Stem Cell Regrowth of Toes

Stem cells from under nails tissue has been shown to regrow soft tissue and bone. Research published from New York University Langone Medical Center has shown bone and soft tissue has been regrown in cases where a partial amputation has occurred of a finger or toe. In cases where a part of the nail matrix or base of the nail bed has been retained doctors at New York University have been able to regrow bone and soft tissue. This can have some implications in our diabetic patients who are always at risk of an amputation.

Diabetes can many affects on the body. In regards to the feet there are three major effects. First, the blood sugar that is broken down from food should get absrobed by organs to get used for energy. However, because the body does not produce enough insulin, the chemical that moves the sugar into the organs, or does not recognize the insulin the body is making, the sugar stays in the blood stream. Ultimately, the sugar can get absorbed into the outside lining of the small blood vessels. The sugar can then develop calcification within the walls of the vessels and create plaques similar to cholestrol plaques. This can affect the blood flow beyond the plaque creating poor blood flow to the area. This normally affects the smaller vessels, such as in the toes and fingers.

Secondly, the blood sugar can also get absorbed into the nerves. This will cause a chemical nerve damage called neuropathy. Early symptoms include burning or tingling first just at night and then can progress to during the day. In diabetes, the hands and feet are often affected equally. Eventually both the hands and feet can become completely numb. This is a problem when you can no longer feel if you step on something or feel if your shoes are too loose or tight resulting in blisters. Often, a patient does not even realize there is a problem unti they see drainage on their sock.

Thirdly, the higher a patient's blood sugar the less able they are to fight off infection. The blood sugar will inhibit the white blood cells which are the main fighter cells of the body.

So you can see for a diabetic patient once they develop a problem it can be difficult to treat. Below is information from the National Diabetes Information Clearinghouse (NDIC)

• More than 60 percent of nontraumatic lower-limb amputations occur in people with diabetes.
• In 2006, about 65,700 nontraumatic lower-limb amputations were performed in people with diabetes.

With such a high risk of amputation with our diabetic patients the opportunity to regrow a toe or finger is exciting news. We will keep updating our information as further studies became available.

Dr. Alexandra "Sandie" Grulke
http://www.podiatrycarespecialists.com/

New Diabetic Drug !

The FDA has approved a new diabetic drug aimed at lowering blood sugar called Invokana by Johnson and Johnson. Diabetes results from too much sugar in the bloodstream and the insulin that prevents this from happening is reduced or non-existent. This drug will block the sugar from entering the blood stream and force excretion of the sugar into the urine. This is a new line of thinking in the treatment of diabetes.

Current medication such as Metformin, target lowering the body's own production of glucose from the liver in an effort to control blood sugar. Invokana is a new drug in a class called sodium-glucose-transporter 2 inhibtiors, SLGT2. These drugs focus on removing the blood sugar from the breakdown of food as it is filtered from the kidneys. This would increase the amount of sugar excreted from the kidney's and lowers the blood sugar. Invokana is still being investigated by the FDA but early results have been promising. This drug, as in all drugs, do have some side effects. With the increased sugar in the urine, an increased incidence of urinary tract infections and yeast infections have been noted. Also, there is a greater chance of cardiovascular events within the first 30 days of treatment, however the risks are then lower after that.

More information is needed on this drug but the early results look promising in the treatment of diabetes.

Dr. Alexandra 'Sandie" Grulke
www.podiatrycarespecialists.com

Dry Skin

It is very important this time of the year to moisturize your feet. Winter time brings dry skin. When skin dries it can crack and cause painful fissures in the skin. When this happens, its an open source for an infection. Its a good idea to moisturize your feet daily. However, do not use moisture in between your toes as this can cause a fungal infection. For more information please visit our site..

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The Chester County Hospital Diabetes Day

Dr's Brad Jacobs and Chad Friedman from Podiatry Care Specialists, PC (with offices in West Chester, PA and Newtown Square, PA) were excited to attend Diabetes Day. It was the 16th Annual Diabetes Day, which was sponsored by The Chester County Hospital. This years location was at the Universal Technical Institute in Exton, PA. It was great for people with and without Diabetes to learn more about the condition and to help manage it.

We got a lot of interesting questions at our booth ranging from diabetic foot care to diabetic shoes. We talked about the differences of Diabetic shoes and regular shoes and the benefits of them. We also discussed what we have to offer to help with Diabetic Neuropathy. We got to meet other vendors while we were there which is a great team way to help and manage people with their Diabetes.

We were thankful to be there and hope to be there again next year. For more information on Diabetes and your feet please visit our web page.

http://www.podiatrycarespecialists.com/

Hershey's Mill in West Chester PA

Podiatry Care Specialists in West Chester, PA and Newtown Square PA, were happy to join the 1st Annual Health Fair at Hershey's Mill. The Senior Helpers of Chester County ran this spectacular event. Dr Theodore Mushlin, Dr Alexandra Grulke, and Fay Mushlin, Practice Administrator, attended the event to help spread the word about Podiatric foot care. In addition, Mark Fallecker from Aetrex Shoes, brought in the iStep Scanner (Please see previous blog on this) to scan the feet of the residents at Hershey's Mill. Some other attendees at this event were Genuardi's, (located on Boot Road in West Chester, PA), offering flu shots and giving out food, and Bayada nurses checking blood pressure and talking to the residents. It was a wonderful opportunity for the residents and very well attended.

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Toning Shoes...Fad or Bad?

There has been an increase lately in the number of shoe companies that are producing these toning shoes. Some of the common ones that are out are the Skechers Shapeups, Reebok EasyTone, New Balance and the MBT's. There are also making these in sandals now. These shoes are claiming to help solve knee and back problems, tone your legs, relieve tension in the neck and ease joint pain. What are all the thoughts on this? Since some of these products are fairly new, we dont have long term studies on them. Once more long term data is out on these we will get a better idea on how these products work over the long term.

I would not recommend these shoes/sneakers to run in. I am going to post a link to a study that was done on them. A team of exercise scientists from the Exercise and Health Program at the University of Wisconsin had studied the 3 shoes above.  They evaluated muscle activation in the toning shoes vs a New Balance Running shoe as well as exercise responses.

For the exercise response the researchers had 12 patients complete 12, 5-minute exercises on a treadmill that with different speeds and gradients(inclines) with the toning shoes and a running sneaker.  For the muscle activation response, 12 patients rotated shoes at random while having electrodes tied to different muscles on the body while doing similar exercises on the treadmill.

The results showed that none of the toning shoes showed a statistically significant increase in exercise response or muscle activation on the treadmill.

As of now, I think there needs to be even more research on these toning shoes. I like how this study was performed and how it showed that there was no difference in muscle activation or exercise response on a treadmill.

Here is the link for further reading.

http://www.acefitness.org/getfit/studies/toningshoes072010.pdf

http://www.podiatrycarespecialists.com/

Exercise With Care

Recently as I have been going to the gym for a workout, or walking outside, I cant help to notice ones footgear. Whats amazing is what I see people wearing when running on the treadmill or using the elliptical. I see different forms of footwear ranging from what should be used, sneakers to things one doesn't want to wear in loafers, shoes, sandals and flats.  Its very important when exercising and going for walks or runs to have your foot supported and have good shock absorption.  You will not be able to get this with loafers, shoes, or sandals. You should always be in a good supportive sneaker when you are very active at the gym. You will not be as fatigued and you can prevent less problems with your feet!

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How we can check your sensation

If blood sugars are high over long periods of time, it can disrupt the function of the nerves. One may lose feeling in their hands and feet. This may cause a tingling sensation in these areas. At worse it can be very painful and keep people up at night. One initial test that we can begin with is with a small object called a Semmes-Weinstein. It is used for early detection of peripheral neuropathy in patients with Diabetes. Its a noninvasive and a NON-PAINFUL test. There are areas we press on the skin with this monofilament to check if a patient can feel it or not. The areas an red in the picture are common areas we will check on the feet. If they are unable to feel it this may be an early sign of neuropathy or loss of sensation. It is important to check because if you are unable to feel the bottom of your feet, you may be more susceptible to stepping on something you are unaware of or developing a skin ulcer that you cannot feel and become infected. As always it is very important to see your Podiatrist for a daily check on your feet if you are diabetic.  For more information please visit our website:

Chad Friedman, DPM

http://www.podiatrycarespecialists.com/

Checking your feet

If you are Diabetic, or even Borderline Diabetic, it is very important to check your feet regularly during the day. Its also important to check inside of the shoes/sneakers you wear for any foreign objects in there. Its important to check them midday and at night before you go to bed. If this is difficult to inspect the bottom of your feet, use a mirror to look at the bottom. Things you want to be on the look out for are any new cuts, red areas, rough areas, cracks, and fissures. Even though they might not be a problem or cause pain, they are potential areas that can lead to this. Its a good idea to get a baseline look at your feet form a Podiatrist to educate you on things that can be done to prevent ulcers or amputations from happening. Please visit our webpage for more information or call for an appointment.

Chad Friedman, DPM

Ingrown Nails

Are you suffering from a painful ingrown nail? The best treatment that you can do is see your Podiatrist right away. NEVER use over the counter products as this can make your nail more infected and painful. Early treatment that one can do is soak the toe that is painful in warm water with Epsom Salt ( 1 tbs. Epsom salt to 1 quart of warm water) for 15 minutes. After this apply an antiobiotic cream such as Polysporin with a bandaid. Typically the earlier you seek treatment for this painful condition the easier it may be to remove the offending nail border and not have to be on oral antibiotics. A lot of times people will get immediate relief once the corner of the nail is removed.

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By, Chad J. Friedman, DPM

Barefoot Running Part 2

We briefly mentioned last week about the potential hazards and dangers of barefoot running. I thought that I would just add a few more interesting things about it. A study published in The Journal of Sports Medicine and Physical Fitness said that barefoot runners had less impact than runners in shoes. On the flip side to this, there has been no documented studies that show running with sneakers can cause foot problems or lead you to an injury. But if you can think about some of the stuff that I had posted last wee I will not recommmend doing it.  This is because it can lead to stepping on something, lacerations, increase in pain, and blisters just to mention a few.

Happy Running/Walking, but of course with sneakers on :)

Chad J. Friedman, DPM

http://www.podiatrycarespecialists.com/

Barefoot Running

There has been a lot of talk in the literature recently on barefoot running. In fact there was even a book written on the topic (Born to Run). Its going to be something that many people will begin to try or continue to do. For me, I will not be recommending it. Some of the reasons for this is the risk of stepping on something, contusions, sprains, strains, and possible fractures. Depending on your foot type, the foot should be constantly supported through all phases of gait. If not, it can cause other muscles to compensate for other muscles and lead to tendon problems or other stresses in the feet. The feet need good support to support the rest of the body. Think about this as well; could you imagine running on a track, concrete, or gravel barefoot? Imagine this even on a hot sunny day. Your feet would burn and increase your chance of developing blisters. And of course this would never be good in a diabetic or someone who has developed neuropathy of their feet(loss of sensation). We will continue to update you on more information that will come out with the topic, but for the time being it is something that I will not recommend.


Happy Running/Walking, but of course with sneakers on :)
Chad J Friedman, DPM

http://www.podiatrycarespecialists.com/

Happy New Year

Podiatry Care Specialists, would like to wish everyone a Happy and Healthy New year!

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Happy Thanksgiving

We would like to wish everyone a Happy Thanksgiving!! Please keep in mind if you are doing a lot of cooking or running around this holiday season to be in good supportive shoe gear and to avoid as much as possible going barefoot or just having socks on

http://www.podiatrycarespecialists.com/

SAP Health Fair

A few months ago Dr Chad Friedman was fortunate to give a lecture at the SAP health fair in Newtown Square PA. The health fair was a success as there were many people who stopped by to learn information about Podiatry and what we have to offer in our practice. If you to would like to know more about our services and what we have to offer for your foot health, please visit our website below or call to make an appointment.

http://www.podiatrycarespecialists.com/

Lecture

Dr Chad Friedman recently gave a lecture at St Albans Church in Newtown Square. The lecture was presented to St Anastasia's members. The lecture presented was on general foot health and included bunion, hammertoes, neuromas, heel pain, arthritis, fractures, diabetes, and wound care. For more information please visit out site for educational videos

http://www.podiatrycarespecialists.com/