Advice on Foot Care

The Melafind® System is a hand held imaging device designed to help physicians identify malignant lesions. The device emits multiple wavelengths of light which help to examine the characteristics of suspicious lesions. The information is collected and then compared to a database within the system. The  Melafind® database consists of 6,000 lesions from 4,500 patients, which the company claims is the largest database in the U.S. The “brain” of the MelaFind® system uses sophisticated mathematical algorithms to compare the characteristics of the suspicious lesions with the characteristics of benign and malignant lesions stored in the database. The Melafind® System was developed by Electro-Optical Sciences and is currently being studied by the FDA and is not yet available for commercial use.

A new topical nail solution is being studied for it’s effectiveness in treating onychomycosis, also known as nail fungus. Toenail fungus is extremely difficult to treat and despite there being a number of medications on the market, many topical medications are not very effective. Terbinafine HCl 10% nail solution (TNS) is currently ending phase III of clinical trials and looking for government approval for patient use. Terbinafine is most commonly known as Lamisil® and is the most popular and effective oral antifungal medication on the market currently.
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The CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2005 and 2007 and found that the prevalence of arthritis in diabetics was 52% and that the prevalence of inactivity was higher in diabetics with arthritis as compared to diabetics without arthritis. This information suggests that arthritis may be an additional barrier to physical activity in diabetics. Diabetics face the same barriers that most adults face when it comes to increasing physical activity: a lack of time and motivation, other responsibilities and difficulty finding physical activities they enjoy. But, for those with arthritis, there are additional barriers which include concern about causing joint damage, aggravating arthritis pain and finding activities which are safe for their joints. Continue Reading »

A study in the American Journal of Sports Medicine in June of 2008 evaluated in-shoe pressure in 22 athletes with high arch (cavus) feet. Two neutral-cushioned running shoes (Asics Nimbus 6 and Brooks Glycerin 3) and a control shoe (Dunlop Volley) were used and the pressures were collected using the Novel Pedar-X system. Compared with the control shoe, both neutral-cushioned running shoes significantly reduced peak pressure. The Brooks Glycerin was the most effective at reducing forefoot pressure and the Asics Nimbus 6 was most effective at reducing rearfoot pressure. The Asics Nimbus shoe was considered the most comfortable shoe, but both neutral-cushioned running shoes were more comfortable than the control shoe.
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Mechanical engineer Jerome Rifkin has spent 8 years developing and building a flexible, mechanical foot. The foot is one of the most complicated structures in the body. With 26 bones, 33 joints, 107 ligaments and 19 muscles, the foot is a difficult part of the body to mimic or replace. Rifkin’s artificial foot differs from other mechanical feet because it has a heel, a midfoot, a forefoot and a big toe. The midfoot essentially connects the forefoot to the heel, but more importantly, it creates a flexible arch designed to give the wearer a more natural step. Continue Reading »

According to research at the 55th Annual Meeting of the American College of Sports Medicine (ACSM), individuals wearing flip-flops alter their gait and may experience lower leg pain as a result. ???????? ????? ????????The study compared the gait of 39 college age men and women wearing flip-flop style sandals and athletic shoes. Both the flip-flops and the athletic shoes used in the study ranged in price and style. The flip-flops ranged in cost from $5.00 - $50.00. The participants in the study walked along a platform which measured the vertical force as the heel and foot hit the ground. Their stride length and leg angle were also evaluated.

A study done at the Arthritis Research Centre of Canada in Vancouver studied 45,869 men, without gout, over a 12 year period. Every four years, 2 questionnaires were sent out to the participants. The first questionnaire asked about intake of coffee, decaffeinated coffee, tea and total caffeine. The second questionnaire was used to evaluate whether participants met the criteria for gout, as defined by the American College of Rheumatology. Continue Reading »

Stretching has always been a part of the treatment regimen for plantar fasciitis, but not all stretches are equal. Research in the past few years has shown that specifically stretching the plantar fascia is more effective than general calf stretching in the short term and has also shown overall pain reduction in the long term. Continue Reading »

Researchers from the Department of Dermatology at Sheba Medical Center in Israel evaluated 68 individuals with nail abnormalities after removing artificial nails. Samples of the nail were taken from the tip of the nail and at the base of the nail and sent to the lab for fungus evaluation.
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An abstract presented at the 2007 American Diabetes Association Scientific Session showed reduced lower extremity complications in diabetics who participated in a diabetic management program.

Reduced Incidence of Diabetes Lower Extremity Complications During Participation in Diabetes Disease Management Programs

Authors:
CARTER COBERLEY, BRENT HAMAR, ZACKARY SAMPLES, MATTHEW MCGINNIS, SADIE COBERLEY, ANDRES PEREZ, DEXTER SHURNEY, Nashville, TN

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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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Researchers at the George Institute for International Health at the University of Sydney, Australia conducted a randomized controlled trial with 152 individuals with chronic knee or hip osteoarthritis. The individuals were divided randomly into three groups. One group of 55 individuals had 12 weeks of hydrotherapy class, one group of 56 individuals had 12 weeks of Tai Chi classes and the control group of 41 individuals had no therapy or treatment.

Results: At 12 weeks, individuals participating in the hydrotherapy or the Tai Chi classes had improvements in function and pain compared with the control group. Only the individuals in the hydrotherapy group had significant improvements in the physical performance measures. Improvements in pain and function were sustained in both groups at 24 weeks. Participants in the hydrotherapy group were also more likely to attend the classes, with 81% of the class attending more than half of the classes available. Only 61% of the participants attended more than half of the Tai Chi classes available.

Summary: Physical activity, whether hydrotherapy or Tai Chi, can decrease pain and improve function for those with chronic knee or hip osteoarthritis. Although this study demonstrates more improvement with hydrotherapy, it is unclear if this is a result of participation, or the actually activity.

Fransen M, et al. Physical activity for osteoarthritis management: a randomized controlled clinical trial evaluating hydrotherapy or Tai Chi classes. Arthritis Rheum. 2007 Apr 15;57(3):407-14.

Obesity and pronated foot type may increase the risk of chronic plantar heel pain: a matched case-control study.

A new study reveals a link between chronic heel pain, pronated feet and obesity. The study included 80 individuals with chronic heel pain and 80 individuals without chronic heel pain. Body Mass Index (BMI), foot posture (foot position while standing), ankle range of motion, lower limb stress and calf endurance were measured in both groups. Questions on the type of activities and time spent were asked.

Results: The chronic heel pain group had a significantly greater body mass index (BMI), a more pronated foot position and greater ankle dorsiflexion range of motion (movement of the foot up, in relationship to the leg). There was no difference between the groups in the measurements of calf endurance or on reported time spent sitting, standing, walking on uneven ground, squatting, climbing or lifting.

Summary: Obesity and pronation are associated with chronic heel pain and this study reinforces the idea that they may be risk factors in development of chronic heel pain. This study does not show an association between the limitation of ankle joint dorsiflexion and chronic heel pain.

Irving DB, Cook JL, Young MA, Menz HB. Obesity and pronated foot type may increase the risk of chronic plantar heel pain: a matched case-control study. BMC Musculoskelet Disord. 2007 May 17;8(1):41

A recent article in Sports Medicine cited a significant increase in the number of people who are running marathons. The yearly incidence of injuries in marathon runners is reported as high as 90%, but it appears that less experienced runners are the ones who are more prone to injury. More experienced runners are less likely to experience injuries. The risk of injury decreases as the years of experience increase. But, the risk of injury increases once the once a threshold of 40 miles/week is crossed. The most common is injury was to the knee, citing patellofemoral syndrome as the most common. Other common running injuries included plantar fasciitis, meniscal injuries of the knee, achilles tendonitis, iliotibial band syndrome and tibial stress syndrome.

 

Fredericson M, Misra AK. Epidemiology and aetiology of marathon running injuries. Sports Med. 2007; 37 (4-5):437-9.

A study in the July/August issue of The Journal of Foot and Ankle Surgery in 2006, has demonstrated that Extracorporeal Shockwave Therapy is an effective and safe treatment for plantar fasciitis.

Extracorporeal Shockwave Therapy (ESWT) has been used for treating medical conditions for many years, but emerged in the mid-90s as a treatment for plantar fasciitis. Shockwave therapy is the production of sound waves, not electrical shocks. The sound waves cause controlled tissue injury at an area of chronic inflammation or degeneration and stimulate a healing response by the body. The treatment was FDA approved for treatment of plantar fasciitis in 2000, but has remained under scrutiny because of conflicting research studies.

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