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One remark I hear frequently from my diabetic patients is that they have the belief that since they are diabetic, they cannot and should not have foot surgery. Is this true?
Let me answer this question by giving an example of a patient I saw in my office recently. She was referred by her primary care doctor for evaluation of sores on the ends of the third toes of both feet. When I first saw her, it was instantly evident that she had some serious problems. Not only were sores (ulcers) present on the ends of the third toes on both feet, but those same toes were red and swollen - classic signs of infection. I also noticed that she had severe contractures of the second, third and fourth toes of both feet. This caused her to put excessive pressure on the ends of the toes. It was this pressure that ultimately caused the ulcers to form, and became a hindrance in the healing of her ulcers. Further testing showed that not only did she have infected ulcers on both feet, but that the infection had progressed to the bone. After a lengthy discussion with her, we decided that it was best to remove the infected portions of the toes. For a podiatrist, this is not the kind of surgery that we want to perform, but sadly at times must be done.
Since her surgery, she has gone on to heal well, and what is left of the third toes on both feet is healthy and shows no signs of problems. However, she has since developed an ulcer on the fourth toe of the right foot. Again, because of the severe contracture of the toe (also known as a hammertoe), excessive pressure on the end of the toe has caused the skin to break down and ulcerate. So, we are back to fighting the battle to save her toe.
I gave this example to illustrate why surgery in diabetics is sometimes not only permissible, but can turn out to be a way to prevent more drastic complications at a later date. In the case of this patient, my plan now is to perform surgery on the remainder of her hammertoes in order to straighten them. This is not so that her feet will look better (although they undoubtedly will will better), but rather to remove deformities that are causing excessive pressure and make her prone to ulceration, infection, and potential amputation.
So, when can and should a patient with diabetes have surgery? In my mind, diabetes in and of itself does not mean that surgery is not possible. Rather, I look at the patient as a whole and determine if he/she is healthy enough to withstand the surgery, and heal properly afterwards. Things that your podiatrist will look for when contemplating foot surgery include the status of the circulation to your feet. This may involve not only an examination, but also non-invasive testing as discussed by Dr. Wishne in a prior post on this blog. In addition, your podiatrist will want to know how healthy you are in general. How is your heart functioning? How are your kidney's functioning? How well is your diabetes controlled? These and many other factors will be considered before surgery is contemplated.
Your podiatrist has had the advantage of seeing many patients who have developed diabetic foot ulcerations, and he knows the types of feet that are prone to develop such ulcerations. If your podiatrist feels that you are at an increased risk for developing a foot ulcer because of your foot deformity (including hammertoes, bunions, bone spurs, ingrown toenails, etc.), he will be doing you a big favor in recommending procedures that can prevent later complications. Every procedure in medicine has potential risks and benefits. The trick is to determine if the risk of surgery is less than the potential benefits that the surgery will offer. For most patients, pain is a major motivating factor to proceed with surgery. In a diabetic patient who may have neuropathy, prevention of future complications rather than the presence of pain is the main reason to proceed in many instances. This is a decision to be made jointly by you and your podiatrist.
Foot and ankle athletic injuries are very common. We specialize in sports medicine getting you back to sports as soon as possible. The most common foot and ankle sports injuries are plantar fasciitis, ankle sprains, shin splints, Achilles tendonitis, peroneal tendonitis, stress fractures, posterior tibial tendonitis, anterior tibial tendonitis, neuromas, tarsal tunnel syndrome, ankle instability, and metatarsalgia. Gait problems can also cause ileotibial band syndrome, patella tendonitis, back pain, hip pain and piriformis syndrome. Medications, injections, splinting, orthotics and/or physical therapy are often quite helpful in treating most injuries. Our doctors will discuss your injury and prescribe a course of treatment that will return you to sport stronger than when you came into the office.
Fall down, go boom? Foot and ankle trauma is extremely common no matter how young or old you are. Fractures, torn ligaments and tendons, sprain and strains, puncture wounds and toenail trauma occurs every day. Our physicians can help put you back together so that you can recover from your accident as fast as possible. Don't wait too long to seek medical advice after your accident or injury. Delaying treatment often only worsens the problem!
Foot pain related to congenital and acquired foot and ankle deformities is extremely prevalent in our society. Pain can be from flat feet or a high arched foot and associated gait problems; or be from a progressive deformity like a bunion or a hammertoe. Our doctors are extensively trained to diagnose and treat the underlying deformity to help you function at your best. We want to prevent your problems from getting worse, no matter what you inherited from your family! God may have had a sense of humor when he created your feet, but we will work with you to optimize your biomechanical function and aesthetics! No one should suffer from ugly, painful feet!
Neurological foot and ankle issues can be a burning or shooting pain, numbness, weakness or just a "pins and needles" sensation. Nerve can be affected by compression at the spine level, knee level, ankle level or in your foot. Neuropathy can be a subtle nerve degeneration from aging, diabetes, and a myriad of other causes. Do not assume your nerve issues will go away or that nothing can be done. A proper diagnosis can lead to alleviation of your nerve troubles.
Healthy Steps Shoe Store and Spa welcomes patients and their families as well as the surrounding communities of Grapevine, Southlake, Colleyville and beyond to help them with their therapeutic shoe gear needs. A certified pedorthotist is always available by appointment for consultation, and safe pedicures by a licensed medical nail technician highlight your spa experience. An extensive array of prefabricated and custom orthotics as well as many foot care essentials are also readily available to compliment your shoe and sandal purchases. We carry a wide variety of comfort shoe gear that are as pretty as they are comfortable.