1. Inspect your feet daily for callus, corn, blisters, bleeding, redness, bleeding or lesions between toes. Use a mirror to see the bottom of the foot and the heel.

2. Have a family or friend check your feet if you are unable to do so.

3. Have regular foot examinations by your diabetic foot care specialist. Always remove footwear / shoes and socks when visiting your doctor.

4. Clean your feet daily, using warm – not hot – water and a mild soap. Avoid soaking your feet. Dry them with a soft towel and dry carefully between your toes.

5. Moisturize your feet with lotion, but avoid getting the lotion between your toes.

6. Each week or when needed, cut your toenails to the shape of your toes and file the edges with an emery board.

7. Add exercise, such as walking, to one’s daily routine to increase circulation to extremities.

8. Always wear shoes or slippers to protect your feet from injuries.

9. Inspect the soles and inside your shoes for foreign objects before putting them on.

10. Shoes should be properly measured (by length and width) at the time of purchase, to be comfortable, easy to put on and to allow your toes to move freely.

11. Wear leather shoes with adequate room for the toes. Running or athletic shoes are best for recreational walking.

12. Change shoes every four to six hours.

13. Always wear well-fitted seamless socks with your shoes. Padded socks may reduce pressure and be more protective.

14. In cold weather, wear insulated boots or heavier socks. Be sure the shoes allow enough room to allow for heavier socks.

15. DO NOT walk barefooted in the house, outside, or anywhere.

16. DO NOT use hot water bottles or heating pads to warm your feet. Use warm socks instead.

17. DO NOT soak your feet.

18. DO NOT use acids or chemical corn removers.

19. DO NOT perform “bathroom surgery” on corns, calluses, or ingrown toenails.

20. Wash feet daily and be sure to dry well between the toes. Apply moisturizing cream liberally, but avoid between the toes.

21. Test the temperature of the bath water with your Elbow or Thermometer. DO NOT let hot water drip onto your toes.

22. Contact your foot care specialist immediately if you detect a new lesion or if your foot becomes swollen, red, or painful. Stay off your foot until you see your doctor.

23. Learn all you can about your diabetes and how it can affect your feet.

24. Maintain good diabetes control.

25. DO NOT smoke.

Corns and calluses are thick layers of skin caused by too much rubbing or pressure on the same spot. Corns and calluses can become infected over time.

Blisters can form if shoes always rub the same spot. Wearing shoes that do not fit or wearing shoes without socks can cause blisters. Blisters can become badly  infected if neglected.

Ingrown Toenails happen when an edge of the nail grows into the skin. The skin can get red and infected. Ingrown toenails can happen if you cut into the corners of your toenails when you trim them. You can also get an ingrown toenail if your shoes are too tight. If toenail edges are sharp, smooth them with an emery board.

A Bunion forms when your big toe slants toward the small toes and the place between the bones near the base of your big toe grows big. This spot can get red, sore, and infected. Bunions can form on one or both feet and are often hereditary. Pointed, tight or ill-fitting shoes can lead to formation of bunions. Surgery can remove bunions.

Plantar Warts are caused by a virus. The warts usually form on the bottoms of the feet.

Hammertoes form when a foot muscle gets weak. The weakened muscle makes the tendons in the foot shorter and makes the toes curl under the feet. You may get sores on the bottoms of your feet and on the tops of your toes. The feet can change their shape. Hammertoes can cause problems with walking and finding shoes that fit well. Hammertoes can run in the family. Wearing shoes that are too short can also cause hammertoes.

Dry and cracked skin can happen because the nerves in your legs and feet do not get the message to keep your skin soft and moist. Cracks allow germs to enter and cause infection. If your blood glucose is high, it feeds the germs and makes the infection worse.

Athlete’s Foot is a fungus that causes itchiness, redness, and cracking of the skin. In this case as well, the cracks between the toes allow germs to get under the skin and cause infection. High blood glucose feeds the germs and worsens the infection, which can then spread to the toenails and make them thick, yellow, and hard to cut.

To protect your feet from injury and infection, always wear shoes or slippers.

Inspect the soles and inside your shoes for foreign objects before putting them on.

Shoes should always be properly measured to be comfortable and easy to put on.

Wear leather shoes with adequate room for the toes.

Running or athletic shoes are best for recreational walking.

Always wear well-fitted seamless socks with your shoes.

Padded socks may reduce pressure and be more protective.

Recommended products: Dr Comfort Shoes, Socks and Insoles

Diabetic Neuropathies are a family of nerve disorders caused by diabetes. People with diabetes can, over time, develop nerve damage throughout the body. Some people with nerve damage have no symptoms. Others may have symptoms such as pain, tingling, or numbness – loss of feeling – in the hands, arms, feet, and legs. Nerve problems can occur in every organ system, including the digestive tract, heart, and sex organs.

About 60 to 70 percent of people with diabetes have some form of neuropathy. People with diabetes can develop nerve problems at any time, but risk rises with age and longer duration of diabetes. The highest rates of neuropathy are among people who have had diabetes for at least 25 years. Diabetic neuropathies also appear to be more common in people who have problems controlling their blood glucose, also called blood sugar, as well as those with high levels of blood fat and blood pressure and those who are overweight.

What causes diabetic neuropathies?

The causes are probably different for different types of diabetic neuropathy. Researchers are studying how prolonged exposure to high blood glucose causes nerve damage. Nerve damage is likely due to a combination of factors:
• Metabolic factors, such as high blood glucose, long duration of diabetes, abnormal blood fat levels, and possibly low levels of insulin
• Neurovascular factors, leading to damage to the blood vessels that carry oxygen and nutrients to nerves
• Autoimmune factors that cause inflammation in nerves
• Mechanical injury to nerves, such as carpal tunnel syndrome
• Inherited traits that increase susceptibility to nerve disease
• Lifestyle factors, such as smoking or alcohol use

What are the symptoms of diabetic neuropathies?

Symptoms depend on the type of neuropathy and which nerves are affected. Some people with nerve damage have no symptoms at all. For others, the first symptom is often numbness, tingling, or pain in the feet. Symptoms are often minor at first, and because most nerve damage occurs over several years, mild cases may go unnoticed for a long time. Symptoms can involve the sensory, motor, and autonomic – or involuntary – nervous systems. In some people, mainly those with focal neuropathy, the onset of pain may be sudden and severe. Symptoms of nerve damage may include:
• Numbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingers
• Wasting of the muscles of the feet or hands
• Indigestion, nausea, or vomiting
• Diarrhoea or constipation
• Dizziness or faintness due to a drop in blood pressure after standing or sitting up
• Problems with urination
• Erectile dysfunction in men or vaginal dryness in women
• Weakness

Symptoms that are not due to neuropathy, but often accompany it, include weight loss and depression.

What are the types of diabetic neuropathy?

Diabetic neuropathy can be classified as peripheral, autonomic, proximal, or focal. Each affects different parts of the body in various ways.
Peripheral neuropathy, the most common type of diabetic neuropathy, causes pain or loss of feeling in the toes, feet, legs, hands, and arms.
Autonomic neuropathy causes changes in digestion, bowel and bladder function, sexual response, and perspiration. It can also affect the nerves that serve the heart and control blood pressure, as well as nerves in the lungs and eyes. Autonomic neuropathy can also cause hypoglycemia unawareness, a condition in which people no longer experience the warning symptoms of low blood glucose levels.
Proximal neuropathy causes pain in the thighs, hips, or buttocks and leads to weakness in the legs.
Focal neuropathy results in the sudden weakness of one nerve or a group of nerves, causing muscle weakness or pain. Any nerve in the body can be affected.

Neuropathy affects nerves throughout the body:

Peripheral neuropathy affects:
• Toes
• Feet
• Legs
• Hands
• Arms

Autonomic neuropathy affects:
• Heart and blood vessels
• Digestive system
• Urinary tract
• Sex organs
• Sweat glands
• Eyes
• Lungs

Proximal neuropathy affects:
• Thighs
• Hips
• Buttocks
• Legs

Focal neuropathy affects:
• Eyes
• Facial muscles
• Ears
• Pelvis and lower back
• Chest
• Abdomen
• Thighs
• Legs
• Feet

A patellar tracking disorder may be caused by a combination of factors, including:
• Weak thigh muscles (quadriceps)
• Tendons, ligaments or muscles in the leg that are too tight or too loose
• Engaging in activities that repeatedly stress the knee
• A traumatic injury to the knee or a history of knee injury
• Excessive weight
• A growth spurt
• A genetic predisposition to knee problems

Knee pain can be slow to heal. However, most people with patellar tracking disorder find relief with a few months of nonsurgical treatment, including rest from the aggravating activity, icing the knee and nonsteroidal anti-inflammatory drugs (NSAIDs). Physical therapy and bracing or taping the knee can also help to relieve knee pain. In chronic or severe cases, surgery may be necessary to realign the kneecap, restore normal tracking and repair damage to the knee.

The simplest type of brace is a one-piece sleeve made of an elastic rubber – Neoprene that fits snugly around the knee area. Appropriate for use by patients with relatively mild Osteoarthritis, these sleeves, which are available over the counter at most pharmacies, compress the affected area, providing warmth and a moderate amount of support. Some patients, especially those who are comparatively active, may benefit from wearing one of these devices.

Sleeves may decrease pain, and a fair number of patients claim that to be the case, but we don’t really know why, since these devices don’t have any structural effect on the joint. Of greater value for patients with more advanced Osteoarthritis is an ‘Unloader Brace’ – a semi-rigid device made of molded plastic and foam, with reinforcing steel struts on each side to limit the knee joint’s lateral movement.

It is a custom-fit brace that is most often prescribed for people with arthritis in the medial compartment. When some people with arthritis in this part of the knee walk, you can actually see the knee wobble towards the inside. It is not dangerous, but this wobbling known as a ‘varus thrust’ can be painful. The unloader brace is designed to provide three points of pressure on the thigh bone, which forces the joint to bend away from the inside of the leg. In effect, it relieves pain by transferring pressure from the inner part of the knee to the outer part.

Postponing surgery:

Although unloader braces are used primarily by patients who have Osteoarthritis in the medial compartment, a brace can also be designed to increase mobility and reduce pain stemming from cartilage destruction in the lateral compartment, allowing the patient to walk more rapidly and for greater distances.

In addition to easing moderate to severe pain, unloader braces are often prescribed as a temporary source of relief for patients with advanced cartilage damage, who will ultimately need to undergo joint-replacement surgery. Some patients can get along quite well for six to 18 months before the brace is no longer effective and they have need for surgery.

Choose right

Unloader devices are unique in structure and differ significantly in purpose from other types of braces that are commonly found in pharmacies and sporting-goods stores. ‘Prophylactic braces’ are designed to prevent injury to an arm or knee. ‘Rehabilitative braces’ are designed to be worn by someone who has had a recent injury or surgery involving the ligaments in the knee joint. ‘Functional braces’ are designed to help control abnormal motion in an unstable knee. Unloader braces, for people whose knee instability is the result of cartilage loss, fall under the category of functional braces.
You will need a prescription from an orthopedic specialist in order to purchase an unloader brace and you will need to purchase it at a store that specializes in orthotic devices, where they will construct the brace so that it delivers the proper amount of force to the joint.

Starting out

Obtaining maximum benefit from wearing an unloader brace will require a certain amount practice. The brace may not feel comfortable at first and it may take a week to a month for you to get used to how it feels on your leg. The more you wear the brace, the better it works. However, patients are urged not to neglect other important therapeutic measures, such as exercises to strengthen the muscles surrounding the knee. Also be wary of over-reliance. Wearing a brace all the time does not permit exercising and strengthening of the leg muscles.

The only drawback of an unloader brace is that it tends to be bulky, making it difficult for a patient to wear one, for example, under a pair of snug-fitting slacks. Furthermore, he adds, unloader braces tend to be relatively expensive. However, in the long term, it is a worthwhile investment for your health.

The Anterior Cruciate Ligament (ACL) is one of the main ligaments of the knee joint, which links the upper leg bone (Femur) with one of the lower leg bones (Tibia) by running crosswise inside the center of the knee joint. The ACL stabilizes knee movement in a forward and backward direction. It would be wise, therefore, to pay more attention to our knees and the beating that they take on a regular basis.

ACL tears are common in sports that require jumping or shifts in weight such as basketball, soccer, or skiing. Falling forward and outward is a classic mishap that can lead to an ACL tear. When torn, the knee usually feels unstable. These tears can lead to injury to other structures within the knee that cushion the bony surfaces. In the long term, the knee develops Osteoarthritis. Therefore, treating a common knee injury such as ACL tear could help avoid knee osteoarthritis.

A sprain and/or partial/minor tear in the ACL may be treated initially with RICE (Rest, Ice, Compression and Elongation), and subsequently with physiotherapy and wearing appropriate knee brace to stabilize the knee. Once completely recovered, it is advisable to continue wearing the brace during sports activities and any kind of exertion to avoid recurrence of the injury and to keep the knee joint stable and strong.

However, in case of a complete/major ACL tear, the ligament is not likely to heal on its own. In such cases, surgery can help stabilize the knee, and might even protect knees from the risk of future knee arthritis.

Other precautions to help prevent Knee Osteoarthritis are:

Weight control - Increased weight puts excessive stress on the knees.

Exercise - Keeping the muscles around the knee strong and flexible can help decrease the stress on the knee cartilage and even improve knee function in people with arthritis

What is Chondromalacia Patella or Runners Knee?

Chondromalacia Patella is the softening and degeneration of the cartilage underneath the patella or as it is more commonly known, the kneecap. Under normal circumstances, the cartilage is smooth and shiny so that it glides easily along the articular groove of the femur as the knee bends. Chondromalacia Patella causes the water content of cartilage to increase and as a result, the cartilage loses its normal shock-absorbing ability, causing the kneecap to rub against one side of the knee joint. The undersurface of the kneecap irritates or blisters the cartilage surface and anterior knee pain results.

Activities that require a significant amount of kneeling, squatting and stair climbing are commonly associated with Chondromalacia Patella. In runners, increased mileage or hilly terrain may bring on the symptoms of Chondromalacia patella.

What are the Symptoms of Chondromalacia Patella or Runners Knee?

(a) A deep aching pain in the front of the knee that worsens when walking uphill or climbing stairs.
(b) Knee tenderness and pain in the front of the knee that worsens after sitting for prolonged time or with using stairs or getting out of a chair, and a grating or grinding sensation when the knee is extended.

To prevent Chondromalacia Patella or Runners Knee:

(a) Avoid or modify those activities which aggravate the condition,
(b) Warm-up and stretch out before sports, especially the quadriceps and hamstrings.
(c) Avoid exercising on hard surfaces.
(d) Avoid squatting, kneeling, stairs and hill running as much as possible.
(e) Ice the knee after aggravating activities and occasionally use aspirin or other anti-inflammatory medication.
(f) Wear a patella stabilizing brace during any activities that might aggravate the conditions of Chondromalacia Patella.
(g) The most important thing is to listen to your body and don’t do the things that increase the pain.

Treatment of Chondromalacia Patella or Runners Knee:

(a) Temporarily avoiding activities that worsen pain.
(b) Take non-steroidal anti-inflammatory medication.
(c) Use knee braces to stabilize the knee during rehabilitation and to continue actively in sports. A patella stabilizing brace applies uniform compression, which helps guide the patella and improve tracking. Knee strap braces provide focused mild pressure on the tendon below the knee cap to help provide pain relief as well as improve knee stability.
(d) Avail of physical therapy to strengthen the quadriceps and hamstring muscles.
(e) In extreme cases, surgery might be recommended.

This excess pronation has resulted in a ‘loss of footprint’ giving rise to a new, modern variety of pain and injuries:

• Plantar Fasciitis
• Achilles Tendinitis
• Metatarsalgia
• Hallux Abducto Valgus
• Patello Femoral Pain
• Tibial Stress Syndrome
• Ilio-tibial Band Syndrome
• Tired Aching Legs
• Lower Back Pain

These biomechanical deficiencies are common in all ages. The solution is to realign the foot to its natural angle. Vasyli Orthotics restore correct foot function and help you reclaim your ‘Foot print’ to overcome common biomechanical complaints.