Tag Archives: Neuropathy

Which physician is best to treat foot and ankle pain?

25 Jun

We sure take our feet and ankles for granted, don’t we?

best doctor for foot pain ankle pain toe pain

That is, until the Millenium Falcon breaks our ankle, or a foul ball clips our right foot. Ouch.

When your feet are painful, you’re miserable. Your lifestyle is instantly affected – pain forces you to dial back or give up walking, running, dancing, standing, or your favorite sports. Prolonged pain might even cause you to go from star athlete to couch potato.

It’s appropriate to visit the ER if you have an unusual amount of pain in your feet or ankles, especially if the pain is sudden and intense, is accompanied by bleeding or swelling, or if your foot and ankle have been involved in a trauma like a fall down the stairs. Or if you tried to break a cement block in half with absolutely no martial arts training.

For less painful events, like a suspected fracture, or wounds that won’t heal, many people choose to see their primary physician, which may or may not be a good choice, depending on that  physician’s field of expertise.

And for even less worrisome injuries, like a minor sprain, or minor heel pain, some seek no medical attention at all – which is never a good idea, as both injuries can develop into more complicated conditions, especially for athletes.

Which doctor is expert in treating foot and ankle problems?

When you have trouble with your ears, you should see an ENT. Trouble with your knees, an orthopedist. When you have pain or discomfort in your feet, toes, or ankles, you should see a podiatrist.

Podiatrists and podiatric surgeons are trained exclusively in the treatment of foot and ankle disorders – they do nothing but study the foot and ankle, it’s diseases and deformities. After all, 1/4 of all of the bones in your body are in your feet, and there are many conditions unique to this area of the body. That’s a lot of ground to cover in med school. If they choose to be a podiatric surgeon, they complete further schooling to study surgical techniques to correct these problems.

In 99% of cases, a podiatrist can resolve your ankle, toe, or foot problem much faster than a general physician. Podiatrists are also expert at spotting the early signs of diseases you can easily overlook, like diabetic foot disorders, rheumatoid arthritis and cardiovascular disease.

Without your feet in good working order, your life can be…. well, challenging. Don’t take them for granted.

Diabetic Nerve Pain Treatment Options and Symptoms

23 Jan
Diabetic Nerve Pain, also known as neuropathy or Diabetic Peripheral Neuropathy, is a nerve disorder common in those who have diabetes. Some people with this nerve damage show no symptoms, while others may feel pain, tingling, or numbness in the hands, arms, feet, toes, or legs.
peripheral neuropathy diabetic nerve pain

Courtesy of NIH

Diabetes is not the only cause of neuropathies – they may also result from vitamin deficiencies (B-12 and Folate), chemical exposures, pressure on nerves, or certain medications, especially those used in AIDS therapies and chemotherapy.

Roughly 70% of people with diabetes will develop some form of neuropathy, including Diabetic Nerve Pain. It can appear at any time during the progression of the disease, but the risk increases with age and the duration of the illness. According to the U.S. Department of Health and Human Services,  The highest rates of neuropathy are among people who have had diabetes for at least 25 years. Diabetic neuropathies also appear to be more common in people who have problems controlling their blood glucose, also called blood sugar, as well as those with high levels of blood fat and blood pressure and those who are overweight.

The early symptoms of diabetic nerve pain are a slight tingling or numbness in the extremities. As the disease progresses, and nerves are further damaged, the tingling or numbness becomes painful and may be quite severe. When these symptoms appear in the feet, hands, or legs, it’s known as Peripheral Neuropathy, and when caused by diabetes, Diabetic Peripheral Neuropathy.

Symptoms of Diabetic Peripheral Neuropathy include

  • Numbness or insensitivity to pain or temperature
  • A tingling or burning sensation
  • Pains or cramping
  • Extreme sensitivity to touch
  • Loss of balance or coordination

How are nerves damaged by diabetes?

Vascular and neural diseases are closely related. Blood vessels depend on nerves, and nerves depend on blood vessels. Scientists know that prolonged exposure to high blood sugar damages nerve fibers, but exactly how that happens is still a matter of debate. What they know for sure is that high blood glucose interferes with the ability of nerves to transmit signals, and weakens the walls of capillaries (tiny blood vessels) that supply nerves with nutrients. When nerves don’t receive enough oxygen and nutrients from blood vessels, cells begin to die, and nerves don’t function properly. Other risk factors for nerve damage of this type are smoking, alcohol abuse, and certain genetic factors unrelated to diabetes.

What you can do to avoid DPN

The best way to avoid DPN or to minimize nerve damage once it begins, is to keep your blood sugar under control, exercise regularly, and see your physician on a regular basis to test you for symptoms. According to John Hare, MD, Medical Director of Joslin Diabetes Center’s Affiliated Centers program, “people who keep their blood sugars consistently in [a] healthful range can decrease their risk of nerve damage by more than 50%. Getting diabetes under better control also may help limit the amount of damage caused by neuropathy once it’s developed.” 

In addition to a diabetes specialist, a podiatrist should also be a member of your diabetes health team. Early symptoms of DPN typically appear first in the feet, and may go unnoticed by the patient. Podiatrists are experts at detecting these symptoms, and early intervention can avoid further damage to the blood vessels and nerves.

Treatments for Diabetic Peripheral Neuropathy

Early in its development, the pain and tingling of DPN can be managed with over the counter pain medicine like acetaminophen (tylenol), aspirin, or ibuprofen (advil, motrin). Some also find relief with over the counter pain creams which contain capsaicin, an extract of hot peppers like cayenne and tabasco peppers. It’s believed that these creams block pain signals, but they’re not effective for everyone. As the disease progresses and pain intensifies, your physician may prescribe narcotic pain killers, medicines such as Lyrica, or anti-depressants such as Cymbalta, which are also approved to relieve some types of severe pain.

A highly effective treatment used by the podiatrists at PA Foot and Ankle Associates is MicroVas, originally developed by the U.S. military to treat hypothermia in Navy SEALS. This non-invasive, pain-free therapy uses electronic impulses to cause muscle contraction and relaxation cycles which stimulate circulation. The increased blood flow raises the oxygen level in the tissues, which promotes healing in the nerves and muscles which have been damaged. MicroVas is successful in over 85% of the patients treated, who report reduced pain and improved sensation.


Why Your Spouse Always Has Cold Feet

13 Dec

Does the temperature of your bedroom plummet when your partner crawls under the bed sheets? When their icy cold feet touch yours, do you scream?


Sometimes, always-cold feet aren’t attributable to any condition. This is especially true in women. In fact, it’s been reported that women are nine times more likely to have cold feet than men. Perhaps this is because men have considerably more muscle mass in their feet, and consequently, more blood flow. In women, the blood supply favors their core and trunk, not their hands and feet.

But certain conditions and diseases can cause perpetually icy feet. Usually, it’s due to poor circulation – not enough blood reaches the skin. If you get up and walk around, or put on a pair of slippers or thermal socks, you can warm them back up. But poor circulation can also be caused by smoking, low iron in the blood, a poor diet, a sedentary lifestyle, lack of sleep, shoes that are too tight, and other factors.

In women, a very common cause of cold feet is hypothyroidism, a condition in which the thyroid gland is underactive. Accompanying the cold feet in this case are cold hands, hair loss, and weight gain. A blood test can determine if you have hypothyroidism, and oral medicine can in most instances correct it.

Raynaud’s Disease is usually seen in young women. It’s a rare disorder in which the lack of blood flow to the feet and hands is caused by spasms in the blood vessels.

Constantly perspiring, a condition called Hyperhidrosis, can also cause cold feet, especially if the surrounding air temperature is on the cool side. Hyperhidrosis is linked to a number of conditions, among them diabetes, anxiety disorders, menopause, and stroke. Consult with your physician to determine the exact cause of your hyperhidrosis.

Diabetic Peripheral Neuropathy is a common side effect of diabetes, the result of nerve damage. Individuals with DPN may feel cold sensations in their feet, but their skin may be a normal temperature. DPN may also cause tingling sensations, numbness, and pain. Podiatrists and podiatric surgeons are experts at treating Diabetic Peripheral Neuropathy and have many tools at their disposal to relieve the symptoms.

Like so many other maladies, cold feet also go hand-in-hand with aging. As we get on in years, our blood doesn’t flow as robustly as it once did. Our hands and feet are the first to feel the effects, as the capillaries that feed the fingers and toes become damaged or blocked. This is a condition called distal hypothermia.

Warm feet are a good sign that you’re healthy. If your feet are constantly cold, visit the podiatrists at PA Foot and Ankle Associates for an examination and diagnosis. Conditions identified and treated early can be more easily resolved than those that have progressed far along.


MicroVas Therapy Testimonial

1 Jul

Linda woke up one day surprised to find a sudden loss of sensation and tingling in her feet. her family physician and neurologist were unsuccessful in treating her neuropathy, so she turned to East Penn Foot And Ankle Associates for MicroVas Therapy. After 18 treatments, Linda’s sense of feeling in her feet is restored and she is able to exercise again.


Do You Know The Symptoms of Type 2 Diabetes?

10 May

type 2 diabetes symptoms

Type 2 diabetes is an insidious disease. Slowly, over a period of years, your cells become resistant to insulin. Symptoms appear occasionally and then intensify as high blood sugar persists in your bloodstream. Then, when concerned with how many times you urinate at night, you see your doctor and discover that you have Type 2 diabetes. It usually comes as a surprise and a rude awakening, because in most cases it’s a result of poor lifestyle and dietary choices, although a genetic predisposition exists as well.

When diabetes is detected early, the chance of developing the very serious complications of diabetes is greatly reduced. High blood sugar brought under control through diet and exercise reduces or eliminates vascular, organ, and nerve damage throughout your body. When blood sugar goes unchecked however, side affects occur such as nerve damage in the feet (diabetic peripheral neuropathy); diabetic foot ulcers; high blood pressure; hearing loss; vision loss; kidney disease; heart disease,  and stroke.

If you’re overweight or obese, rarely exercise, eat at fast food restaurants frequently, rarely eat fruits or vegetables, drink sugary soft drinks once a day, or have a history of diabetes in your family, you may be at high risk of developing Type 2 diabetes. If any of those terms describe you, and you start to exhibit any of the symptoms below, please see your physician immediately and get tested for diabetes.

Symptoms of Type 2 Diabetes

  • Frequent urination
  • Unusual thirst
  • Unusual, extreme hunger
  • Unexplained weight loss
  • Unusual fatigue and irritability
  • Blurred vision
  • Cuts and bruises that are slow to heal or become infected easily
  • Tingling/numbness/pain in your hands or feet
  • Frequent skin, gums, bladder infections

Diabetic Socks: Why you need them and how to choose them

31 Jan

diabetic socks

Diabetes complicates your life quite a bit. It requires a radical change to your diet, daily blood sugar monitoring, significant weight loss, and starting an exercise program. You may also need to change your wardrobe and add diabetic shoes and diabetic socks.

What are diabetic socks?

No, diabetic socks aren’t insulin dependent. They’re socks made specifically for diabetics, created from special materials that promote healthy circulation, reduce irritation and infection, and keep your feet drier than typical socks. As we’ve written in this blog, diabetes can have a big impact on your feet, ankles, and lower legs. It affects blood circulation, reducing your ability to heal normally, and it causes neuropathies, which reduce your ability to feel sensation or pain in your feet.

You’d think that normal socks couldn’t possibly cause damage to your feet, but if you’re diabetic, they surely can. A simple seam running across the front of a cotton sock can rub against a diabetic’s sensitive skin and cause a blister. If you have a neuropathy, you may not notice this blister until you actually see it, and by then it may be infected, requiring significant medical attention.

What to look for in a diabetic sock

Diabetic socks should have non-binding tops which allow for better blood circulation. A normal sock has either a slightly tighter stitching or elastic at the top to keep them from falling down. This light pinching above your ankle can actually reduce blood circulation to the feet in diabetic patients.

Diabetic socks should have a seamless design. This means the socks won’t rub against your toes, which is significant if your diabetes causes your feet to swell. The seam of a traditional sock rubbing against a swollen foot can become unbearable.

Diabetic socks should be made from materials that wick moisture away from your feet. This will keep your feet nice and dry and reduce the chances of getting a bacterial or fungal infection like athlete’s foot or toenail fungus, which can become quite serious for diabetics if not addressed immediately.

You can find diabetic socks in PA Foot and Ankle’s online store

MicroVas Therapy Heals Diabetic Peripheral Neuropathy

28 Nov


MicroVas, also known as Micro Vascular Therapy or MVT,  is one of the treatments used by PA Foot and Ankle Associates to relieve the symptoms of Peripheral Neuropathy in the feet. In most cases, but not all, this condition results from diabetes.

What is Diabetic Peripheral Neuropathy?
diabetic peripheral neuropathy microvas

click for larger image

Neuropathies are the most common side affect of diabetes, occurring in up to 50% of patients. A neuropathy can appear in any part of the body, affecting any organ, the muscles, or sensation, but most often affects the feet and legs, followed by the hands and arms. Symptoms may appear suddenly or may develop slowly over a period of years.

Symptoms of diabetic peripheral neuropathy include:

  • Tingling or burning sensation
  • Sharp pain which may be worse at night
  • Difficulty or pain when running or walking
  • A “heavy” feeling in your legs
  • Numbness in the extremities
  • Reduced ability to feel pain
  • Reduced ability to feel changes in temperature
  • Extreme sensitivity to touch
  • Lack of sensation when touching an object
  • Muscle weakness
  • Ulcers, infections, deformities, bone pain, joint pain in the foot
  • Feeling of wearing stockings or slippers when feet are bare

Peripheral Neuropathy may take years to develop in a diabetic patient, or it may be present at the time of diagnosis. If you’ve been diagnosed with Type 1 or Type 2 diabetes, it’s essential that you’re tested regularly for symptoms of Peripheral Neuropathy to avoid the additional complications which can develop.

What is the MicroVas treatment?
microvas treatment diabetic peripheral neuropathy

A patient undergoing MicroVas Therapy

MicroVas was originally developed by the U.S. military to treat hypothermia in Navy SEALS. It’s a non-invasive treatment which uses electronic impulses to cause muscle contraction and relaxation cycles to stimulate circulation in the capillaries (the tiny blood vessels near the skin surface).  This increased capillary blood flow raises the oxygen level in the tissues in order to promote healing in the nerves and muscles which have been damaged.

Blood flow in the capillaries and the tissues they feed is compromised in many diabetic patients because persistent high blood sugar causes vascular damage and nerve damage, and with the vascular damage comes decreased blood flow to the surrounding tissues. When blood flow is reduced, gas and fluid exchange is reduced, which allows toxins to build up in the tissues, causing further damage. MicroVas stimulates blood flow in these regions to remove toxins, speed healing, and restore balance and proper function.

MicroVas treatments are administered in our office, take roughly 45 minutes each and there are no complications. How many treatments are required will depend on the severity of your condition and will be determined by your podiatrist.

More information on diabetic neuropathy

More information on MicroVas treatment

The impact of diabetes on your feet – and how to prevent it

27 Sep

Diabetes is caused by the body’s lack of production of insulin, or the inability of insulin to perform its function. There are many side effects of diabetes, including cardiovascular disease, hypertension, kidney disease, and stroke, but the devastation this disease takes on one’s feet is sometimes overlooked until it’s too late.

diabetes how to check your feet

Diabetics should check their feet daily

One of the most frequent problems we see at PA Foot and Ankle Associates are diabetic patients who have sores on their feet which won’t heal. This is due to diabetic neuropathy, a condition of the nervous system in which patients lose sensation in their feet. When a sharp object cuts the bottom of their foot for instance, they’re completely unaware of it until they have a visual cue of some sort. Unfortunately, during the interim the cut becomes infected, leading to a much more serious problem which sometimes results in the amputation of a toe or foot.

Read how Dr Teichman of PA Foot and Ankle used state of the art technology to save a diabetic patient’s foot from being amputated.

If you’re diabetic, or even borderline diabetic, it’s essential that you understand the threat to your feet and what you can do to prevent a serious complication. Here’s a checklist:

Take care of your diabetes. Getting your blood sugar under control and understanding proper diet and lifestyle choices will delay or prevent the onset of many side effects. Read: Diet tips for diabetics

Check your feet every day for cuts, sores, red spots, swelling, or infected toenails. If you have trouble bending over to see your feet, use a plastic mirror (not glass – they break) or ask a family member to help. Call us immediately if a cut, sore, blister, or bruise on your foot does not heal in 24 hours.

Wash your feet each day in warm water, but never hot. Avoid soaking your feet, because it will dry out your skin. Dry your feet well, especially between your toes and then use a foot powder to keep your feet dry. This will help to avoid fungal infections like athlete’s foot. Use a thin coat of skin lotion on the tops and bottoms of your feet to keep the skin soft and smooth. Do not use the lotion in between your toes, as this might create a moist environment and lead to infection.

Wear shoes and socks at all times. Don’t walk barefoot indoors our outdoors, because you may step on something which will cut or irritate your feet. Wear seamless socks, stockings, and nylons with your shoes to prevent blisters and sores from developing. Avoid cotton socks – the best materials are those which wick moisture away from your feet to keep them dry. When you put your shoes on, always check the insides to make sure the lining is smooth and there are no pebbles or other foreign objects hiding in there. And make sure those shoes are comfortable and offer plenty of protection top and bottom.

Keep the blood flowing to your feet. Put your feet up when you’re sitting, wiggle your toes for 5 minutes a few times each day, and move your ankles up and down and in and out to improve blood flow in your feet and legs.

  • DO NOT cross your legs for long periods of time
  • DO NOT wear anything which might restrict blood flow to your feet: tight socks, rubber bands, garters, restrictive footwear or foot products with elastic
  • DO NOT smoke. Smoking constricts blood vessels, reducing blood flow to your feet. If you have high blood pressure or high cholesterol, work with your health care team to lower it

Be more active. Ask us to design an exercise program that is right for you. Walking, swimming, and bicycling are good forms of low impact exercise that are easy on the feet. Avoid high impact activities like running and jumping, and wear properly fitting athletic shoes that offer good support.

Communicate with your Doctor. Schedule regular appointments with us to check the circulation in your feet and to inspect the overall health of your feet.

For those who don’t take diabetes seriously, Click here to see an image of how truly bad your foot can become without proper care. WARNING: this picture is not for those with a weak stomach.

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