Copyright | Family Foot & Ankle Wellness Center 2012
Arthritis is a frequent component of complex disease processes that may involve more than 100 identifiable disorders. It is characterized by inflammation of the cartilage and lining of the body's joints. If the feet seem more susceptible to arthritis than other parts of the body, it is because each foot has 33 joints which can be afflicted, and there is no way to avoid the pain of the tremendous weight-bearing load on the feet. Arthritis may be a disabling and occasionally crippling disease; it afflicts almost 40 million Americans. In some forms, it appears to have hereditary tendencies. While the prevalence of arthritis increases with age, all people from infancy to middle age are potential victims. People over 50 are the primary targets. Arthritic feet can result in loss of mobility and independence. But that may be avoided with early diagnosis and proper medical care.
What is
Arthritis?
Arthritis, in general terms, is
inflammation and swelling of the cartilage and lining of the
joints, generally accompanied by an increase in the fluid in the
joints. Arthritis has multiple causes; just as a sore throat may
have its origin in a variety of diseases, so joint inflammation and
arthritis are associated with many different illnesses.
Some
Causes
Besides heredity, arthritic symptoms
may have their source in a number of phenomena:
Symptoms
Because arthritis can affect the
structure and function of the feet it is important to see Dr.
Bruscia if any of the following symptoms occur in the
feet:
Skin changes, including rashes and growths
Some Forms of
Arthritis
Osteoarthritis is the most common
form of arthritis. It is frequently called degenerative joint
disease or "wear and tear" arthritis. Although it an be brought on
suddenly by an injury, its onset is generally gradual; aging brings
on a breakdown in cartilage, and pain gets progressively more
severe, although it can be relieved with rest. Dull, throbbing
nighttime pain is characteristic, and it may be accompanied by
muscle weakness or deterioration. Gait patterns – normal walking –
may grow erratic. It is a particular problem for the feet when
people are overweight, simply because there are so many joints in
each foot. The additional weight contributes to the deterioration
of cartilage and the development of bone spurs. Rheumatoid
arthritis (RA) is a major crippling disorder, and perhaps the most
serious form of arthritis. It is a complex, chronic inflammatory
system of diseases, often affecting more than a dozen smaller
joints during the course of the disease, frequently in a
symmetrical pattern – both ankles, or the index fingers of both
hands, for example. It is often accompanied by constitutional signs
and symptoms – lengthy morning stiffness, fatigue, and weight loss
– and it may affect various systems of the body, such as the eyes,
lungs, heart, and nervous system. Women are three or four times
more likely than men to suffer RA, indicating a linkage to
heredity. RA has a much more acute onset than osteoarthritis. It is
characterized by alternating periods of remission, during which
symptoms disappear, and exacerbation, marked by the return of
inflammation, stiffness, and pain. Serious joint deformity, and
loss of motion, frequently result from acute rheumatoid arthritis.
However, the disease system has been known to be active for months,
or years, then abate, sometimes permanently. Gout (gouty arthritis)
is a condition caused by a build-up of the salts of uric acid – a
normal byproduct of the diet – in the joints. A single big toe
joint is commonly the locus, possibly because it is subject to so
much pressure in walking; attacks of gouty arthritis are extremely
painful, perhaps more so than any other form of arthritis. Men are
much more likely to be afflicted than premenstrual women, an
indication that heredity may play a role in the disease. While a
rich diet that contains lots of red meat, rich sauces, and brandy
is popularly associated with gout, there are other protein
compounds in such foods as lentils and beans which may play a
role.
Diagnosis
Different forms of arthritis affect
the body in different ways; many have distinct systemic affects
that are not common to other forms. Early diagnosis is important to
effective treatment of any form. Destruction of cartilage is not
reversible, and if the inflammation of arthritic disease isn't
treated, both cartilage and bone can be damaged, which makes the
joints increasingly difficult to move. Most forms of arthritis
cannot be cured, but can be controlled or brought into remission;
perhaps only five percent of the most serious cases, usually of
rheumatoid arthritis, result in such severe crippling that walking
aids or wheelchairs are required.
Treatment
The objectives in the treatment of
arthritis are controlling inflammation, preserving joint function
(or restoring it if it has been lost), and curing the disease if
that is possible.
Athlete’s foot is a skin disease caused by a fungus, usually occurring between the toes. The fungus most commonly attacks the feet because shoes create a warm, dark, and humid environment which encourages fungus growth. The warmth and dampness of areas around swimming pools, showers, and locker rooms, are also breeding grounds for fungi. Because the infection was common among athletes who used these facilities frequently, the term "athlete's foot” became popular. Not all fungus conditions are athlete’s foot. Other conditions, such as disturbances of the sweat mechanism, reaction to dyes or adhesives in shoes, eczema, and psoriasis, also may mimic athlete's foot.
Symptoms
The signs of athlete's foot, singly
or combined, are drying skin, itching, scaling, inflammation, and
blisters. Blisters often lead to cracking of the skin. When
blisters break, small raw areas of tissue are exposed, causing pain
and swelling. Itching and burning may increase as the infection
spreads. Athlete's foot may spread to the soles of the feet and to
the toenails. It can be spread to other parts of the body, notably
the groin and underarms, by those who scratch the infection and
then touch themselves elsewhere. The organisms causing athlete's
foot may persist for long periods. Consequently, the infection may
be spread by contaminated bed sheets or clothing to other parts of
the body.
Prevention
It is not easy to prevent athlete's
foot because it is usually contracted in dressing rooms, showers,
and swimming pool locker rooms where bare feet come in contact with
the fungus. However, you can do much to prevent infection by
practicing good foot hygiene. Daily washing of the feet with soap
and water; drying carefully, especially between the toes; and
changing shoes and hose regularly to decrease moisture, help
prevent the fungus from infecting the feet. Also helpful is daily
use of a quality foot powder.
Tips
Treatment
Fungicidal and fungistatic
chemicals, used for athlete's foot treatment, frequently fail to
contact the fungi in the horny layers of the skin. Topical or oral
antifungal drugs are prescribed with growing frequency. In
mild cases of the infection it is important to keep the feet dry by
dusting foot powder in shoes and hose. The feet should be bathed
frequently and all areas around the toes dried
thoroughly.
Consult Dr.
Bruscia
If an apparent fungus condition does not
respond to proper foot hygiene and self care, and there is no
improvement within two weeks, consult Dr. Bruscia. He will
determine if a fungus is the cause of the problem. If it is, a
specific treatment plan, including the prescription of antifungal
medication, applied topically or taken by mouth, will usually be
suggested. Such a treatment appears to provide better resolution of
the problem when the patient observes the course of treatment
prescribed by the podiatrist; if it’s shortened, failure of the
treatment is common. If the infection is caused by bacteria,
antibiotics, such as penicillin, that are effective against a broad
spectrum of bacteria may be prescribed.
Diabetes mellitus is a chronic disease which afflicts about 16 million people in the United States, half of whom are unaware they have the disease. It is a metabolic disease characterized by elevated glucose (blood sugar), resulting from defects in secretion of the hormone insulin, defects which cause tissue to resist absorption of insulin, or both. Chronic elevation of blood sugar (hyperglycemia) is associated with long-term damage to the eyes, heart, kidneys, feet, nerves, and blood vessels. Symptoms of hyperglycemia may include frequent urination, excessive thirst, extreme hunger, unexplained weight loss, tingling or numbness of the feet or hands, blurred vision, slow-to-heal wounds, and susceptibility to certain infections. Those who have any of these symptoms and have not been tested for the disease should see a physician without delay. Individuals with diabetes are prone to many complications, both acute and chronic. About 15 percent of those with diabetes will develop an open wound (ulceration) on a foot during their lifetimes, and 20 percent of these ulcerations will lead to amputations. The annual incidence of nontraumatic lower extremity amputations among people with diabetes is about 54,000, according to the American Diabetes Association. Among African-Americans, the amputation rate is 1 1/2 to 2 1/2 times that of whites, and Native Americans have even higher rates, three or four times that of whites.
An Unwelcome Lifetime
Companion
Diabetes, once diagnosed, is present
for life. Considerable research is focused on finding a cure, and
much progress has been made in treatment and control of the
disease. The majority of people with diabetes have type II
diabetes. Type I, insulin-dependent diabetes mellitus, once
referred to as juvenile, or juvenile-onset diabetes, afflicts five
to 10 percent of people with diabetes. Type II,
non-insulin-dependent diabetes mellitus, once known as adult-onset
diabetes, afflicts the other 90-95 percent, many of whom use oral
medication or injectable insulin. The vast majority of those people
(80 percent or more) are overweight, many of them obese. Obesity
itself can cause insulin resistance. The socioeconomic costs of
diabetes are enormous. The dollar costs have been estimated at 592
billion annually, about equally split between direct medical costs
and indirect costs. Diabetes is the fourth leading cause of death
by disease in the United States. Individuals with diabetes are two
to four times as likely to experience heart disease and stroke. It
is the leading cause of end-stage kidney disease and new cases of
blindness among adults under 75. The trauma of amputation is
particularly debilitating. It often ends working careers, and
restricts social life and the independence which mobility affords.
For more than 50 percent of those who experience an amputation of
one limb, the loss of another will occur within three to five
years. The key to amputation prevention is early recognition and
foot screening, at least annually, of at-risk individuals. Those
individuals considered to be at high risk are those who exhibit one
or more of six characteristics: (1) peripheral neuropathy, a nerve
disorder generally characterized by loss of protective sensation
and/or tingling and numbness in the feet; (2) vascular
insufficiency, a circulatory disorder which inhibits blood flow to
the extremities; (3) foot deformities, such as hammertoes; (4)
stiff joints; (5} calluses on the soles of the feet; and (6) a
history of open sores on the feet (ulcerations) or a previous lower
extremity amputation.
The Role of Dr.
Bruscia
Dr. Bruscia is a foot care specialist with
skills in recognition and treatment of diabetic foot conditions.
Because diabetes is a systemic disease, affecting many organs of
the body, ideal case management requires a team approach, involving
Dr. Bruscia as well as the family physician, several medical
specialists, and a dietitian. Dr. Bruscia, as an integral part of
the treatment team, has documented success in the prevention of
amputations. It is one of the most serious conditions treated by
Dr. Bruscia, whose training stresses salvage of the foot rather
than amputation. A comprehensive approach to prevention of
complications must include good glucose control, adherence to diet,
an exercise program, proper medication and hygiene, and regular
foot care. Those who follow the medical team's advice have a good
chance of preventing or delaying the complications of the disease,
and living normal lives. Furthermore, with such a regimen as
groundwork, it is estimated that more than half of the lower
extremity amputations among people with diabetes could be
prevented.
Warning
Signs
For the person with diabetes who has
not yet developed foot complications, there are warning signs which
should be recognized and called to the attention of the family
physician or Dr. Bruscia.
They include:
Visit Dr. Bruscia Regularly
For the person with diabetes a number of practices and precautions should be employed. Regular visits to Dr. Bruscia for foot inspections, no less than annually and preferably more often, are recommended. The doctor may conduct specific diagnostic tests to assess the presence or progression of diabetes complications. Such tests may include assessments of circulation, using an instrument known as the Doppler for measurement of blood flow; vibration sense, using a tuning fork; sensation (light touch and deep pressure), using a plastic monofilament slightly thicker than a toothbrush bristle in what is called the Semmes-Weinstein test; and foot structure, using X-rays. Dr. Bruscia will probably also reinforce self foot care, reminding patients of previously dispensed advice. There is a sizable list of “do's and don’ts.” Shoes are at the top of the list Poorly fitted shoes are involved in as many as half of the problems that lead to amputations. Foot shape and size may change over the years; peripheral neuropathy contributes to change. Everyone, particularly those with diabetes, should be fitted by experienced shoe fitters for every new pair of shoes. New shoes should be comfortable at the time they're purchased – they should not require a break-in period – but it is a good idea to wear them for only short periods of time at first. Shoes should have leather or canvas uppers, fit both the length and width of the foot, leaving room for the toes to wiggle freely, and be cushioned and sturdy. Athletic footwear may fit the bill nicely. It’s a good idea to change shoes during the day, to relieve pressure areas. Avoid high heels and shoes with pointed toes. Never wear shoes with open toes or heels, including sandals, especially those with straps between the first two toes. Shake shoes out and feel inside them for rough stitching or foreign objects, such as small pebbles. Never go without socks. Diabetics who have difficulty finding shoes that fit should ask Dr. Bruscia to prescribe corrective shoes, or refer them to a shoe specialist, the pedorthist. For those eligible, Medicare provides coverage for extra depth shoes or specially molded shoes, and inserts, for those with advanced cases of diabetes. The medical or osteopathic doctor treating an individual for diabetes can certify the need for therapeutic shoes which Dr. Bruscia can prescribe.
Other cautions:
As a member of the health care team, Dr. Bruscia is vitally concerned about hypertension (high blood pressure) and vascular disease (heart and circulatory problems). There are several reasons for this concern. First, because you are a patient, Dr. Bruscia is interested in all aspects of your health and your treatment program. Second, he supports the goals of high blood pressure detection, treatment, and control. Dr. Bruscia should know if you have any of the following cardiovascular or related conditions:
Copyright | Family Foot & Ankle Wellness Center 2012