1

 Feb

As of 2015, about 10% of all Americans are now living with diabetes. The Center for Disease Control predicts this number to increase year on year. Diabetes, or hyperglycemia, is when the blood sugar of a person is too high and their body is unable to lower it due to not producing enough insulin. Over time, such a high amount of sugar in our blood will lead to changes and damage of our body and its underlying organ systems. For the feet and lower extremities, having diabetes that’s uncontrolled over time, leads to peripheral vascular disease (PVD) and peripheral nerve damage (peripheral neuropathy) with the patients noticing numbness, tingling sensations and shooting pains. With either of these pathologies, people may have serious complications from simple issues such a little cut or break in the skin of their foot. This is due to both the slow rate of healing from the bad blood flow of arterial disease along with the patient not noticing the problem due to the numbness of peripheral neuropathy until it’s too late. This is why it is important to see a medical professional for education and evaluation for appropriate shoe gear wear, self-foot checks and establishing a relationship in case any problems is seen for a quick evaluation. If you are diabetic and unsure about how to take care of your feet or are experiencing any issues to the foot and ankle, let the staff at Central Carolina Foot and Ankle know how we can help you at (919)477-9333.        



By: GARY Y. LIAO, D.P.M.  |

Posted in  hidenews

Tagged:  hidenews

4

 Jan

Why would anybody write a blog about feet? 

I’ve said this before but I’ve been doing this for a long time. I’ve been fascinated with feet for most of my life, and I’ve spent a lifetime helping people with hurting feet. As I step back and try to slow down (as I’m not ready to fully retire), I have pondered how I can help more people and share the years of knowledge I’ve acquired,  the idea of writing a Blog started to make sense. There is a lot of mis-information and mass media out there selling products that boast treatments and solutions for different foot and ankle problems. But everyone’s feet are different and there is no cookie cutter solution that fits all. So I’m hoping to create a place for conversations so we can help you better understand the mechanics and complexities behind hurting feet and work with you to resolve it.

I’ve always been intrigued with the biomechanics of the foot—how its many parts relate to one another during walking and movement. After many years of study I’ve amassed a wealth of knowledge and experience in the field of biomechanics.

So let’s start with a look at “Movement”. 

The fluid motion of walking that we accept as being normal really occurs all the way through the entire body. It’s a fascinating process. Walking requires very little energy. It is, in fact, an act of falling, and in capturing yourself, again and again, before you actually do fall.

During a gait analysis, when I watch someone walk, I pay attention to everything -- even to the position of the head. If their head is tilted right or left, for example, it may indicate that they have a leg length discrepancy that I need to be aware of. 

Let’s consider Marjorie, a previous patient of mine, for a moment. On one of her visits she complained of a lot of pain when walking. Examination revealed that the problem was clearly Achilles tendon bursitis, the result of a sharp strain that causes injury to the calf muscle. As a result, she experienced a good deal of pain while walking.

The condition usually responds well to icing immediately after an injury and rest, anti-inflammatory medications such as aspirin or ibuprofen, and gentle stretching exercises. But I had seen Marjorie before, and I realized that her tendonitis was simply a reflection of a more serious problem. The condition is called Hallux Rigidus, which simply means that the great toe (her big toe) joint, in this case on her right foot, had become rigid and would no longer bend. And that condition had profound consequences on her ability to walk in a healthy, balanced, natural way. We were able to help Marjorie and now she is fully recovered and is enjoying pain free activity. Hallux Rigidus is just one of many conditions we treat at Central Carolina Foot & Ankle Associates that affects mobility and movement. Depending on the degree of deformity and condition of the joint, it can be treated functionally with prescription orthotics that change the foot’s relationship to the ground, thereby improving motion at the joint – or if severe, surgically via several different types of procedures.

When you come in to see one of the doctors at Central Carolina Foot and Ankle, we’re going to listen to you first, then closely examine your feet, probably watch you walk, obtain x-rays or other diagnostic tests, and then explain to you what we think the problem is and how we think we can resolve it.  We want you to understand why you have foot pain and we want the treatment plan to make sense to you. Because educated, informed patients usually do what it takes to get well. We figure we are in this together.

It you are experiencing pain while walking or other problems with your feet please call our office (919) 477-9333 and let us help you start working on the solution!




By: GARY Y. LIAO, D.P.M.   |

Posted in  hidenews

Tagged:  hidenews

15

 Dec

Ever hear the phrase “Life is a balancing act”? As a podiatrist I definitely agree that everything we do is about keeping our balance. Every time we walk, it’s quite a feat of balancing. Young children walk with their feet wide apart, to maintain their balance. As people mature, they are able to walk with a gait that is much more narrow—they are in better balance—and when they run, they are balancing on a single support: first one foot, then the other, directly under the body.

As we age, we again spread our feet apart, like a young child. I can almost tell how old a person is by how far apart their feet are when they walk. I would suggest that there is a relationship between balance and many foot disorders.

Everything from the floor to the hips is a balancing act. The aches and pains people have are often secondary to the fact that one muscle group is stronger than another, and there’s an imbalance occurring. We use orthotics—prescription, custom-made shoe inserts—to balance the foot. The goal is always to balance the inside of the foot to the outside of the foot, and the rear foot to the forefoot.

The ankle joint is essentially a teeter-totter. For the woman who wears high-heeled shoes for 35 years, you can be certain that the back of her leg is tighter than the forefoot. When she changes her lifestyle—perhaps she retires from work—she may opt for a lower, more stable shoe. Often in such cases, the tension at the back of the leg becomes a serious problem as she begins to press down on the forefoot. Bunions, hammertoes, and calluses may result, because her forefoot to rear foot relationship is no longer in balance.

The goal is to maintain the rear foot to forefoot balance she has had for many years, and for some women that means continuing to wear shoes with a moderate heel. Often, later in life, a woman will move from a heeled shoe to bedroom slippers, and even go barefoot much of the time, and that truly creates a huge imbalance that is damaging to the feet. My recommendation in such cases is to retain a moderate heel, and come down from that very gradually, if at all.

Take into consideration when people lose toes, due, for example, to trauma or diabetes, it may result in a serious problem with their balance. Think of your foot like a three-legged stool. The legs of the stool are the heel, the fifth (little) toe, and the first (big) toe. The function of the toes, especially the big toe, is to help us balance, and to propel us forward during walking or running. The 14 bones of the toes are among the smallest in the body, and they are susceptible to problems—sometimes originating in childhood, and often the result of trauma. Unassisted walking is difficult with injury or absence of any of the toes, especially the big toe. There is actually a delicate balance between these three points of the “stool,” and when it is disrupted, the entire structure—the body—becomes unstable and wobbles.

We can and do build orthotics that change the balance points of the tripod, to accommodate loss as effectively as possible. An orthotic can be a big help, but in most cases a cane, walker, or some type of support is still necessary.

We see many patients who have lost toes to diabetes; diabetic neuropathy is a condition that is far too common, and amputation is too often the result. I saw a gentleman today who has lost all of the toes on one foot. We have built orthotics for him to help him with balance, but in the best circumstance the “tripod” is still unstable.

I talk a lot about the biomechanics of the foot, and to a large extent, this involves balancing the bony structure of the foot to the ground. When you balance your foot, you are balancing to a flat surface: the ground. Putting an orthotic between your foot and the ground changes the way the foot meets the ground. An orthotic is a balancing device.

I’ll say this every time I write, when you come in to see one of our doctors at Central Carolina Foot and Ankle, we’re going to listen to you first, then closely examine your feet, probably watch you walk, obtain x-rays or other diagnostic tests, and then explain to you what we think the problem is and how we think we can resolve it.  We want you to understand why you have foot pain and we want the treatment plan to make sense to you.  Because educated, informed patients usually do what it takes to get well.  We figure we are in this together.


If you are experiencing pain while walking or other problems with your feet please call our office (919)477-9333 and let us help you start working on the solution!




By: GARY Y. LIAO, D.P.M.   |

Posted in  hidenews

Tagged:  hidenews

2

 Oct


A man in his early 20s came to see me last week. He was concerned because he had discovered a purple hue and rough texture on the bottom of both feet. It was a surprise to him when I said he needed to stop smoking. His feet were reflecting a problem with circulation that is certain to get worse unless he makes some lifestyle changes. Continuing to smoke would have a strong likelihood of unpleasant consequences.

At the risk of sounding melodramatic, there are two silent killers that in combination threaten not only the limbs but the lives of hundreds of thousands of people. Those two diseases are diabetes and smoking. I do consider addiction to nicotine to be a disease state. Individually and especially in combination, they are too often lethal. Overcoming this addiction is difficult I know, as I was once a smoker myself. But the benefits of quitting are nothing short of amazing for your overall health and critical for your feet.

When it comes to foot health, circulation is a key issue. Peripheral vascular disease is the medical name given to a group of problems that cause poor circulation to the feet and legs. The most common cause of peripheral vascular disease is atherosclerosis (hardening of the arteries) where there is a gradual thickening of the walls of the arteries. And the number one cause of micro vascular disease is diabetes.

But you may not have known smoking is the number one accomplice. In fact, smoking is one of the biggest threats to the health of your feet, because it affects the small blood vessels; constricting them much as diabetes does. Smoking causes decreased blood flow to the feet and all parts of the body, making wounds heal more slowly. A lot of people with diabetes who ultimately need amputations are smokers. I’ve seen that correlation consistently and repeatedly over many years in our practice.

In fact, many podiatrists are reluctant, and often refuse, to do needed surgery on smokers who are unwilling to quit, because their prognosis is generally so poor. Poor circulation means poor flow of the vital ingredients in the blood needed for healing. That translates into surgical wounds that heal more slowly or, perhaps in severe cases, not at all. And, the prospect of infection increases dramatically. Nicotine is the culprit. It is a toxic and addictive substance that causes vasoconstriction of blood vessels. When nicotine is present in the body, blood vessels close down or get smaller, decreasing the amount of blood flowing to the surgical site.

Smokers who quit can reap almost immediate rewards. Our bodies are always attempting to overcome our bad habits and guide us to health, and they’re always trying to repair damage from smoking. Studies show that within minutes of finishing a cigarette, the body begins a number of health-giving changes. The American Lung Association reports that within 24 hours of quitting, the chance of a heart attack decreases, and within 48 hours of quitting, nerve endings start to improve and re-grow and the ability to taste and smell is enhanced. Carbon monoxide levels decrease rapidly allowing oxygen to be carried by red corpuscles to the tissues.

Two weeks to three months after quitting, circulation improves, walking becomes easier, and lung function increases. Between one month and nine months later, coughing, sinus congestion, fatigue, and shortness of breath decrease. One to five years out, the risk of coronary heart disease decreases by half, and stroke risk is the same as for non-smokers. At the 10-year mark, the risk of lung cancer is half that of continuing smokers, and the risk of other cancers decreases, as well, as does the risk of ulcers.

There are a variety of foot health issues that relate, directly or indirectly, to diabetes, poor circulation, and smoking. Heading the list is neuropathy, which is nerve damage that lessens ability to feel pain, heat, and cold. With loss of sensation, foot injuries are not always discovered promptly, increasing the chance of infection. That is the sequence at the heart of many amputations.

Diabetes also often causes changes in the skin of the foot, which may become very dry, peel, and crack. Nerves that control the oil and moisture in the foot are impaired. Calluses can be another problem. They occur more often and build up faster on the feet of people with diabetes. If not trimmed, calluses get very thick, break down, and turn into ulcers.

It is fundamental and essential for people with diabetes in whatever form, from mild and severe, to have an ongoing relationship with a podiatrist to offset the possibilities of severe foot health problems. Managing diabetes effectively is a team effort. You are not alone, we’re here for you.

I say this every time I write, when you come in to see any of our doctors at Central Carolina Foot and Ankle, we’re going to listen to you first, then closely examine your feet, probably watch you walk, obtain x-rays or other diagnostic tests, and then explain to you what we think the problem is and how we think we can resolve it.  We want you to understand why you have foot pain and we want the treatment plan to make sense to you.  Because educated, informed patients usually do what it takes to get well.  We figure we are in this together. It you are experiencing pain while walking or other problems with your feet please call our office (919) 477-9333 and let us help you start working on the solution!



By: GARY Y. LIAO, D.P.M.   |

Posted in  hidenews

Tagged:  hidenews

30

 Aug

Did you know that slipping a well-designed piece of hard plastic under your foot (inside your shoes) can change your life? 

As you know, I have great respect and empathy for the foot. I often remind my patients that in any given day, their feet will strike the ground 5,000 times, and if they weigh 150 pounds, the foot will absorb about 750,000 pounds of shock per day per foot. That’s a lot of hard work! And for runners, the amount of weight per foot per strike doubles. So “yes” a small piece of hard plastic, an orthotic, can help relieve the load and truly change your life.

While walking and running are second nature, they are in fact biomechanically complex. From heel strike to toe off, your foot moves through a specific and complex sequence of movements to propel you forward. And not all feet are perfectly designed to accomplish that task. When there are foot misalignments, the simple task of walking becomes inefficient at best and painful at worst. With a custom-designed orthotic, we can manipulate and precisely support how the foot strikes the ground.

Some people use one of the multiple over-the-counter (OTC) inserts to help with their discomfort or pain. And they can at times be very useful. For patients with atrophy of the fat pad in the heel or the ball of the foot, OTC gel pads can be very helpful, and they are also beneficial for patients with a very high-arched, rigid foot that inherently has little shock absorption. Even people with plantar fascitis sometimes get relief of pain for a few months from OTC gel products, but in the long term orthotics are far more beneficial.

Acquiring custom orthotics is like getting prescription glasses rather than drug store readers. Our eyes are unique, and so are our feet. Every patient has a foot of a shape and structure like no other, and so no matter how well made a mass-produced shoe, it was not designed specifically for any one set of feet.

By contrast, an orthotic is a custom-made insert that goes inside the shoe. Correctly designed, an orthotic helps properly control foot movement and facilitate propulsion. Slipping them inside your shoes makes an ordinary shoe a custom-made fit that meet your needs.

The first step in designing an orthotic is a complete biomechanical exam, which we do here in the office. That includes an evaluation of walking, of gait, and very precise measurements of motion and the joints of the foot. We then create a cast mold of the foot, while it is in a neutral position, and develop the prescription for the laboratory that makes the orthotic.

Orthotics are also beneficial in treating other foot problems, such as tendonitis, neuromas, bunions, and excessive calluses. These are conditions that often result from structural misalignments of the foot.

There’s also a relationship between orthotics and chronic knee, hip, and back pain. Shock that feet do not properly absorb must be compensated for higher up in the body. These compensations, over time, can contribute to chronic pain. By correcting how the foot strikes the ground, the body can achieve better shock absorption and balance, minimizing the cause of the pain.

I say this every time I write, when you come in to see any of our doctors at Central Carolina Foot and Ankle, we’re going to listen to you first, then closely examine your feet, probably watch you walk, obtain x-rays or other diagnostic tests, and then explain to you what we think the problem is and how we think we can resolve it.  We want you to understand why you have foot pain and we want the treatment plan to make sense to you.  Because educated, informed patients usually do what it takes to get well.  We figure we are in this together. It you are experiencing pain while walking or other problems with your feet please call our office (919)477-9333 and let us help you start working on the solution!



By: GARY Y. LIAO, D.P.M.   |

Posted in  hidenews

Tagged:  hidenews

20

 Jul

People with diabetes have a lifelong challenge to manage their disease effectively and that involves a series of critical choices related to lifestyle, diet, exercise and yes, the care of their feet. 

We're dealing with a staggering epidemic of diabetes affecting more than 29 million people in this country, 1.7 million new cases diagnosed per year. In 2010, about 73,000 non-traumatic lower-limb amputations were performed in adults aged 20 years or older with diagnosed diabetes. And diabetes is the leading cause of end-stage kidney disease among adults. (You can see more of these eye-opening stats at diabetes.org)

I have patience tell me they are “borderline diabetic”. But there is no such thing. Either you are diabetic or you're not. And if you are diabetic, proper care of your feet is high on the list of critical choices you need to make every day. 

Individuals with diabetes are prone to complications that can lead to infection and surgery. Patients can suffer from neuropathy, which is the complete or partial loss of sensation in feet and legs due to poor circulation. And high glucose levels can hinder normal immune response to bacterial infection. Diabetes can have a foot infection and not realize it. It may only take a matter of days for it to become serious. 

Most diabetics experience some form of neuropathy that may take years to develop. Because neuropathy is such a persistent and insidious problem for diabetics, one of the most important things they must do is see a podiatrist frequently. I recommend my diabetic patients come see me every 3 months. Between visits there things they must do, choices they must make for themselves - such as avoiding going barefoot at home. 

Walking barefoot at home can be dangerous to someone who has lost or is losing the feeling in their feet. When most people step on a piece of glass or any sharp object they feel it. Someone suffering from neuropathy will not. Wearing some form of house shoe all the time can cut down on accidents that can lead to a major infection. 

Proper footwear is essential to diabetics. Most people won't wear shoes that hurt their feet, but someone who is losing feeling in their feet may not feel such pain. And a poor fitting shoe can cause calluses, blisters, and ulcers -which can lead to infections. All kinds of things can go wrong.

Two vital lifestyle choices for diabetics are avoiding alcohol and smoking. Smoking causes vascular disease and diabetes is a vascular disease. All alcohol breaks down to simple sugar which of course is one of the worst things for diabetics to ingest. Making the choice to smoke or drink alcohol devastating for a person with diabetes. 

Obesity is also linked to diabetes in numerous ways -including putting more wear and tear on the feet. Extra pounds add extra work for the feet that needs extra care. 

Everyday vigilance can cut down on many infections and surgeries for diabetics. Feet need to be cleaned every day and the bottom of the foot examined. This is important, because a small cut or scratch on their feet needs to be treated before it becomes worse. I've had patients come to me with a large sore on the bottom of their foot and they tell me they had no idea it was there because they have lost feeling. It is so important to look at the bottom of the feet every day.

Finding out you have diabetes can force lifestyle altering decisions in many areas. Fortunately, taking extra care of the feet is one area that comes with many options. Properly fitting shoes, regular visits to the podiatrist, healthy living, and self-examining your feet can prevent many debilitating situations. It is important for everyone not to take foot care for granted and that is especially true for people with diabetes.

I say this every time I write, when you come in to see any of our doctors at Central Carolina Foot and Ankle, we’re going to listen to you first, then closely examine your feet, probably watch you walk, obtain x-rays or other diagnostic tests, and then explain to you what we think the problem is and how we think we can resolve it.  We want you to understand why you have foot pain and we want the treatment plan to make sense to you.  Because educated, informed patients usually do what it takes to get well.  We figure we are in this together. If you are experiencing pain while walking or other problems with your feet please call our office (919)477-9333 and let us help you start working on the solution!



By: GARY Y. LIAO, D.P.M.   |

Posted in  hidenews

Tagged:  hidenews

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Central Carolina Foot & Ankle Associates

NORTH DURHAM
INDEPENDENCE MEDICAL PARK
4119 Capitol Street
Durham, NC 27704 
(near Duke Regional Hospital) 
919-477-9333   

SOUTHWEST DURHAM
HIGHGATE CENTRE
5107 Southpark Drive
Suite 202
Durham, NC 27713 
(close to RTP and Chapel Hill)
919-544-2583