Solutions for Diabetic Foot Problems

Posted by on Wednesday, July 27th, 2011

I am delighted to introduce myself as the newest member of the Center for Podiatric Care and Sports Medicine. I hope to add to the excellent work done by Dr. Geldwert and Dr. Lai. I’d like to take some time to talk about a subject that has a very personal significance for me; Diabetic foot pathology, specifically Charcot Deformity.
I have been a Type 1 insulin dependent diabetic since age 10. I share the same daily concerns and struggles as all diabetics. I consider myself very fortunate to be involved in a profession where I can make a real impact on the lives of those sharing my disease. Diabetes can affect many body systems. One area of the body affected most commonly is the foot. Diabetics often face problems that arise from poor circulation and nerve function. A major issue I’d like to focus on is Neuropathy and the problems it can cause and Charcot Neuroathropathy, often referred to simply as Charcot Foot.

Neuropathy is a condition affecting the nerves, which leads to a gradual loss of protective sensation. While many people develop numbness, the condition may also cause strange feelings known as paresthesias, which can also be very painful. Over time, the body loses the proper feedback from normal foot function and biomechanics. Eventually joints can undergo a degenerative problem known as Charcot neuroarthropathy. This condition dramatically changes the structure of the bone and joints of the foot. The foot breaks down and severe foot deformity follows. Most commonly the process affects the midfoot, and leads to a “rocker-bottom” deformity. However, the process can occur in any joint, and lead to other types of bony deformities. Often, this abnormal bone position leads to increased forces on the skin and soft tissue, which eventually break down and ulcerate.

These ulcerations account for a large majority of diabetic hospital admissions, as they often get infected. These infections can often reach the bone (a condition known as osteomyelitis).
Untreated or improper treatment can lead to serious life or limb threatening infections.

If you suffer from these conditions, a foot care specialist must be an integral part of your health care. Treatment plans run from the simple to complex depending on the details of your condition. Proper wound care is vital, including regular monitoring and debridement of any non viable tissue. There are also several devices which can offload the high pressure areas causing ulcerations.

There are also several surgical options which I have training in including soft tissue and skin procedures to cover the wound, as well as skin substitute grafts. Also, depending on the deformity and one’s overall health, surgical reconstruction may be an option. This is designed to either remove the bony prominence, or correct the bony deformity. This can be accomplished with internal hardware fixation, external hardware fixation, or a combination of both.

Charcot Deformity can be a troubling, frustrating problem. If you suffer from this condition, or other diabetic foot issues, I can help. Call the office, 212-996-1900 or 914-328-3400 for an appointment.

Triathlon Injury-Plantar Fasciitis

Posted by on Wednesday, July 20th, 2011

In March I was invited to speak to TRIARQ,a community of physicians,patients and physical therapists, on Plantar Facsiitis. I would like to share some of the salient points of the lecture. Plantar Fasciitis is a condition whose cause is primarily biomechanical in nature.The pain associated with plantar fasciitis is usually located to one of three areas on the foot. The attachment of the fascia to the heel,under the center of the heel or along the arch.The pain of plantar fasciitis is usually delayed. What I mean is that in the early stages of plantar fasciitis you can run without pain but the pain occurs about 1-2 hours after your run.The pain is usually worse the next morning ,especially the first steps out of bed and is bad after periods of inactivity.When the condition becomes more chronic the pain can occur during a run as well as afterwards.
In 1998,Dr. Lai and I presented a paper at the annual meeting of the American College of Foot and Ankle Surgeons entitled Conservative treatment of Plantar Fasciitis and Intermetatarsal Neuroma with Orthotic Devices.The purpose of the paper was to present a retrospective review of 53 consectutive neuroma and 107 consecutive plantar fascial patients who were prescibed orthotic devices for treatment.We concluded that orthotic devices are an effective treatment for neuroma and plantar fasciitis. The significance of our paper was that neuromas and plantar fasciitis are common foot problems which should be treated conservatively first with orthotic devices before considering surgery.The results of our paper concluded that most cases of plantar fasciitis and intermetatarsal neuromas improved or resolved with conservative treatment. The corrections on the orthotic must be very specific for the patients biomechanical problems and condition in order to be successful and that 92% of patients did not require surgery.
Since 1998 we have found that with the advent  of newer technologies including Extracorporeal Shockwave Therapy,Platelet Rich Plasma Therapy injections and biopuncture with plant based injectables we have increased our success rate even more.We now operative on less than 3% of patients with plantar fasciitis.In those patients who require surgery we either will do a coblation(Topaz) procedure or an Endoscopic Plantar Fascial release through a minimal incisional approach.