tuggerahlakespodiatry

WHAT IS DIABETES?

Wed, 15 Nov 2017 08:07:43 GMT

Diabetes is a chronic condition that results in elevated blood sugar levels. This is either caused by reduced insulin secretion (a hormone produced by the pancreas) and /or reduced insulin sensitivity. Due to glucose being required for energy production by the cells of the body, reduced insulin secretion and reduced insulin sensitivity result in a reduction of glucose utilization and an increase in free glucose in the bloodstream.

The two main types of diabetes are type 1 (approximately 13.5% of diagnosed diabetics) and type 2 (approximately 85% of diagnosed diabetics). The remaining diagnosed diabetics are diagnosed during pregnancy, known as gestational diabetes. According to the Australian Department of Health, during 2014-2015, there was an estimate of 2.1million diabetics in Australia.

Type 1 Diabetes Mellitus (T1DM) is an autoimmune condition where cells responsible for insulin production in the pancreas are defective, resulting in absence of insulin secretion and increased blood sugar levels. People who have been diagnosed with T1DM are often diagnosed early in life, during childhood or adolescence and will require lifelong insulin injections for survival.

Type 2 Diabetes Mellitus (T2DM) is the most commonly diagnosed form of Diabetes. It is often the result of hereditary factors, lifestyle factors (such as exercise and diet) and obesity, resulting in reduced insulin sensitivity and may also have reduced insulin secretion/production. People with T2DM may be able to control their sugar levels through lifestyle and diet modification, however; diabetic medication and /or insulin are required in some cases to control blood sugar levels. T2DM is often diagnosed later in life, however, due to the rise of childhood obesity, childhood T2DM is becoming more prevalent.

Podiatrist and Diabetes

Our main concern as podiatrists is how diabetes can affect the delicate blood vessels of the feet. The microvessels in your feet are responsible for supplying the nerves of your feet and are vulnerable to high blood glucose levels. As free glucose begins to rise, a substance called sorbitol begins to form which alters the way water flows in and out of your body’s cells. As sorbitol levels inside the cell begin to rise, more water will rush into the cell to equalize the concentration. This is known as osmotic regulation. Unfortunately, when too much water rushes into the cells of the delicate microvessels, the vessels can burst. This can lead to damage to the blood vessels of the retina, kidney and peripheral nerves.

When the peripheral nerves have been affected by unregulated glucose levels, your sensitivity to injury can be affected, as well as the ability to effectively heal injuries. This means that you may no longer feel the stone in your shoe, if you cut your foot on a shard of glass or if you have a high-pressure area under your foot. If these injuries go unnoticed, it can lead to ulceration and possibly infection.

PODIATRIST RECOMMEND

A 6 monthly check up with your podiatrist will help to detect any changes in your blood flow and nerve function before they develop into more serious problems. Making sure you’re wearing the proper footwear, checking your feet regularly and contacting your podiatrist if you notice any injuries or red swollen areas of your feet will help prevent more serious complications. Taking care of your general health is also just as important. Exercising regularly, monitoring blood sugar levels daily, monitoring your diet with a dietician, avoiding walking barefooted, wearing well fitted enclosed shoes. Having your skin and nails treated by a podiatrist for any ingrowing toenails, corns, calluses, hammertoes and any other foot problems or concerns with blood flow or sensory function will all help to prevent further complications associated with diabetes.

FUNGAL NAIL INFECTIONS

Wed, 15 Nov 2017 07:24:48 GMT

Onychomycosis occurs when fungi invade the toenail or fingernail and /or the skin under the nail (nail bed). Toenails are more commonly affected than fingernails, because they grow very slowly, allowing the fungi more time to develop. As a result, toenails require longer treatment time than fingernails do.

Fungal nail infections are common. Worldwide 2%-18% of the population have a fungal nail infection at any given time. They are most common in people over 60 and rare in children, affecting less than 1% of children at any given time.

How do you acquire onychomycosis?

You can get a fungal nail infection when you come into contact with the fungi, and they begin to grow on or under your nail. Fungi grow best in warm, moist areas, the shoe is an ideal environment hence the area around the toes is at risk. Fungal nail infections can be spread from one person to the next, either through direct contact with commonly used floors, shoes, or other personal items, such as nail clippers or nail files. It may spread from skin infections that are present on the sole of the feet, in between the toes or from the area in the nail folds to the nails. Shoes that are moist, tight, and do not allow air to move around your feet contribute to fungal infections.

Symptoms and Types of fungal nails

There are five main types of nail fungus, they may occur singularly or as a combination of subtypes.

Distal lateral subungual onychomycosis (DLSO) thickened skin on nail bed under the nail which is lifting and is yellow-white in colour and or yellow streaks and the nail maybe separating from the central part of the nail bed.

White superficial onychomycosis (WSO) small white speckled or powdery patches on the surface of the nail, the nail can become crumbly and does not invade the nail bed under the nail.

Proximal subungual onychomycosis (PSO) a white area(leukonychia) that moves downwards from the tip of the nail, there is often inflammation of the skin around the base of the nail.

Endonyx onychomycosis (EO) a milky white discolouration of the nail, the nail is not lifting and there is not any thickening of the skin on the nail bed.

Candidal onychomycosis usually develops in people with immuno depression or candida fungal infection of the mucous membranes, it will affect several or all nails and the skin surrounding the nail is inflamed. Sometimes the end of the toe ill become bulbous in nature.

As the condition progresses the appearance can be distressing for some people. Onychomycosis can sometimes cause discomfort when wearing shoes, walking or standing for long periods of time.

How is onychomycosis diagnosed?

A thorough history of your nail condition, your general health and by examining the nail and surrounding tissues will usually be enough to determine the presence of fungi. If the infection is stubborn and not responding to the first line of treatments then a pathology test of your nail clippings may be warranted, unfortunately, pathology is not always indicative of the presence of the fungi.

Treatment: Onychomycosis is treated with antifungal medication.

A nail lacquer is usually the first line of treatment. The lacquer is applied to the nail, the frequency of application will be dependent on the medication advised.
The nail may need to be removed and the anti-fungal treatment can then be applied directly to the nail bed.
A preparation with urea and anti-fungal medication maybe applied to remove the nail and treat the fungus at the same time.
An oral medication maybe prescribed by your GP, this can only be prescribed after a positive pathology result was identified for the presence of fungus.

1 ( www.webmd.com )

2-7 ( www.emedicine.mediscape.com )

TIPS ON HOW TO TAKE CARE OF YOUR FEET

Tue, 22 Aug 2017 17:05:57 GMT

Check your feet everyday: Look for dry skin , cuts, sores, blisters and breaks in the skin. Check between your toes and use a mirror if you cannot see the bottom of your feet. If you notice any changes in colour or changes to moles and freckles see your podiatrist or GP.

Wash your feet daily and dry carefully between your toes and pat the tops and the soles of your feet, following this apply moisturizer to prevent dry skin from cracking. Do not use medicated corn pads or callous removal creams and ointments. Do not put moisturizer between your toes or on open sores.

When cutting your nails, cut straight across and then file the corners gently with an emery board to remove any sharp corners or edges.

When choosing footwear make sure that your footwear is comfortable immediately, always purchase your shoe with a fifth fingers width from the longest toe to the end of the shoe. A shoe with a deep wide toe area is most desirable to fit the toes comfortably. The materials should be breathable and laces or velcro fasteners provide the most secure fit to the foot. It is best to purchase your shoe towards the end of the day when your feet maybe a little larger due to fluid retention. Purchase your shoe to suit the activity. High heels are not advised as they change your foot and upper body posture.

Socks should be supportive but not tight, with minimal seams. Moisture wicking socks can be purchased and are ideal for feet that perspire and for sports people.