The Foot Blog

Posts for: November, 2013

By Dr. Mitchell Waskin
November 15, 2013
Category: Diabetic Foot Care
Tags: Untagged

 

Watch more videos by Dr. Waskin

 

I always find this interesting: What is it worth to people to be healthy? Would you pay $5,000 a year to have an 85 percent decrease in your chance of having an amputation (and being dead from that amputation within five years after that)? How about if it was $1,000 — would you pay $1,000 to help keep yourself alive longer? Or, even $500? What is your health worth to you? 

 

Well, here's an easy one, folks. You can have an 85 percent reduction in your risk of amputation (and of dying within five years after that amputation) — just by coming and doing this 30-minute exam that your insurance company is going to pay for. 

 

Every time I give one of my diabetes seminars, as I look at the eyes of people sitting in the room, I can almost tell what people are thinking. Everyone's thinking, it is really stupid not to come and get this exam — once a year! 

 

An annual Comprehensive Diabetic Foot Exam could save your feet, and maybe even your life. 

 

For more information about having an annual comprehensive diabetic foot exam, give us a call at 804-320-FOOT (804-320-3668), or check out the links below. Please help us spread the word about this simple but lifesaving exam — If you know someone who has diabetes, please share this post with them using the social sharing icons at the bottom of this page.

 

By Dr. Mitchell Waskin
November 15, 2013
Category: Diabetic Foot Care
Tags: Untagged

Watch more videos by Dr. Waskin

 

We have a medical spa attached to our clinic for medical grade manicures and pedicures. Why? Several years back, I went around to try to find a place where I could refer some of my patients, where they can actually get clean pedicures — because people get infections all the time from pedicure salons. 
 
You might think that's not that big a deal, but if you're diabetic, and you're immunocompromised and you're at risk for infections, or you're undergoing chemotherapy treatment and you're at risk for infections — all of a sudden it becomes very important. You might say, just don't go to pedicure salons. Well, what if you can't take care of your own nails, or you don't have a family member who can help you with that? 
 
So, I went out searching, and I went to a lot of the better salons. Do you know how many I found that actually gave truly clean pedicures? Zero. Not one. 
 
So, we developed this medical grade spa here in our clinic. We have highly trained pedicurists, it's actually clean, and it's just like going to a nice salon for a pedicure or manicure. In fact, our medical grade spa is so clean, the oncologists at the cancer hospital at Johnston-Willis refer people undergoing chemotherapy over here to get manicures and pedicures.

 

For more information about our medical grade spa, give us a call at 804-320-FOOT (804-320-3668), or check out the links below. And, if you know someone who enjoys getting a manicure and pedicure, but worries about germs and infection, please share this post with them using the social sharing icons at the bottom of this page.

 

By Dr. Mitchell Waskin
November 15, 2013
Category: Diabetic Foot Care
Tags: Untagged

Watch more videos by Dr. Waskin

 

The last thing you want is for someone who has decreased feeling in their feet — or decreased circulation — to have something like a bunion chronically rubbing inside the shoe, or a bent-up toe called a hammer toe, rubbing inside the shoe. In a short period of time, this can break down into an ulcer, which is very dangerous if you have diabetes.
 
I've had patients who — just one time — put on a pair of shoes that didn't fit correctly. They said, "I just wanted to go out, we were going someplace nice. I put this shoe on —I know, I wasn't supposed to wear that shoe, because you told me, doc, I'm supposed to wear this other kind of shoe that's good for my feet — but it was only one night, it was only a few hours." And then, they would be in my office the following week, with a hole in their toe. That sort of thing often ends up leading to amputation — just from the one-time thing. Because, it all works together: the decreased sensation, the decreased circulation, and wearing incorrect shoes. 
 
This is the reason that we have a staff pedorthist (professional shoe fitter) as part of our diabetic program. We do a huge amount of diabetic shoe fitting in our clinic. 
 
So, why do we offer diabetic shoes in our clinic? There was a time when I used to refer people out to get their diabetic shoes elsewhere. The problem was, I would have people come back the next year for another exam, and I would look and say, "I don't see your diabetic shoes. Did you get them?" They'd say, "Yeah, I got them." "So, why aren't you wearing them?" "Well, they were really ugly, so I didn't like them, so I didn't wear them." 
 
It turned out that I was referring all these people out to get diabetic shoes, but because they were ugly or too heavy, patients would buy the shoes because their doctor told them to — but then they would go home and throw them in the closet and never wear them —which does absolutely no good. 
 
That's the reason we decided to start carrying the shoes right here in our clinic. And my pedorthist, who knows something about fashion, set out on a mission to find those shoe companies that make stylish diabetic shoes — not those ugly orthopedic looking shoes. And she's done a very good job of it, and she has hundreds of styles of shoes! As a result, we now find that the great majority our diabetic patients who need diabetic shoes are actually getting the shoes they need — and actually wearing them. Why? Because they look like regular shoes. 
 
Most people don't realize the variety of diabetic shoe styles available. For example, we all know New Balance, they make probably the best running shoes out there. New Balance actually makes a diabetic version of their shoes. It looks identical to their other New Balance running shoes. You would never know the difference from the outside — all the differences are on the inside. Hush Puppies, Drew — a lot of companies make diabetic versions of their shoes. But few providers carry them, because they don't want to have to deal with it. It's much easier just to say, "Hey, I've got this orthopedic looking shoe: black or brown, pick one." That's what most of the places do. 
 
So now, by offering a variety of fashionable looking diabetic shoes, we've been able to get our patients to really wear their diabetic shoes — which really help to protect their feet. In fact, properly fitting diabetic shoes are so important, that almost every single insurance company will pay for the shoes and the special insoles that go in the shoes, if people will wear them.

 

For more information about our diabetic shoe program, give us a call at 804-320-FOOT (804-320-3668), or check out the links below. And, if you know someone who could benefit from our diabetic shoe program, please share this post with them using the social sharing icons at the bottom of this page.

 

By Dr. Mitchell Waskin
November 15, 2013
Category: Diabetic Foot Care
Tags: Untagged

 

 

Watch more videos by Dr. Waskin

 

I'm often asked by patients if their primary care physician can do their annual comprehensive diabetic foot exam. While the primary care physician is certainly capable of doing this exam, there are a number of reasons why most primary care physicians actually will refer the diabetic patients to us for this examination. 

 

First and foremost, we have the time to spend just on the foot. Your primary care physician is looking at everything from the top of your head to the bottom of your foot and everything in between. We take about 30 minutes to do this exam, just of your feet. 

 

The second thing is that we have specialized equipment that can pick up pathology earlier — for example, we have equipment that can look at your circulation much more closely, compared to a physical exam. We have some equipment that can pick up early nerve damage, showing if you have a loss of feeling in your feet at a much earlier time than a clinical exam. 

 

We also have a certified pedorthist on staff. That's someone who's gone to school to learn about medical shoe fitting and custom shoe inserts and foot and ankle bracing. If you have a problem with your foot, that may be coming from your shoe, then the pedorthist can modify your shoes — or even get you special shoes, if needed. 

 

For more information about this annual comprehensive diabetic foot exam, and why you should see your podiatrist for that, give us a call at 804-320-FOOT (804-320-3668), or check out the links below. Please help us spread the word about this simple but lifesaving exam — If you know someone who has diabetes, please share this post with them using the social sharing icons at the bottom of this page.


By Dr. Mitchell Waskin
November 07, 2013
Category: Diabetic Foot Care
Tags: Untagged

 

Watch more videos by Dr. Waskin

 

Patients often ask me, what's involved in an annual comprehensive diabetic foot exam? Actually, it's a very simple, comfortable and painless exam to have done. 

 

We start by looking at your medical history: what other problems do you have besides diabetes? We look at the medications you're taking, because some medications can mimic certain symptoms of diabetes. We want to know what your allergies are. Beyond that, it becomes more of a basic exam …

 

For example, we look at your circulation. We feel the pulses in your feet, to see how good they are. If we have any problem feeling the pulses, we have specialized equipment that can, in much more detail, determine the circulation down to your feet. 

 

We want to look at the skin and the nails, to see if there are any problems indicating either a local issue going on in your feet, or a more systemic problem that's going on with your diabetes. We want to look even at just the nails — how thick are they? Sometimes patients will get thick nails, and in a diabetic patient, that can cause a sore to form under the nail. Are the nails ingrowing? Maybe there's a little infection from the ingrowing nail. Maybe that's not a big problem in someone without diabetes, but in diabetic patients, a small infection can become a big problem very quickly. 

 

We want to see how good the feeling is in your feet. We look at things like the ankle reflexes. You've probably had a reflex test before, perhaps during a physical at your primary care doctor's office. We want to look to see if you have that reflex. Because, when you lose that reflex, it's one of the earliest indicators of nerve damage. 

 

We check your temperature sensation. Can you feel cold, from the tops and bottoms of your feet? When you lose temperature sensation, that's also an indicator of some damage to the nerves. 

 

We use a tool called a monofilament to test the sensation in your feet. It's very soft, and it doesn't hurt. But it's set at a certain pressure, and if you can feel it, then you have enough sensation to know if you're causing damage to your feet. We can check by touching the monofilament to different areas of your feet to see if you can or can't feel it. 

 

One of the earliest indicators of nerve damage is vibratory sensation. When you have your physical with your primary care physician, they might take a tuning fork and touch it to your foot. Well, that's good, but it's not really that accurate. We use something called a biothesiometer, which we can adjust to measure how much vibration you feel, so we can actually quantify the level of nerve function that you have. Again, it's completely painless. We touch the device to your toe, and as we adjust it, you just tell us when you can or cannot feel it anymore. 

 

We look at deformities in your foot. Do you have any bunions, or hammer toes (toes that bend up)? These are areas that can rub in your shoe and become points of infection. These are also places where ulcers might form. And ulcers are serious in diabetics, because 15 percent of diabetic patients who get an ulcer will go on to have an amputation of their leg — which is what we're ultimately trying to prevent. 

 

As you can see, a comprehensive diabetic foot exam a very simple examination, completely painless, and it takes about 20 - 30 minutes. If you have diabetes, making sure you get this exam every year is one of the most important things you can do to manage your diabetes and prevent amputations. 

 

For more information or to schedule your diabetic foot exam, give us a call at 804-320-FOOT (804-320-3668), or check out the links below. Please help us spread the word about this simple but lifesaving exam — If you know someone who has diabetes, please share this post with them using the social sharing icons at the bottom of this page.