumed foods, such as white bread and even mashed potatoes. However when consuming chocolate, if it is part of a meal or as a small dessert, the food already in your stomach may delay the absorption of the sugar, and may slow the rise in blood sugar vs. if you eat chocolate alone or on an empty stomach. This means that the body has a bit more time to deal with the rise in blood sugar caused by sugar in chocolate. It is important to keep in mind, however, that too much chocolate can lead to obesity, which is a complicating factor for diabetics.

What about special "diabetic" chocolate? This type of chocolate is made with sorbitol, which is a sugar alcohol. If eaten in excess, side effects may include laxative effects or cramping. While the diabetic chocolate is designed to not raise blood glucose levels, it still has plenty of calories, and it is important not to think of this special chocolate as a license to overeat.

So the bottom line is this - whether you eat chocolate or not, as a diabetic, the key is to eat in moderation. Ultimately, checking with your doctor or dietician can determine whether you can safely eat traditional chocolate or "diabetic" chocolate with sorbitol. The most important fact to take away from this is that it is of the utmost importance to discuss your diet, chocolate or not, with your endocrinologist, diabetes educator, dietician, or primary care doctor. No one dietary plan will be right for every patient, and open and honest communication with the doctor is one of the best ways to avoid the complications that may result from having diabetes. They may have further insight into recommendations, and yes, you have to take their word for it if they determine that chocolate may not be right for you.

D. Rose and a turn of events...his sprained ankle

At yesterday's Bulls game, their best player and possible MVP of the season Derrick Rose went up for a layup... and "turned" his ankle. Ultimately, the first place Bulls lost the game, but they are still ahead in the series. All the talk is how will their highest scorer come back after an ankle sprain?
It happens to many of us, wether you are a weekend warrior or a seasoned athlete... an ankle sprain may set you back, but there are a few things you can do in the case of an ankle injury: RICE is the most common pneumonic.
Rest:
The first 24-48 hours after the injury is considered a critical treatment period and you must adhere to this. Gradually put as much weight on the involved ankle as tolerated, but not if you have pain.
Ice:
For the first 48 hours post-injury, ice is very important. Use an ice pack and elevate the ankle. The ice pack can be a bag of frozen vegetables (peas or corn), allowing you to be able to re-use the bag. Do NOT ice an ankle sprain for more than 20 minutes at a time, and do not place the ice directly on the skin; there should be a cloth or towel in between. You will not be helping heal the ankle sprain any faster, and you can cause damage to the tissues!
Compression:
Use compression when elevating the ankle sprain in early treatment. Using an Ace bandage, starting with the toes and moving upwards, overlapping the elastic wrap by one-half of the width of the wrap. The wrap should be snug, but not cutting off circulation to the foot and ankle. If your foot becomes cold, blue, or toes feel numb, it is too tight... re-wrap!
Elevate:
Keep your ankle sprain higher than your heart as often as possible.

Keeping these key points in mind, you may be on your way to healing that ankle sprain... but remember, it never hurts to get it checked out by your podiatrist in order to determine anything more severe such as a tear of one of the ankle ligaments, or to rule out a fracture in one of the bones, in severe cases.
More severe ankle sprain injuries, including complete tears of the ligaments and fractures of the bone may need different treatment and rehab than a simple ankle sprain.

Let's hope D. Rose and his trainers adhere to these... and we see him on the court ASAP.

Choosing the Right Shoes - Diabetes or Not

Often times patients ask how to chose the right shoe. As a diabetic, these questions should be included and addressed during your periodic diabetic foot checks with your podiatrist. At these checkups, your podiatrist will do a series of tests during the examination to determine the need for a specific diabetic shoe, which is available by prescription, or if a certain type of shoe is better than another. If it is determined that you are not at risk for further problems, then you are able to buy retail shoes without a prescription.
Here are some hints to follow:
-Choose a stretchy material that will be forgiving on the feet.
-Shoes should be fitted in the afternoon. Many times your feet will swell more throughout the day and they may fit tighter.
-Have your feet sized every time you buy shoes. You may think you are one size because you " always have been," but you may be surprised at what you may find.
-If the shoe is not comfortable at the store, it will not change and become comfortable later.
- If one foot is slightly bigger than the other, then purchase the bigger size.
- The toe box should be roomy enough for you to be able to wiggle your toes
- The fit should be snug enough at the heel so that there is no slippage or gapping
If you still have questions, consult your podiatrist! Often times even the questions answered at the visit can guide you in the right direction.

Diabetes and the NCAA Tournament...athletes can live with it too!

Diabetes is a condition that affects all walks of life, young and old, people of all backgrounds, and even.... athletes. With the brackets and the NCAA tournament the talk of everyones lips, it is little known that Georgetown guard Austin Freeman was diagnosed with diabetes last season when he missed a home game loss to Notre Dame with what was originally thought to be a stomach virus. The "virus" continued to plague him, and he was just not getting better... and that's when the doctors knew it was something much more. This condition is not expected to affect his career; many athletes lead successful college and pro careers with diabetes. They just have to take careful consideration when training and playing with the conditions that diabetes presents, which is something all diabetics have to face whether a trained athlete or not. He will have to carefully monitor his blood sugars and make sure that he has enough hydration when on the court. Diabetics are not able to convert sugar to energy because the body can't properly use the insulin it produces, or, the pancreas just quits making insulin. In his case, he is a type 1 diabetic, and in his case, he no longer produces insulin. This means he needs daily insulin injections or the constant delivery of insulin through an insulin pump.

But the important thing is that one can live with diabetes with a lifestyle change, as demonstrated by Austin Freeman; it can be done.

Simple Home Diabetic Foot Exam

As a diabetic, it is important that you do a diabetic foot exam on your feet every day. First of all, as a diabetic, you should have a relationship with a podiatrist, or foot and ankle specialist, and he or she should have good communication with you and your primary care physician. As a team, the three of you can keep your diabetic feet healthy. Here are a few of the basic recommended things you can do at home to help with your diabetes foot care.

Daily foot exam: Take a look at your feet every day, top and bottom. It may be helpful to take a hand-held mirror and look at the bottom of your feet as well. You need to examine your feet every day and after any trauma you may experience no matter how minor you think it is. Trauma is just a fancy word for any sort of physical injury or bump to your feet. Tell your podiatrist about anything like this that happens.

Foot Cream: apply a moisturizing cream on your feet every day on the top and bottom of your feet, but never between your toes.

Socks: Avoid wearing tight elastic socks or nylons. They can cut off or impair your circulation without you being aware of it. Wear cotton or wool socks instead. Nylons can cause shearing and they trap moisture and do not allow your skin to breathe.

Clear the Area: Make sure the area where you walk is clear of clutter. get any items you're likely to trip over or bump into out of the way.

Footwear: Make sure to wear sturdy and comfortable shoes wherever possible to help protect your feet. You may qualify for diabetic shoes through the Medicare shoe program. At Prairie Path Foot and Ankle clinic and Schaumburg Foot and Ankle clinic, we are certified to fit our qualifying patients with Dr. Comfort brand shoes. Please visit our office in Elmhurst or Schaumburg Illinois to see if you qualify.

Taking these simple measures at home along with a comprehensive plan of diabetic footcare and surveillance with the help of your podiatrist will keep your feet healthy, and will keep you active and healthy.

Diabetic Foot Ulcers- Their connection to neuropathy?

According to the CDC, almost 24 million Americans have diabetes. That is merely an estimate! And, in addition, it is reported that about , six million of those individuals are undiagnosed. Along with diabetes, there are several other complications that may lead to serious conditions, including diabetic foot ulcers.

Patients with diabetes have a 15%-25% lifetime risk for developing a foot ulcer. Why and how does this happen? One of the common findings in patients with diabetes is diabetic neuropathy. This may manifest itself in the form of tingling and numbness in the fingers and toes. In the foot, patients describe the feeling of neuropathy as sharp shooting pain, tingling, burning, or just plain numbness. Due to the lack of sensation, an area of increased friction due to a bony prominence or an ill fitting shoe can easily break down the skin. In a person without diabetes, the breakdown of skin can be a blister or corn or callus and the person would feel pain. The pain would signal the nondiabetic person to remove their shoe, inspect the wound, or seek medical help. However in a diabetic patient with neuropathy, he or she is unable to feel any pain, blistering, or infection until is too late. An open sore forms, or an ulceration, and in this case, when an ulceration occurs, the risk for infection is present and may range in severity from a superficial area to one that pervades the bone. Infection is the leading risk factor for amputation among those with diabetic foot ulcers.

So please, if you are diabetic, seek help from a foot specialist. For example at our clinic, Prairie Path Foot and Ankle Clinic, we take pride in serving our diabetic patients with the utmost care. Your primary care doctor should check your feet at every visit, and you as a patient should be checking your feet daily as well. A visit to our office will put you at ease and answer any questions you may have about diabetic foot care and prevention. Leave your feet it in our hands!