Posts for: December, 2017

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

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.

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.

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.

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.

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.

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).

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.

December 14, 2017
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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.

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


“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

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