The good news is that with a little preparation, leg cramps can be prevented.

1.  STAY HYDRATED
Dehydration causes concentration of the blood and increased lactic acid levels in the muscles. Adequate hydration dilutes the blood and lowers the lactic acid levels in the muscles. While sports drinks are currently in vogue for sports training, regular water is both affordable and appropriate for preventing dehydration problems. The average adult should drink eight to ten 8-ounce glasses of water a day. Drink more if you exercise, or if it's hot or humid. And remember, you don't have to be thirsty to get dehydrated. We exhale up to a pint of water in the form of water vapor each day and our water loss can be very subtle over time so it’s nearly unnoticeable.

2. EAT A BANANA
Bananas are a great source of potassium, which helps to prevent muscle cramps. Eating a banana on race day can help to prevent post-race cramping. But be careful not to eat too many. Too many bananas can cause stomach aches and diarrhea. Too many bananas can also cause irregular heartbeats due to potassium overload.

3. STRETCH
Stretching improves circulation in the muscles and helps to break up adhesions within the muscle fibers. Toe touches and wall push-offs are a great way to stretch those tight calves and hamstrings and break up the muscle adhesions. I recommend three sets of 10 twice daily, but more often if you have the time or inclination. If you have a night splint lying around from your last bout of plantar fasciitis, dust it off and start wearing it again to prevent cramping. If you practice yoga, ask your instructor to help tailor your classes to emphasize the stretching of your feet, leg, and back muscles.

4. DRINK TONIC WATER
Tonic water has quinine, which is also good for preventing cramps. Drink a small bottle (4 ounces) after your run to prevent cramping. Like the caution with bananas, be careful about ingesting too much tonic water because it can cause stomach aches and diarrhea. Quinine in high doses can cause seizures and irregular heartbeats.

5. WEAR GOOD SHOES
If your shoes are worn out, they can transmit the stress of footstrike into your body in abnormal ways and force your muscles to work harder to compensate for the increased stresses. Wearing high-quality, motion-control running shoes that are in good repair (for example, no mid-sole tilting, no holes in the out-soles, etc.) can reduce impact stress and muscle fatigue/overuse injuries.

6. BUY A PAIR OF "GOOD" INSOLES
When an old house settles on its foundation, window frames warp and cracks develop in the walls. Our bodies are like houses and our feet are our "foundations." Our feet are designed to collapse (or "pronate") to absorb the shock of standing, walking, and running. If our feet are excessively pronated, we can be predisposed to developing foot and leg pains because our feet and leg muscles have to work harder to hold us upright and allow us to move forward.

The use of a high-quality insole from a running store may provide enough arch support/motion-control to prevent excessive muscle strains and the resultant cramping. If your symptoms improve but are still present despite the use of athletic insoles, consider seeing a chiropodist for evaluation for custom-molded foot orthotics (molded appliances which provide even more support than athletic insoles).

7. GO ON A RECOVERY RUN/WALK
Going on a light (20-30 minutes) recovery run/walk the afternoon of (or the day after) your long run encourages the movement of blood in the worn-out muscles to help flush out the excess lactic acid. Yoga, lower-extremity aerobic weightlifting (i.e., multiple, rapid repetitions performed with light weights), spinning, or swimming are other activities which could be used as alternative recovery activities after long runs.

Ontario Improving Wound Care for Patients with Diabetes

Province Funding Casts to Treat Diabetic Foot Ulcers

Ministry of Health and Long-Term Care

Ontario is covering the cost of specialized casts to provide more support for patients with diabetic foot ulcers.  

Wound care devices, which include removable, non-removable and total contact foot casts, can significantly improve patients' quality of life by relieving pressure around the heel, ankle and toes so the foot can properly heal. These casts will be made available free of charge at eligible locations such as foot and wound care clinics, specialized programs for diabetes and community health, complex continuing care and rehabilitation centres.

The province is also supporting wound care training and education for health care workers, which will include specialized skills development in diabetic foot ulcer management.

Ontario's plan to create fairness and opportunity during this period of rapid economic change includes a higher minimum wage and better working conditions, free tuition for hundreds of thousands of students, easier access to affordable child care, and free prescription drugs for everyone under 25 through the biggest expansion of medicare in a generation.
 

Quick Facts

  • Ontario is providing more than $8 million over three years to provide three types of foot casts, also referred to as offloading devices, to treat diabetic foot ulcers. These devices include removable, non-removable and total contact foot casts which can cost between $150 and $620.
  • This funding followed Ontario’s acceptance of the Ontario Health Technology Advisory Committee’s recommendations to fund three types of offloading devices.
  • The province is also investing more than $50,000 this year to support 14 health care specialists across the province to attend the Wounds Canada Conference for hands-on training and education. This funding is part of the larger wound care strategy.
  • Offloading devices can be an effective treatment tool for diabetic foot ulcers and can significantly improve patient outcomes and reduce the risk of amputation.

Additional Resources

Quotes

“Making it easier for patients to access the services they need is a key priority for our government. Diabetic foot ulcers can be extremely debilitating, and if not properly treated, can negatively impact a person’s health and quality of life. We are making these wound care devices available free of charge to patients who need them in order to improve their healing and subsequently, their overall health.”

Dr. Eric Hoskins

Minister of Health and Long-Term Care

“The government's announcement today is excellent news for persons with diabetes who suffer from diabetic foot ulcers. The funding of offloading devices (pressure relieving), will prevent amputations and the devastating suffering and cost that result from them. We are proud that Ontario is the first province to provide universal funding for offloading devices for the treatment of foot ulcers and we encourage all other provincial governments across Canada to implement this evidence based cost saving therapy. The announcement is the culmination of a meaningful partnership between organizations representing nurses, physicians, other health professions and the public.”

Doris Grinspun, CEO, Registered Nurses' Association of Ontario (RNAO), and Mariam Botros, CEO, Wounds Canada

“Amputations are one of the most feared consequences of diabetes. Diabetes Canada recognizes the Government of Ontario’s leadership in providing public funding for offloading devices, which treat diabetic foot ulcers and prevent amputations. Diabetes Canada encourages the Government of Ontario to continue working on this issue, and encourages other provinces to follow Ontario’s leadership in helping Canadians living with diabetes with their foot care.”

Amanda Thambirajah

Director of Government Relations, Ontario, Diabetes Canada

December 14, 2017
Category: Uncategorized
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Diabetes in Real Life

Daily foot care can prevent later problems

 
What should a person with diabetes be doing on a daily basis to ensure good foot health?

Neuropathy, vasculopathy and a faulty immune system affect the feet of patients with diabetes and can lead to needless and preventable foot pathology. People with diabetes on a daily basis should be visually and manually inspecting both their feet and their shoes. The foot inspection is to identify a crack in the skin or a locally red swollen or warm area. The shoe inspection is to identify any defect in the shoe itself and any foreign objects in the shoes.

People with diabetes who notice dry skin on their feet or legs due to autonomic neuropathy should apply a urea-based moisturizing lotion. They also need to wear appropriate socks and shoes for their activities. They should practice preventive foot care to avoid developing foot ulcers from the combination of sensory neuropathy and mechanical, chemical or thermal trauma. Foot ulcers can lead to infection, hospitalization and the most dreaded complication of the diabetic foot, amputation. People with diabetes have a list of recommended tasks they are to perform daily to manage their foot health. They should be aware of any changes to their foot health, and if they find a problem, they should seek professional attention promptly.

Every person with diabetes should have a yearly comprehensive diabetic foot exam by their foot specialist that includes a monofilament test.

What are the most common foot problems?

A quick list of the most common foot problems includes those of the nails; keratosis, or corns and calluses; bone and joint deformities; and nerve and heel pain. No matter what the foot problem, visiting a podiatrist for a comprehensive diabetic foot exam, X-rays and laboratory tests is the first step to resolution.

The most common foot problem involves the toenails, which can be thick or discolored, ingrown or deformed. Trimming toenails can be difficult and often not realistically possible for people with diabetes, who should seek professional care for nail trimming and medical treatment of mold yeast or fungal nail infections. I have witnessed patients with diabetes who unknowingly have cut the end of their toes off while trimming their nails. How does this happen? The reasons include poor vision, poor lighting, poor eye-motor coordination, and inappropriate and nonsterile instruments. A person with diabetes who has nail problems and poor vision should have professional foot care by a chiropodist.

 

Endocrine Today, November 2017

In this issue, Susan Weiner, MS, RDN, CDE, CDN, talks with podiatrist Mark Hinkes, DPM, about foot problems that commonly affect people with diabetes.

Prevention & Recovery

Why orthotics make for happy feet

From pain reduction to performance enhancement, show your feet some love with orthotic inserts.

A trip to see a Canadian Certified Pedorthist is your first step to happy, healthy feet. These experts in lower-limb anatomy and biomechanics, assess your gait and specialize in making custom foot orthotics and modified footwear. From feet, back and knee aches, to performance and comfort upgrades, your lifestyle and medical history are considered. "We look at posture, the range of motion in your joints and the activities you enjoy participating in, to see if your biomechanics are contributing to your pain," says Peter Morcom, President of the Pedorthic Association of Canada. After a thorough assessment, "we use video to show you exactly what your gait looks like, and how and if modified footwear can help."

When it comes to foot orthotics, there are two main functions. The first helps to decrease excess motion in an over-pronated foot, often called a flat foot. The second, most commonly used with high rigid arches, provides equal weight distribution and shock absorption. Foot orthotics come in all shapes and sizes, and are made from a variety of materials, from plastic to EVA foam to graphite. While any foot type can benefit from an orthotic, not every foot will need one. An appointment with a Canadian Certified Pedorthist is the easiest way to assess your challenges.

Off-the-Shelf Versus Custom

If you're looking to increase comfort, performance, and even if you're experiencing some pain, a simple, off-the-shelf orthotic might be your best bet, and your quickest solution. The more affordable cost is also a plus, ranging between $30-$100. "These products can be a great test, or trial period, before you go the custom route," says Morcom. But because there are many different products on the market, a consultation with a Canadian Certified Pedorthist is still an important part of understanding which type of orthotic is best for you. Just like custom options, off-the-shelf products can vary in arch-height, amount of cushioning and stiffness or rigidity.

With custom orthotics, you get better control and patient specificity. Once your gait and lower limb assessment is complete, a pedorthist will cast your foot using either plaster, a foam mold or 3D laser scan. While off-the-shelf and custom foot orthotics may look similar in the end, the precision that goes into the casting process allows for lots of specialized additions. "There are benefits like forefoot posting, for example, which can change the actual angle your foot rests at, or metatarsal pads and many other personalized adjustments," says Morcom. While the cost is significantly higher for custom, $350-$650, they are often covered by benefit plans and have a much longer lifespan.

The Feet Sheet

  Off-the-shelf Custom
 Cost 

 $30-$100

 Not covered by benefits

 $350-$650

 Often partially or fully covered by benefits

 Life  Span

 1 year

 5+ years
 Wait  Time  Immediate  Two weeks from assessment
July 19, 2016
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5 Gnarly Foot Problems All Runners Can Relate To — And How To Fix Them

 

Slipping on a new pair of flats or heels, it’s safe to assume you’re going to end up with a blister at the end of the day. Runners have the same expectation—that guaranteed foot unhappiness will ensue—after a long run or a few months training for a race.

While spending lots of time on your feet in any situation can lead to some nagging pain, there are some ~special~ things about running that doom your dogs. “There’s a sheer repetitive nature to running, where you’re constantly doing the exact same motion over and over and over again,” Lori Weisenfeld, D.P.M., a New York City sports podiatrist, tells SELF. “Also, we sweat a lot when running, and sweat and friction combined are not the best combo.” And here’s a reason to dislike hills even more: “Even if it’s not a monumental one, slightly going up or down puts stresses between [your shoes] and your feet.” All these factors combined make runners particularly prone to some gnarly foot problems.

Wearing a good pair running sneakers that fit you properly is your first line of defense. “The proper sneaker is absolutely essential when you’re running,” Weisenfeld says. But if we’re being honest, even the most perfect pair of kicks won’t make you immune to runners’ feet. Here’s how to handle the most common issues.

1. Blisters

Plain and simple, blisters are caused by friction. If you’re prone to them, it means your foot is moving around too much in your shoe. This could be because you’re not wearing the right size, or you’re not wearing the right socks. Weisenfeld says to look for sport-specific socks with a lot of cushioning and made with synthetic materials (not 100 percent cotton or wool “because that will absorb the moisture but not allow it to evaporate”). She recommends the running socks from Thorlo. If you get blisters in between your toes, try rubbing Vaseline in between them before slipping into your socks, or use a blister block stick like Body Glide Foot Anti Blister Balm.

If a blister is tense and painful, Weisenfeld suggests draining it with a sharp, sterilized instrument. “On the roof of the blister but close to where it attaches to the skin, lance the blister so all the fluid comes out.” If you use a tiny pinhole, it will most likely seal up and fill up again, she adds, so use something a little thicker so it can fully drain. Just don’t rip the top layer of skin off—no matter how tempting it is. “It acts as the body’s natural biologic dressing for the blister, so the best thing to do is leave that in place.” If a blister elicits a throbbing pain or turns red, it could be a sign of infection.

2. Calluses

If this hardened mass of skin tends to build up on your heels, it’s probably from the edge of your shoe rubbing against the back of your foot. If your callus resides on the side of your big toe, it can be from wearing too-tight shoes or your running form, Weisenfeld explains. “If you over-pronate, your arches roll inward and as that happens, you’re rolling onto the big toe when you’re pushing off.” Over time, a big ol’ callus can form.

If calluses are a problem for you, make sure your shoes are wide enough across the front so there’s no pinching. Weisenfeld also recommends switching to a more supportive and stabilizing shoe to stop your foot from rolling, and wearing good running socks that wick away sweat and reduce friction. They might not look so great in sandals, but calluses are usually harmless and shouldn’t be painful. If they’re bothering you, Weisenfeld recommends gently filing them down with a pumice stone twice a week in the shower and moisturizing with a foot cream. If one hurts, it could be that a blister has formed underneath. It could also be a corn or a wart, not actually a callus. If a callus is dry, red, and cracking, it could be a sign of chronic athlete’s foot. All these scenarios deserve attention from a chiropodist.

3. Thickened toenails

Ever notice your toenails seem thicker and harder to cut than they used to? That’s their response to the constant banging and pressing against your shoes. “Nails will respond to constant repetitive trauma by thickening up,” Weisenfeld explains. If you’ve had some bruising, sometimes the nail will start to regrow before the old one has grown out or fallen off, causing an unnatural thickness. This can also be confused for fungus, so if your nails appear very thick and dense, see a foot doc to make sure it’s not something that needs to be treated with antibiotics. They may want to thin the nail out, too, especially if it’s causing you pain or discomfort.

4. Black toenails

Oftentimes, a bruised, black toenail is often the result of ill-fitting sneaks. “If shoes are old and floppy and stretched out, your toes are more likely to start slipping and jamming into front of the shoe,” Weisenfeld says. This trauma can cause bruising between the nail and the nail bed. “Once blood or even clear blister fluid gets under the toenail, it separates the nail from the nail bed and it won’t reattach. In that spot, the nail is dead.” If your entire nail is black, a full new toenail will eventually grow in. Weisenfeld says it takes about a year for a new big toenail to completely grow in.

If the nail hurts, you can try to drain the blood, but this may be best left to a physician or chiropodist. “It won’t save the nail, but it will relieve pressure and pain. “To stop feet from sliding as you pound the pavement, try custom insoles that lock them in place. If you ever just have a persistent black spot on your nail and there’s no pain, visit a chiropodist to rule out skin cancer.

5. Ingrown toenails

An ingrown nail looks (and feels) like the nail is piercing the flesh around it. “Your body doesn’t care it’s a nail, it just knows something’s poking that doesn’t belong there, so it acts like it’s a foreign body,” Weisenfeld explains, leading to pain and infection. Running isn’t the most common cause of ingrown toenails, but if you’re prone to them, it can make things worse: An ill-fitting shoe and repetitive pressure on your big toe can push it into the skin around it, especially if your nail tends to curve downward. You should never try to remove an ingrown nail yourself—it can seriously damage it and make it become more infected (talk about gnarly)—so be sure to book an appointment with a chiropodist to get it properly taken care of.





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