Advice on Foot Care

The Influence of Exercise on Foot Perfusion in Diabetes.

Researchers at the Wound Healing Research Unit at Cardiff University in the UK measured changes in circulation in the foot following brief periods of exercise in participants with and without type 2 diabetes and arterial disease. There were 61 participants and 116 limbs were evaluated. The participants were divided into groups based on the presence or absence of diabetes, peripheral vascular disease and peripheral neuropathy. Measurements were used to evaluate circulation to the lower extremities and specifically at the foot and toes (Transcutaneous oxygen tension (TcPO(2)), transcutaneous carbon dioxide tension (TcPCO(2)), ankle-brachial pressure indices, toe pressures and toe-brachial pressure indices (TBI).

Results: After exercise, toe pressures and toe-brachial pressures increased in the non-diabetic group with arterial disease, but not in the group with diabetes. After exercise, the foot TcPO2 values increased in groups with diabetes.

Summary: These results suggest that brief periods of exercise can improve the cutaneous perfusion (increased circulation in the smaller vessels to the skin and superficial structures) in the feet and toes in patients with diabetes and those with diabetes and arterial disease as a result of the local heating after exercise.

Williams DT, Harding KG, Price PE. The influence of exercise on foot perfusion in diabetes. Diabet Med. 2007 Jun 25.

I worked at the Western States 100 finish line in Auburn this past weekend, giving the finishing runners needed foot care. The run is conducted along the Western States Trail starting at Squaw Valley, California, and ending in Auburn, California, a total of 100 miles. The trail ascends from the Squaw Valley floor to Emigrant Pass and then follows the original trail used by the gold miners. The runners head south and west and climbs over 18,000 feet during the run and descends almost 23,000 feet before reaching Auburn.

The most common foot problem is blisters. Blisters on the toes are common, especially the 5th toe and under the great toenail. Other common places for blisters are the heel and under the ball of the foot. Black toenails are standard for many ultra runners, and losing a toenail during training or after the race is not uncommon. The Western States run is unique in that there is a lot of descending and climbing in and out of the canyons. The decents are steep and the trail is rocky and loose. This causes more jamming of the toes against the front of the shoes and this friction causes blisters and excess pressure on the toenails.

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Freel Peak is the highest peak in the Lake Tahoe Region at 10,881 feet. The two most popular routes to the top are through Armstrong Pass. The shorter of the two routes involves driving on USFS road 051 off of Highway 89 to the base of Armstrong Pass. It is only 1 mile to Armstrong Pass and the junction of the TRT - Tahoe Rim Trail.

We decided to head up Fountain Place Road and take Armstrong Pass Trail, a 3 mile hike to the TRT. Armstrong Pass Trail is an enjoyable, mostly shaded trail following a creek at a reasonable grade. Continue Reading »

Cool New Gear For Runners & Walkers

The Nike+ iPod Sports Kit allows you to listen to your favorite tunes while you run or walk AND track your speed and distance. A sensor placed on the Nike shoes tracks time, distance and speed and transmits this information to the iPod receiver. The iPod can give audible feedback and let you know your pace or how many calories you have burned. The sensor and receiver come with the kit and Nike sells shoes with a compartment specifically made for the sensor, although other companies do sell sensor pouches which can attach to your current pair of running or walking shoes.

Researchers at the Institute for Diabetic Foot Research in New York, studied 49 type II diabetics with distal subungual onychomycosis (DSO - the most common type of toenail fungus). The patients were treated with ciclopirox 8% topical laquer (Penlac®) once daily for 48 weeks.

Results: At the end of the study 63% of the patients achieved clinical improvement, 86% of patients had mycologic improvement and 54% attained a mycologic cure. No serious adverse advents were observed during the trial period.

Summary: This study concludes that Penlac® is a safe and effective treatment for diabetics with mild to moderate toenail fungus.

Brenner MA, Harkless LB, Mendicino RW, Page JC. Ciclopirox 8% nail lacquer topical solution for the treatment of onychomycosis in patients with diabetes: a multicenter, open-label study. J Am Podiatr Med Assoc. 2007 May-Jun;97(3):195-202.

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Hiking can be one of the most enjoyable and affordable ways to exercise. It is not necessary to buy lots of fancy gear to hike (although it may seem otherwise if you browse any of the retail outdoor catalogs). It is also not necessary to be at a top fitness level. You simply need a good pair of hiking boots, a water bottle and a trail.

Although hiking can be a sport for anyone, it is important to hike on a trail that fits your ability. Steep, rocky and lengthy trails with little shade should be left to experienced hikers. But, there are many shorter trails with beautiful views for beginner hikers. Carrying water is a must, but a hydration pack is not necessary unless large quantities of water are needed for longer hikers. A hat and glasses are a plus to keep sun off your face and out of your eyes. Sunscreen is important for most hikes and for longer hikes, reapplication is usually necessary. For medium length hikes or short hikes in moderate temperatures cotton shirts and shorts are fine. Shirts and shorts made with wicking fabrics are an advantage for longer hikes, hikes in warmer weather or when weather shifts more than 20 degrees during the hike. The wicking fabric allows the Continue Reading »