Winter and your Feet

Winter and your Feet

This year we have had a very late and cold winter. Due to the significant low temperatures I have been seeing a lot of people with complaints of cold, discolored feet. Many of these patients are young healthy woman and are concerned about losing the circulation in their feet. Many of these patients state that they have never had these symptoms before and are concerned. After testing and further questioning, these patients are diagnosed with Raynaud’s phenomenon.

What is Raynaud’s phenomenon?

Raynaud’s phenomenon is a condition of vasospasms, which means there is decreased blood flow due to the cold temperature or stress. This can cause the toes and fingers to turn different colors, including purple, red or blue. Other symptoms of this phenomenon are extreme cold extremities and pain. This phenomenon is not to be confused with Raynaud’s disease, which is a systemic condition usually caused by a disease process.

The three colors of Raynaud’s are white, which is the initial stage, when there is decrease blood to the toes. The second stage is blue fingers and toes, which is due to a decrease in the oxygen to the extremities. The third and last phase is when the toes turn red, which is when temperature increases and blood returns to the digits.

How is this diagnosed and treated?

Diagnosis can be made by either clinical appearance or via a biopsy. Many patients that first present with this have a confusing appearance to their toes. It looks like a mix of Raynaud’s and dermatitis (which is a skin irritation). A biopsy will deny or confirm the diagnosis.

There are many options for treatment. The first option for a mild case is to wait until the weather gets warmer or the stress decreases. Stopping to smoke and decreasing caffeine intake can also diminish the symptoms. There are topical medications that can be prescribed to help vasodilate, or increase blood flow to the digits. If a topical medication does not work there are oral medications, which are blood pressure medications. Since blood pressure medications vasodilator the arteries they will help to decrease the symptoms of the Raynaud’s. If a patient has a severe case, which is associated with other diseases, there is surgery to help decrease the symptoms. Lately, Botox has been used in extreme cases of painful Raynaud’s

In conclusion, during the winter months, it is important to keep your digits warm and not allow long times of exposure to cold climates. If you are unsure of what is causing your skin to change colors, please go to your physician for a consultation.

For more information, please visit our website at www.footnj.com

Diabetic Foot Care and Shoes

According to the American Diabetes Association, one in five people with diabetes end up at the hospital due to the foot problems.  Poor foot care can tragically lead to amputation of the foot or leg. To avoid this it is imperative that you learn proper foot care techniques and check your feet daily: top, bottom and in between the toes.

It is also important that you wear shoes at all times to protect them from injury.  Diabetic neuropathy of the feet may cause a loss of sensation and the patient may not even realize when an injury has occurred.

http://footnj.com/podiatrist-new-jersey-about-us/23/232-diabetic-foot-care-and-shoes

What precautions should I take to prevent injuries to my feet due to diabetes?

Washing your feet every day can help prevent serious health problems. Be sure to:

• Use lukewarm water and test the temperature with your hand before stepping in to make sure it’s not too hot!
• Completely dry your feet after washing, as infections like to form in moist areas such as between the toes.
• Soften skin with water-based hand and foot creams as dry and cracked feet often cause infections.  Do not place moisturizing creams in between the toes. Avoid oil and petroleum jelly as they actually dry the skin.

Other suggestions include:

• If you are a diabetic, controlled by diet or medication, you should never cut your own toenails. All toenail care and trimming of corns or calluses should be done by a podiatrist as recommended by the American Diabetic Association and almost all insurance companies.
• Quit smoking as it decreases oxygen and blood flow to the feet.
• Don’t cross your legs.
• Avoid sitting or standing in the same position for lengthy periods of time.

What types of shoes should I wear?If you are a diabetic suffering from peripheral neuropathy or circulation problems of the feet it is important to have shoes that are wide, soft, have high toe boxes as well as padded heels and tongues. Patients with reduced sensation or circulation wearing improperly fitting shoes run an increased chance of developing foot ulcerations and infections.

The federal government through Medicare has developed standards for a properly fitting diabetic therapeutic shoe. Shoe manufacturers submit their designs through Medicare for approval as a diabetic therapeutic shoe. For those patients who are diet or medication control diabetics, with symptoms of peripheral neuropathy or circulatory insufficiency, Medicare will pay for one pair of diabetic therapeutic shoe per calendar year as well as three pair of diabetic therapeutic insoles for the shoes.

Dr. Irina Tsyganova and her office staff can measure and fit patients who meet Medicare's standards of eligibility for diabetic therapeutic shoes. The shoes can be dispensed and picked up at Dr. Tsyganova's office. At that time, Dr. Tsyganova and her staff will make sure that the fit is proper.

Medicare provides for a diabetic patient with certain specific complications to be dispensed one pair of diabetic therapeutic shoes each year.  Medicare will pay for 80% of the cost.  If you have Medicare co-pay insurance, the company will pay the additional 20% leaving the patient with no out of pocket expense for the shoes. This is provided that all deductibles are met and that the patient has not previously been dispensed diabetic therapeutic shoes in the same calendar year.

All diabetics and patients with peripheral neuropathy or circulatory insufficiency should refrain from wearing shoes that will put pressure on bony prominences of the foot. Types of shoes to be avoided are shoes with high heels, pointy toes, thin soles and low toe boxes. In addition, these patients should avoid flip-flops and sandals because they provide very little protection from the environment.

http://footnj.com/podiatrist-new-jersey-about-us/23/232-diabetic-foot-care-and-shoes