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Saturday, 13 February 2016 15:43

Frostbite & Frostnip - the danger is lurking

FrostnipWe’re in a Polar Vortex which is downright cold for all of us but especially dangerous for Diabetics, small children and the elderly. With the incredibly low temperatures, it’s important to be aware of Frostbite and Frostnip and how to treat it if you or a loved one is affected.

Frostbite is tissue damage caused by cold and is rated according to severity; first, second, and third degree. Skin turns white, blue or mottled and feels frozen. Frostnip is the mildest level of frostbite. Skin will look pale and feel cold, numb and stiff.

Frostnip can easily be treated at home. If you think you may have the symptoms of frostnip, get out of the cold as soon as possible. Immerse the affected area in warm water (100º to 105º Fahrenheit) to thaw the frozen tissue. As an alternative, use your own body heat to warm the area. Do not use vigorous (rubbing) or high heat methods (heating pad, stove, water hotter than 105 º, etc.) to avoid burning the skin.

If the skin tingles and burns as it warms, your circulation is returning. The skin may turn red, but should not blister or swell. If the skin does not seem to warm, if it remains numb, or if it blisters or swells, seek immediate medical attention as you may be suffering from Frostbite.

Frostbite requires emergency medical care. If you think you may have frostbite, get out of the cold as soon as possible. If you cannot get medical help immediately and there's no risk that the area might be re-frozen before you get help, warm the affected area as you would for frostnip.

Protect your feet and toes by wearing two pairs of socks and choosing appropriate footwear. The first pair of socks, next to your skin, should be made of moisture-wicking fabric. Wear a pair of wool or wool-blend socks on top of those. Your boots should also provide adequate insulation. They should be waterproof and cover your ankles. Make sure that nothing feels tight, as tight clothing increases the risk of frostbite. And limit your time outdoors as an extra precaution.

Fifth Metatarsal FractureJulian Edelman is the most recent star athlete to be sidelined by a Jones fracture, but he is certainly not the first. Earlier in the NFL season, Dez Bryant underwent a single surgery to repair a similar injury and sat for 6 weeks before returning to the field.  Kevin Durant, the 2013-14 NBA MVP, missed much of the 2014-15 NBA season and underwent three surgeries to repair the injury. The difference in recovery times for Bryant and Durant highlights the complexity of treating this injury as well as the nuances each individual encounters throughout their treatment.

A Jones fracture is a fracture to the long bone on the outside of the foot, the fifth metatarsal, that is caused by a sudden inward and downward twisting of the foot or direct force to the area.  Patients experience pain to “the outside” of their foot with swelling and pain with walking.

These injuries can be diagnosed with a standard x-ray of the foot and are particularly difficult to treat as they occur in an area of the bone with limited blood supply.  Adequate blood supply is essential for healing.

While 6-8 weeks of non-weight bearing is the typical method of treatment for most patients, surgery is usually preferred for high-level athletes.  Surgery for this injury consists of introducing a single screw into the bone to hold the two fragments together so that they can heal.  Even with surgery, it is approximately 6 weeks until return to activity can be expected.  The most common complication that patients experience with this injury, as seen with Durant, is failure of the two bone fragments to heal.  When this happens, regardless of the initial method of treatment, patients require surgery to repair the non-healing bone.

Disclaimer: The author has never evaluated, treated or reviewed the medical records of the individuals mentioned in this article.  All statements and opinions are based on publicly available material released from the individual or their representatives.

We recently ran into a middle-aged friend and sometime patient who was complaining of growing aches and pains in her knees, hips and back. She wasn't an athlete, or particularly active, so the pain probably wasn't from overuse. She also didn't have a weight problem, so stress on the joints from obesity wasn't the answer. She remarked that she thought she might have Lyme Disease and had set up an appointment with her family physician to be tested. Sorry to hear that, we said, That's truly a painful condition.

back pain

And then we looked down at her shoes - the most beat-up, worn-out flats we ever saw.

"You have flat feet, don't you?"

"Yes, I do."

"Do you wear those shoes often?"

"Yes, I love them."

"Throw them away and never wear them again. Those shoes have zero support and flat feet need arch support. I bet if you wear sneakers instead your pain will go away."

"I hadn't thought of that."

Most people assume that the growing pain in their knees, hips, or back is caused by a crippling disease or an unknown injury. But in fact, the source of your pain may actually be rooted in your feet - or more specifically, heels and arches which aren't supported correctly (as in our friend's case), or feet that are out of alignment with your ankle and leg.

The older we get...

As we age we have to take better care of our feet. After forty-plus years of neglect, they gradually become painful, arthritic, misaligned, and prone to bunions and hammertoes. Our feet are designed to distribute and support our body weight evenly across the forefoot and heels, and a critical part of this is the proper alignment of the foot/ankle and the ankle/lower leg.  In the case of those who have flat feet, arch support is required for proper alignment and to avoid fatigue.

When we're out of alignment, or lack arch support, we get tired and sore, which causes us to shift our body weight to get comfortable. Then the sides of our foot, forefoot or heel carry too much weight and our ankles, knees, hips and legs compensate, which causes stress on the joints. And when the stress is continuous, the joints become irritated and painful.

It may be hard to believe that such acute and bothersome pain can be caused by a lack of arch support or the misalignment of your foot/ankle/lower leg. In many cases, a simple change in footwear to a quality pair of athletic shoes, worn as often as possible, is the answer. To correct your alignment and relive fatigue, your podiatrist may also recommend custom orthotics to be worn inside your shoes.

And how is our friend doing now, one month later? She reports that she's been wearing sneakers as often as possible and her back, hip and knee pain is nearly gone. Voila!


Plantar Fasciitis is without a doubt the most common cause of heel pain - 10% of people are afflicted with it at some point in their lives. But if your heel pain continues for more than 2 months, it may not be plantar fasciitis at all.

heel anatomy diagram

Heel pain that lasts more than 8 weeks may be caused by a ligament tear in the heel, whose initial symptoms are almost identical to plantar fasciitis. However, the treatments for the two conditions are very different. In the case of a misdiagnosis, the treatment for plantar fasciitis can even make your heel pain worse.

Plantar Fasciitis or Plantar Fascia ligament tear?

Plantar fasciitis is a micro tear of the plantar fascia ligament, which occurs from overuse (too much demand on the ligament). A plantar fascia rupture (or tear) is less common and typically more painful. Pain from either injury will be felt in the bottom of the heel.

Even though the two injuries affect the same ligament, the treatment for plantar fasciitis vs. a plantar fascia tear are practically polar opposite. If you have a typical case of plantar fasciitis, the treatment protocol is usually stretching exercises via physical therapy, rest, ice, over the counter anti-inflammatories (ibuprofen or naproxen), and in some cases custom orthotics. If a patient follows the prescribed treatment, their plantar fasciitis will usually heal in 3-6 weeks.

Read more about plantar fasciitis.

But if your heel pain is caused by a tear to the plantar fascia ligament, those stretching exercises may make your condition worse. Healing a plantar fascia tear takes anywhere from 2-5 months, depending upon its severity. Treatment typically involves immobilization of the foot and lots of rest, to allow the tissue time to reconstruct without further stress. In some cases, surgery will be necessary to completely repair the ligament.

For this reason, a visit to a podiatrist is always recommended for heel pain. The subtle differences in these injuries can easily be missed by a general physician, and the wrong treatment can worsen your condition. Heel pain also puts more stress on the other joints in your body, as we shift weight off of our heel. It's common to develop pain in the ankle, knees and back as well when we have heel pain.

The best way to prevent heel pain is to be proactive. Wear supportive shoes to work and properly fitting and padded athletic shoes when you exercise. The key to protection is arch support and padding in the heel to absorb impact. It's also a good idea to do a proper warm-up before exercising, including gentle stretching exercises for your legs, ankles and feet.


Like clockwork, every spring we hear the same complaint in our office:

"I had pain in my feet/ankles/toes after I ran. And then I ran the next day and they hurt more. I can't understand it, because I'm running exactly the same route I did as last year."

protect your feet and ankles when running

Each spring, every athlete is anxious to jump right back in where they left off. But we forget just how quickly our bodies get out of condition, especially as we age.

Your body has de-conditioned over the winter months (assuming you're not working out regularly at the gym). Ligaments, muscles, bones, and interconnective tissue have become much weaker from lack of use. When we demand the same from them as we did when we were in peak condition at the end of last season, the disconnect between desire, endurance and strength becomes obvious. The result is soreness, stiffness, tendonitis, sprains, fractures or worse, which could sideline us for months.

Whenever we have a significant break from our training schedule, even a few weeks, it's important to build back up slowly to pre-break levels. This is especially true when we lay off all winter, or when we're recovering from an injury or an illness.

In fact, your hard-earned fitness can begin decreasing in as little as 2 weeks, especially if you're in peak condition. According to Dr. Edward Coyle, the director of the Human Performance Laboratory at the University of Texas at Austin, the maximum oxygen that an athlete can uptake and utilize (your endurance) plunges in the first month of inactivity and continues to decrease for the next 3 months of inactivity. Even the enzymes involved in metabolizing energy become less active. In fact, for the casual athlete, all the benefits derived from the previous season -  the ability to uptake and utilize oxygen - may be completely lost when they lay off their routine for 4 months or more.

And after your endurance decreases, your muscle mass and strength also take a hit. Which is when you feel ankle pain or heel pain pushing that last mile.

runner forgot somethingThe good news is, if you've been a runner or otherwise training for 10 years or more, you can maintain fitness longer than those who've been at it for less time. And highly trained athletes don't decline to the same levels as the casual athlete, even after a long layoff.

So how do you get back into condition?

  • Take it slow and don't go BIG right from the start. Begin by working below your break point and don't push
  • Warm up for longer periods before your workout. Make sure you've stretched your legs, feet and ankles sufficiently
  • Allow 1 day of rest between each run or workout. More if you have pain or soreness in your knees, shins, feet or ankles.
  • Focus on consistency and good habits, not speed
  • Progress gradually and extend your workouts by a small amount each session
  • If you feel any pain, stop immediately. Resume your training only when the pain has completely subsided
  • Wear a new pair of athletic shoes to support your feet and legs properly

Breaks are an important part of training, as they're important for your physical and mental health. They can also help you come back stronger and faster. Your best bet is to rest when injured or ill and do some cross-training in the gym during your downtime to maintain strength and endurance. That's a far better strategy than hurting yourself every spring.

Put down that soda or milkshake: A recent European study has found that drinking one sugar-sweetened drink per day - just one - can raise your risk of Type 2 diabetes by up to 25%.

milkshakes, diabetes

The new British study, published in Diabetologia, the journal of the European Association for the Study of Diabetes, tracked the beverage consumption habits of more than 25,000 adults ages 40-79 over a period of 11 years, to see who was more or less likely to develop diabetes. None had diabetes at the start of the study. The research showed that those who drank unsweetened or lightly sweetened coffee, tea or water daily instead of sugar-sweetened drinks like sodas and milkshakes, were up to 25% less likely to develop diabetes.

The association of tea and coffee with diabetes has not been well-studied in the past. This is also the first study to link sweetened-milk beverages like milkshakes and flavored milks to diabetes. The authors write that the association is “unsurprising” since added sugar contributes more than half of the sugar contained in these drinks.

In a press release, the senior author of the paper, Dr. Nita Forouhi of the University of Cambridge, said, “The good news is that our study provides evidence that replacing a daily serving of a sugary soft drink or sugary milk drink with water or unsweetened tea or coffee can help to cut the risk of diabetes.”

Just one cola per day is too much sugar

Overall the study found that each 5% increase in the daily amount of calories from sweetened beverages was associated with an 18% increase in diabetes. Soft drinks like Coca Cola and Pepsi, sweetened milk beverages like milkshakes, and artificially sweetened beverages like diet sodas were all associated with approximately a 22% increase in diabetes.

Surprising findings from the study:

  • Those who consumed one artificially sweetened diet drink each day showed a 14% greater chance of developing type 2 diabetes.
  • Drinking fruit juice, which is high in naturally occurring fruit sugars, did not increase the likelihood of developing diabetes.
  • Unsweetened tea or coffee had an inverse association with diabetes (the incidence of type 2 diabetes decreased).

However, the association with artificially sweetened beverages lost statistical significance when the researchers took weight into account, suggesting that “those who are overweight or obese and at higher risk of chronic disease consume a higher amount of [artificially sweetened beverages] than those at lower risk.”

Public health experts recommend that a typical adult diet - about 2,000 calories a day - should include no more than 130 calories from added sugar. If you drink just one 12-ounce can of Coca Cola Classic, with 140 calories, you'll exceed that limit.

"Our study adds further important evidence to the recommendation from the World Health Organization to limit the intake of free sugars in our diet," states Dr. Forouhi. "Replacing soft drinks and sweetened-milk beverages with [artificially sweetened beverages] did not reduce type 2 diabetes incidence, but drinking water or unsweetened tea or coffee as alternatives to soft drinks and sweetened milk beverages lowered the incidence of type 2 diabetes significantly. These novel findings are of clinical and public health relevance,... [as] reducing consumption of sweet beverages... and promoting drinking water and unsweetened tea or coffee as alternatives may help curb the escalating diabetes epidemic."

Flat feet (flatfoot, pes planus, fallen arches) occur when the arch in your foot drops, causing the bottom of your foot to flatten. This is easy to note, as the entire sole of your foot will contact the floor when you stand. In many cases, flat feet are hereditary and cause no pain.

flat foot, flat feet, flatfootBut for those who once had arches, Flatfoot slowly develops from wear and tear (aging) or trauma, causing pain in the arches, heels, ankles, knees or hips, as the leg and foot fall out of alignment. The culprit is usually damage to the posterior tibial tendon which runs along the inside of your ankle - when it weakens, it can no longer support the arch.

Why you need your arches

We all start with zero arch. We're born with flat feet and slowly our arches develop during childhood, becoming fully developed in adulthood.

The arches and the biomechanics of the lower leg are intimately linked - our arches literally put a "spring" in our step, determine how we walk and distribute our body weight proportionally across our feet and legs. Arches also need to be sturdy and flexible to adapt to various surfaces. When the strength or flexibility of the arch fails, the alignment and balance of the foot and leg suffers.

What causes flat feet?

The most common cause of Adult Acquired Flat Foot Deformity (AAFFD) is damage to the posterior tibial tendon, one of the most important tendons in your leg. Starting at the calf, the posterior tibial tendon travels down the inside of your leg and heel, and attaches to the bones on the inside of your foot. The main function of the tendon is to support your arch and foot. If the tendon suffers chronic damage such as persistent inflammation, it may lose its ability to support your arch, and the arch will slowly collapse. Pain and discomfort from AAFFD can be substantial, occurring anywhere in the foot, heel, ankle, knee, back, or hip.

Inflammatory arthritis, especially rheumatoid arthritis, attacks the cartilage in the joints as well as the ligaments that support the foot. The inflammation causes not only pain, but also may change the shape of the foot and cause the arch to drop.

Ligament injury causes the joints to fall out of alignment. The job of the ligaments is to hold the bones in place and prevent them from moving. When the ligaments are damaged, the bones fall, flattening the arch.

Fractures or dislocations of the bones in the midfoot can lead to Flatfoot deformity.

Charcot Foot Disorder, a complication of diabetes, results from a nerve condition (diabetic peripheral neuropathy) which causes a loss of sensation in the feet. An infection in the foot, unknown to the patient, causes weakness in the ligaments and bones, leading to collapse of the arch and other complications. Complicated surgery is required to correct the problem.

Other reasons for developing Flatfoot include

  • Obesity
  • Muscle diseases
  • Pregnancy
  • Aging
  • Trauma

Symptoms of Flatfoot depend on the cause of the condition, but may include :

  • Difficulty standing or walking for long periods, and pain that gets worse with activity. High intensity activities such as running can be especially difficult.
  • Pain or achiness occurring anywhere from the mid foot, heel and arch to the hip and back.
  • Pain along the inside of the foot or ankle (path of the posterior tibial tendon). May be accompanied by swelling.
  • Stiffness in the feet
  • Feet tire easily
  • Standing on toes is difficult
  • Pain on the outside of the ankle, caused by a shifting heel bone which puts pressure on the fibula (ankle bone)
  • In the presence of diabetes, patients may discover a lump on the bottom of their foot. This may develop into an ulcer and consequently Charcot foot disorder. Any difference in the top or bottom surface of the foot should immediately be brought to the attention of a podiatrist

Treatment for flat feet

  • Custom orthotics may be prescribed to support your feet correctly and reduce pain
  • A change in footwear: Your podiatrist may suggest you buy a pair of high quality, supportive shoes to reduce stress on your feet and support them correctly
  • Physical therapy to stretch the Achilles tendon. A short Achilles can contribute to Flatfoot, and stretching it will improve flexibility in the foot
  • Surgery may be recommended to repair the arch and improve flexibility

Watch the story of how we alleviated the pain of Flatfoot (and other conditions) for one of our patients.

Heel pain and ankle pain usually appear separately. But sometimes, pain in the heel and ankle can occur together as a result of one injury or multiple, associated injuries.ankle pain and heel pain


Runners and other athletes are especially prone to overuse injuries in the heel and ankle. Some, especially those with long legs, are also prone to having a stiff Achilles tendon and stiff calf muscles. As the foot and ankle literally hinge on these mechanisms, inflexibility leaves the tendon, heel and ankle at risk of injury, especially when we play sports. Usually, the injury appears in the form of Achilles tendonitis, calcaneal (heel bone) bursitis, or plantar fasciitis.

If, at the first sign of pain you rest, elevate and ice the sore area until the pain subsides, healing may be achieved without medical intervention. If you ignore the pain and keep training, the injury may become very serious. If pain continues for 4 days or more, see a podiatrist.

Stress fracture

A stress fracture in the ankle or foot generally occurs gradually from overuse. Depending on the location and severity of the fracture, pain can radiate through the entire foot, ankle and/or heel. The pain may be accompanied by numbness or tingling, redness, swelling and a feeling of instability.

It's essential that any fracture  - whether a small stress fracture or a more serious break - be treated by a podiatrist to insure that it heals correctly. Don't blow it off - ask anybody who's middle aged or older and they'll tell you how much these "minor" stress fractures come back to haunt you later in life.

Nerve conditions

Tarsal Tunnel Syndrome and peripheral neuropathy can cause considerable pain and discomfort. Tarsal Tunnel is an entrapment of the posterior tibial nerve which passes through your ankle. When the nerve becomes compressed, pain can be felt from the sole of the foot and throughout the ankle. Pain may also radiate to the leg and hip. Peripheral neuropathy, usually a side effect of diabetes, can cause tingling and pain at any point in the foot and lower leg.

Both conditions require the intervention of a podiatrist to relieve symptoms.

Tendinitis, Tendinosis, or tendon rupture

In or near the ankle, the Achilles tendon is the most likely tendon to cause pain. But pain may also be felt from injury to the peroneal, posterior tibial or flexor hallucis longus tendons. The area of swelling and tenderness usually indicates which tendon has been damaged.

Treat with rest, ice and anti inflammatories, and see a podiatrist for an evaluation.

Ankle Impingement Syndrome

Anterior Ankle Impingement or Posterior Ankle Impingement Syndrome occurs when soft tissues around the ankle become pinched. When the ankle is bent fully up or down, pain occurs. Runners, footballers and dancers are notorious for developing these syndromes.

Treat as above with tendinitis.

Ankle Sprain

An ankle sprain occurs when the ankle ligaments are subjected to an unnatural twisting, causing stretching or tearing of the ligaments.  A sprain can easily cause pain in the entire area around the ankle, including the heel.

Treatment by a podiatrist is necessary to insure that the sprain heals correctly. Damaged ligaments which are not cared for properly become weak and are more likely to be reinjured and cause long-term problems.


Arthritis can occur in any joint in the body. It's especially debilitating when it takes up residence in the ankle. Due to the inflexibility of the arthritic ankle, arthritis patients are prone to plantar fasciitis.

Rheumatoid Arthritis

This chronic autoimmune disease attacks joints at any point in the body. RA usually starts in the small joints of the hands and feet, and progresses to the larger joints. More than 90% of Rheumatoid Arthritis patients develop symptoms in their feet and ankles, usually occurring in both feet simultaneously. Difficulty climbing stairs is an early sign that the ankle is beset with RA. Difficulty on uneven ground suggests that the hindfoot - the heel area - is showing signs of the disease. A podiatrist can identify your symptoms and you will be referred to a rheumatologist for treatment.


If you've ever taken a yoga class, one thing was probably clear immediately: your feet and ankles weren't nearly as strong as you thought they were. In the U.S. and much of the world, we go about our daily business in shoes which protect our feet and our health. If we're athletes, we buy shoes which protect our feet from injuries and hopefully give us a little extra juice when we need it.

But on the downside, those shoes can prevent the muscles in our feet from getting the exercise they need. And as we age, it shows: bunions, hammer toes, aching arches, aching toes, poor balance, and a host of other maladies (some of these are inherited traits).

yoga strengthens feet ankles

Strong feet and ankles are essential for anyone, and especially as we age, to maintain our balance. Running, biking, weight lifting and any athletic activity is great, but they tend to develop one side of the body more than the other, due to our natural left-hand, right-hand propensity. Yoga aims to create equal strength and also loosens the joints, helping them avoid injury and maintain flexibility.

One of the first lessons in yoga is how to stand. This may seem silly at first, but our feet are our foundation, and we quickly learn that we need to unlearn some bad habits. Over the years we lean into the sides of our feet, lean back on our heels, lean forward, or shift weight from sore areas. All of these habits change the way we walk and stand, throwing our legs and ankles out of alignment and placing stress on other parts of our body. The result is pain and stiffness anywhere between the toes and neck.

Try these simple yoga-based exercises to build strength in your ankles, feet and toes. Do all exercises barefoot on a flat surface. If you have medical problems with your feet or ankles, or are obese, consult your physician before attempting.

Learn To Evenly Distribute Your Weight

The strength of your feet - and especially your arches - determines if your leg is aligned with your ankle. Strengthening your arches starts with an awareness of how you stand.

Standing upright in bare feet, sense where your weight falls in your feet. Your feet are meant to carry your body weight evenly - not back on the heels or on the balls of your feet. Press down evenly through the heels, the balls, and your toes. You'll feel the difference in your balance immediately. While standing upright and evenly balanced, spread the soles and toes as much as you can and reach the toes forward.

Stretch and Strengthen Your Feet

One of the most common yoga poses, Downward-Facing Dog, stretches the soles of your feet and strengthens your arches. In this position, gently push your heels toward the floor as much as possible. Learn how to do it here.

strengthen feet ankles

To stretch the tops of your feet and strengthen your ankles, try Hero Pose (only do this if you have no knee problems). Kneel on the floor, keeping your thighs perpendicular to the floor and touch your inner knees together. Slide your feet apart, slightly wider than your hips, but keep the tops of your feet flat on the floor. Then sit down between your feet. If your buttocks don't rest comfortably on the floor, support them with a thick book placed between your feet. Now lift your sternum, sitting as upright as possible, and try to release your shoulder blades away from your ears. Hold for 1 minute.

Raising yourself on your toes is a simple and excellent way to strengthen your feet. While this may seem easy at first, try doing it very slowly. You'll be surprised at how much effort you'll expend.

Strengthen your toes

Stand with your feet so that they're directly under your hips. Try to lift just the big toe on each foot, while keeping the other toes on the floor. Then do the opposite: lift all the toes except the big toe. Switch back and forth. You'll find that one part of that exercise will be a lot easier than the other. That's because those who pronate (roll the foot inward when they walk) typically have a hard time lifting their big toes, and those who supinate (roll the foot outward) have a hard time lifting the other toes.

Leaning is Exercise

Leaning teaches us how to balance our weight across our feet. Those who shift their weight to their heels leave the front of their foot without much to do, and the foot weakens.

Stand with your feet a comfortable distance apart and put a soft bend in your knees. Lean forward at the ankle as if you were about to ski down a slope. Do not lean from the waist or hips - keep the lean in your ankles. This exercise wakes up the muscles in your toes and the soles of your feet.

If your feet feel tired after these exercises, that's good - it means that the muscles are being worked. If your feet are sore, that's not good - back off a little next time around.

Every parent knows that their children's feet grow at alarming speed. One day you buy them new shoes and the next day the shoes are too tight. It's enough to make you want to send them into the world barefoot.

heel pain in children

The never-ending growth spurts in children's feet are due to the fact that the foot is one of the first parts of the body to grow to full size. This speedy growth is accompanied by uneven development in the lower leg and ankle, making muscles and tendons very tight and the heel less flexible. This inflexibility exposes the heel to injury and places a lot of stress on the growth plate, a soft area at the end of the heel which eventually fuses with the heel bone (calcaneus).

Sever's Disease (calcaneal apophysitis), the most common cause of heel pain in children, is a painful inflammation of the heel's growth plate. The heel bone is not fully developed until age 14 or 15, and is constantly adding new bone at the growth plate (physis). When the growth plate is subjected to a lot of repetitive stress, like that in athletics, inflammation can develop.

It should be noted that the symptoms of heel pain in adults are different from heel pain in children. In adults, heel pain is usually at its worst in the morning and decreases or subsides as the tissue warms up with activity. But in children, heel pain usually doesn’t diminish as the child moves around – in fact it may get much worse.

Fortunately, Sever’s Disease is a temporary condition and with rest and treatment, symptoms will usually subside within 8 weeks. If the condition persists, it's important that your child sees a podiatrist for a thorough evaluation and treatment plan. The risk of recurrence of Sever’s Disease diminishes with age and typically doesn't occur after 15, when foot growth is complete and the growth plate has fused to the rest of the heel bone.

severs disease heel pain in children

Factors which contribute to Sever's Disease

  • Obesity
  • High level of physical activity
  • Long periods of standing which put pressure on the heel
  • Flat feet or a high arch
  • Pronated foot - one which rolls inward when walking
  • Short leg syndrome (one leg is shorter than the other)

Symptoms of Sever's Disease

  • Pain or tenderness at the back of the heel, and/or along the side and bottom of the heel, extending to the arch
  • Redness and swelling in the heel
  • Difficulty walking or running
  • Feet are stiff upon waking
  • Heel pain increases with activity
  • Child walks on tiptoes, limps, or favors one foot over another

To relieve your child's heel pain

  • Rest
  • Ice and elevate the foot
  • If approved by physician, use over the counter pain medicine to control pain
  • Suspend athletic activities until pain subsides
  • Wear athletic shoes which fit properly and pad the foot
  • Of obese, begin weight management program
  • Stretching exercises for the heel and hamstrings (under supervision of physical therapist)
  • No high heeled shoes

If your child complains about heel pain, don’t take it lightly, as early intervention and treatment by a podiatrist is key to a continued healthy development.

Did you ever have one of those really active days - running, hiking, jumping, maybe just standing for a really long time on your feet - and the balls of your feet ached like crazy? Well my friend, you were probably suffering from the dreaded Metatarsalgia.

metatarsalgia symptoms Metatarsalgia isn't as serious as it sounds. It simply refers to minor pain and inflammation of fatigued and overused metatarsal bones (the long bones in your feet). The pain appears in the area where the metatarsals join your toe bones, otherwise known as the ball of your foot - the area of your sole behind your toes (not just behind the big toe). The pain usually begins as a mild ache and worsens over a period of months.

Usually, metatarsalgia is caused by ill-fitting shoes combined with lots of activity. Most cases of metatarsalgia aren't serious, and rest, ice and over the counter pain medicine will resolve the pain.

But if left untreated, the classic cascade effect may kick in: The balls of your feet hurt, so you unconsciously shift weight to other parts of your feet, which eventually causes pain in those areas, which again causes you to shift your weight. Since your legs, ankles and feet are drifting farther out of alignment, the joints above your feet start feeling the impact and you suddenly have pain in your knees, back, or hips. And it all began with minor, treatable pain in your feet.

Prolonged metatarsalgia which doesn't resolve in 10 days should always be reported to your podiatrist, as it can be a symptom of other, more serious conditions.

Symptoms of Metatarsalgia include

  • Sharp, aching or burning pain at the head of the metatarsals, in the ball of your foot, just below and underneath the toes
  • Pain that becomes worse when you're on your feet, especially when running, walking or flexing
  • Pain decreases as you rest
  • Sharp or shooting pain, numbness, or tingling in your toes
  • A feeling of having a pebble in your shoe

metatarsalgia foot diagramContributing factors to Metatarsalgia

Intense training. Most runners are accustomed to occasional bouts of metatarsalgia, as the front of the foot absorbs significant shock when running. But this can be true of anyone who plays a high impact sport, especially basketball, soccer, tennis, football, or track and field events. It's sometimes a sign that your athletic shoes are worn out and need to be replaced.

The shape of your foot. If you have a high arch, extra pressure is placed on the metatarsals, increasing the chance of pain from overuse. If your second toe is longer than your big toe, more weight than normal is shifted to the 2nd metatarsal head, and that may cause pain as well.

A muscle imbalance. Tight toe extensors or weak toe flexors don't properly support the metatarsal bones and may cause fatigue and pain from overuse. A too-tight tight achilles tendon may be a contributor as well.

Stiff ankles, perhaps the result of a previous injury or arthritis, don't support the foot correctly, placing too much pressure on the forefoot.

Excessive pronation - the side-to-side movement of your foot - may contribute.

Foot deformities such as flat feet, bunions, gout, arthritis and  hammertoe can cause metatarsalgia. Many patients with bunions complain of pain in the balls of their feet.

Carrying too many pounds. Your forefoot carries most of your body weight when you walk of run. Extra pounds means extra pressure on the metatarsals. Additionally, as we age, the fat pad in the foot tends to thin out, reducing its cushioning effect. A weight management plan may reduce your symptoms.

Poorly fitting shoes and high heels. That's right, ladies. While high heels make you look great, they're murder on your feet (like I had to tell you that). High heel shoes are a very common cause of metatarsalgia in women, as they transfer your body weight to the front of the foot, working against how the foot is designed to carry your weight.  Athletic shoes which don't support your feet correctly are also guilty of causing metatarsalgia.

Stress fractures in the metatarsals or in the toe bones change the way you walk, which may result in metatarsalgia.

Morton's Neuroma, a growth of fibrous tissue around the nerve between your 3rd and 4th metatarsal heads causes symptoms similar to metatarsalgia.

Your podiatrist may recommend one or more of these treatments for Metatarsalgia

  • Rest and complete non-weight bearing for at least 24 hours
  • Ice
  • Over the counter pain medicine such as advil or aleve
  • Cortisone injection in the sore area to relieve pain and inflammation
  • Pressure bandage on the sore area
  • Ultrasound therapy
  • Custom orthotic devices to support and realign your feet
  • Metatarsal pads
  • Change in footwear (usually to good quality athletic shoes with proper support or flat shoes with a wide toe box)
  • When pain has subsided, stretching and strengthening exercises for your feet, supervised by a physical therapist
  • Alternate forms of activity may be recommended such as swimming or bicycling
  • Weight management if you're overweight

One of the keys to a killer golf game is strong ankles. As your ankles and feet are the only body parts in contact with the ground when you swing your clubs, keeping them in peak condition is essential.

golf swing strong anklesEvery golfer knows that their game depends on their swing and their swing depends on balance. If you have poor mechanics or tend to shift your weight, your balance will suffer and your swing will go off the rails. Strong ankles are key to maintaining your balance and hence your swing, so you'll spend less time in the sand trap. Or complaining of back pain.

The exercises below are meant to strengthen ankles and calf muscles, including ankle inverters and everters, responsible for the side-to-side movement of your feet. Strengthening these groups of muscles is extremely important for stability through your golf swing, especially on uneven surfaces.

1. Raise yourself on your toes. This is pretty self-explanatory. It's simple and very effective at strengthening the muscles in your calf, foot and toes.

While lightly holding on to the back of a chair to mainatin balance, slowly raise yourself on the toes of both feet. Repeat 10 times. For a challenge, try raising one foot off the ground, shift all of your weight to the opposite foot, and raise yourself on the toes of just one foot.

If you're in decent shape and would like a bigger challenge, hold on to light free weights while doing this. Don't go too heavy on the weights or you'll place undue stress on the muscles and do more harm than good. For balance training, alter your stance by pointing your toes in or out, or place one foot in front of the other.

2. Balance yourself on one leg. Not much explanation needed here. Pick one foot off the ground and hold for 20 seconds. Repeat with the other foot. If you're just starting, make sure you have a table or chair close by to hold onto until you maintain your balance. For "advanced users", stand on a pillow, which will simulate an uneven surface.

ankle exercises for golf

3. Stretch your heels and calf. Runners will be familiar with this one, as it's excellent at stretching out your heel cords. Stand facing a wall, keeping your back straight. Place your hands on the wall. One leg should be slightly forward and bent and the other leg extended behind you with the heel flat and the toes pointed in slightly. Keep both heels flat on the ground and press your hips toward the wall. Hold for 30 seconds and repeat. Then switch legs and repeat. To add an ankle stretch,  perform the stretch from this position again, but bend both knees slightly. Keep your hips centered over both feet.

4. Sitting calf and ankle stretch: Sit on the floor with both legs extended straight. Loop a hand towel around the ball of your left foot and grasp the ends of the towel. Gently pull the towel towards you while keeping your leg straight. You'll feel the stretch in your calf and ankle. Hold for 30 seconds and repeat with the right foot.

5. Increase your ankle's range of motion. Sit in a chair of sufficient height so your feet do not touch the floor. Leading with your big toe, write each letter of the alphabet with your foot. Keep the movement small, using just your foot and ankle only, not your leg.

6. Strengthen your ankle's dorsiflexion and plantar flexion. You'll feel the muscles going to work in your calf, shin, the back of your heel, and the top of your foot. With your legs straight our in front of you and your heel on the floor, anchor an elastic band on a chair or table leg, and then wrap it around your midfoot. Pull your toes toward you and push your heel forward. Repeat 10 times. This strengthens dorsiflexion. To strengthen plantar flexion, loop the elastic band around the ball of your foot and hold the ends in your hand. Without pulling on the band, point your toes forward and then slowly return to the starting position. Repeat 10 times.

Keep your ankles in tip-top shape and you'll have a much better time on the greens.

Wednesday, 11 February 2015 09:40

What Causes Plantar Fasciitis?

You know plantar fasciitis (PLAN-tur fas-e-I-tis) when you have it - a sharp, searing, knife-like pain on the bottom of your heel. In the morning, that first step out of bed can be excruciating, becoming less so as you walk and warm up the muscles and the plantar fascia ligament. Pain can also make itself known when you stand up after sitting for a while.

"itis" is a medical suffix used to indicate the inflammation of an organ - in this case the plantar fascia.plantar fasciitis

To understand plantar fasciitis, a little anatomy lesson is handy. The plantar fascia is a thick ligament made of dense, fibrous tissue which has very little stretch in it. It's main function is to act as a shock absorber. The plantar fascia starts at the bottom of your heel, runs across the arch and the ball of your foot, and then spreads out, attaching at the base of the toes.

When you take a step, and as your foot impacts the ground, your foot actually flattens, which lengthens the foot ever so slightly. This causes the plantar fascia to lengthen as well, as much as it can (remember, it doesn't have much stretch in it). Then when your heel lifts off the ground, the ligament returns to normal. When your foot impacts the ground hard, such as when playing sports, the foot flattens a little more than usual, and the plantar fascia stretches a little further than it would like to. As a result, small, usually minute tears develop where the ligament attaches to the heel bone (calcaneus). These small tears cause the ligament to bleed a little, and the tension of the plantar fascia pulling at the heel bone causes a spur to form on the bottom of the heel. However, the heel spur is not the cause of pain - it's caused by the plantar fascia trying to tear away from the heel bone. Many people have heel spurs and have no pain whatsoever.

Why does your foot flatten and tear the plantar fascia? The answer lies just below your ankle.  When your foot contacts the earth, the subtalar joint, just below your ankle joint, flexes to absorb the impact. The flexing of the subtalar joint causes the arch of your foot to flatten (pronation) or heighten (supination). If the foot excessively flattens, it's said to overpronate, and the plantar fascia is constantly under strain. Over time this weakens the ligament where it attaches to the heel bone, and pain occurs. Then when you are at rest, the plantar fascia starts to mend itself. But even a full night's deep sleep isn't enough to heal the plantar fascia entirely, and when weight is applied with that first step in the morning, the fascia tears again, causing pain. It is this persistent irritation of the plantar fascia that is known as plantar fasciitis.

Another contributing factor to plantar fasciitis is a tight calf muscle. The calf muscle attaches to the foot by way of the achilles tendon behind your heel. If the calf muscle is tight it limits the movement of the ankle joint, contributing to over pronation. Calf muscles can become rigid due to exercise, but also inactivity. High heels, even boot heels can cause the calf to tighten, and in some people, it's just naturally so.

Read about how PA Foot and Ankle Associates treats the symptoms of plantar fasciitis

Wednesday, 28 January 2015 13:57

Foot Fractures in Adults

If you're an adult, there's a very good chance that you've fractured or broken a bone in your foot at some point. After all, there are 26 bones in each foot, and they have to take the impact of everything from walking to skydiving. That means there's a high percentage that at least one of them is going to fracture under the stress, which can range from a small crack in the bone known as a stress fracture, to a complete break which penetrates through the skin.

broken foot fractured footThe adult foot is divided into three sections: the forefoot, made up of the toes (phalanges) and the longer bones which connect to them (metatarsals); the midfoot, which contains a collection of bones that form your arches (navicular bone, cuboid bone, and cuneiform bones); and the hindfoot, which contains 2 bones that form part of your ankle and all of your heel (talas bone and calcaneus). Additionally, in most people there are very small bones called sesamoids at the base of the big toe. That's a lot of moving parts, and a fracture can occur in any of them.

Symptoms of a foot fracture

  • Tenderness, bruising, or swelling
  • Breaks in the skin of the injured area
  • Pain when you try to stand or walk
  • Inability or decreased ability to move your foot
  • "Cracking" sounds when you move your foot
  • Foot is misshapen

It's essential to have a foot fracture treated as soon as possible by a podiatrist, so that the bone and tissue injury heals correctly. Without treatment, you run the risk of developing arthritis in the fractured area, blood clots, deformity, persistent pain, infection, weakness, reduced movement, loss of feeling in your foot or damage to blood vessels, tissues and nerves.

Types of fractures in the foot

  • Stress Fracture: A bone is subjected to repeated stress, usually the result of athletic activities, walking or marching.  When the bone can no longer absorb the stress, it cracks. This is known as a "stress injury".
  • Hairline fracture: A minor crack in the bone which is difficult to see on x-rays.
  • Open Fracture: The skin and soft tissue covering the bone are torn, and the bone may be seen coming out of the skin. This kind of fracture can easily lead to infection.
  • Closed Fracture: The skin is not torn.
  • Comminuted: Bone is broken in multiple spots, usually due to trauma or osteoporosis.
  • Avulsion Fracture: Small fragments of bone detach from where tendons or ligaments attach to the bones.
  • Joint fracture (intraarticular): Affects the surface of one of the joints. May lead to a loss of motion and osteoarthritis.
  • Simple Transverse: A clean break across the bone.
  • Displaced: The bone breaks in two pieces and must be realigned.
  • Nondisplaced: Even though the bone is completely cracked, normal shape and alignment are intact.
  • Angulated: The broken ends of the bones are at an angle.

There are a number of options your podiatrist may choose to treat your foot fracture. The treatment depends on what kind of fracture you have, where it's located in the foot, and how much discomfort it's causing you. Your podiatrist may choose one or more of the following treatments:

  • Air boot (walking boot), cast, or splint. Immobilizing your foot is key to healing the bone correctly, reducing your pain, and preventing additional fractures or other damage.
  • Prescription or over the counter medicine to reduce pain
  • Antibiotics if the fracture might lead to an infection.
  • Surgery if the fracture is severe. Your podiatric surgeon may need to remove damaged and infected tissue to prevent infection and speed healing. They may also realign the bones and fix them in place with screws, wires, pins, metal plates, or external fixation devices.

After initial treatment, your podiatrist will order you to rest and elevate the foot whenever possible, and ice the foot if it's swollen or painful. When the bone has healed, they may order physical therapy to help improve range of motion and strength in the bone and help to decrease any residual pain.


Thursday, 15 January 2015 13:26

My Child Has Heel Pain: Is It Serious?

One of the most important aspects of a child's physical and emotional development is game play - the kind that doesn't involve sitting in front of a video screen. Organized sports, activities like climbing trees, biking, going for a swim, or just playing imaginary games with other kids in the neighborhood are all positive for their growth (think running, walking, jumping, moving - organized or otherwise). Good habits learned early follow a child into adulthood, and are key in combating the childhood and adult obesity epidemic.

heel pain in children

But of course, foot, ankle, and heel pain complaints and other injuries run hand-in-hand with activity. Parents should note that the cause and symptoms of heel pain in children can be considerably different from heel pain in adults. If you've experienced heel pain, specifically plantar fasciitisyou know that its very bad in the morning, but diminishes as the tissue warms up with activity.

But in children, heel pain usually becomes much worse as the day wears on, and may be due to a condition called Sever's disease, an inflammation of the growth plate in their heel. This condition is especially common in children who are highly active or overweight. Heel pain in adolescents may also be due to plantar fasciitis, fractures in the heel bone, bursitis, achilles tendinitis, or other conditions. The good news is, a podiatrist can successfully resolve Sever's disease or other heel pain conditions in your child in almost every case.

Check out the Facebook page for NFL Play 60 to see how you can encourage your child to be more active.

When your child doesn't complain about their heel pain

Unfortunately, some children are slow to complain about heel pain and other injuries, which is where parents have to keep a watchful eye. When a child has pain in their heel, or pain elsewhere in their foot or ankle, it can cause any number of changes in the development of their bodies, as they shift weight and change their gait to compensate for the pain. This imbalance also makes them prone to further injuries. Parents should be mindful of changes in their children's body langauge and behavior, so that a heel pain injury can be addressed early.

Your child may be experiencing heel pain if you notice any of these changes:

  • Difference in the way they walk
  • Favoring one foot over another
  • Occasional limping
  • Walking on their toes
  • Unusual fatigue
  • Problems running

If your child complains about heel pain (or any other kind of pain), take it seriously and don't encourage them to "walk it off" or "play through it" - that's old school advice and may cause more damage in a person of any age. Your child should immediately leave the game or curtail their activities. To treat the injury at home, they should rest, ice their foot, and use an age and weight appropriate dose of advil or aleve to manage the pain. They should not resume strenuous physical activity until the heel pain has completely subsided.  When your child resumes activity, it should be gradually, accompanied by appropriate stretching exercises to warm up their ankles and feet. Children should also wear athletic shoes which support their feet properly (but it's okay to let them run barefoot when appropriate).

If your child's heel pain continues for more than one week, make an appointment to see a podiatrist for an exam and diagnosis. Early intervention and treatment is the key to successfully resolving their complaint so they can get back to kid stuff as soon as possible.


Very few adults are strangers to heel pain. At some point in our lives, we've run too hard, hiked too far, gained too much weight, played basketball in past-their-prime sneakers, or didn't rest when we should have. Sometimes it even appears for no reason we can pinpoint. But without a doubt, we never forget that pinching and excruciating pain in our heel.

heel pain causes and treatment

Heel pain occurs in the underside or the back of your heel. When it appears on the underside, it's usually a result of damage or irritation to the plantar fascia, the tendon which runs from your heel to the base of your toes. This type of heel pain is called plantar fasciitis. If heel pain occurs at the back of your heel, the cause is usually damage to the Achilles tendon, such as achilles tendinitis. But heel pain can also be caused by arthritis, a bruise, heel spurs, gout, pinched nerve, bursitis ("pump bump"), peripheral neuropathy, a fracture, bone infection, or other conditions. For this reason, any heel pain should always be evaluated by a podiatrist to determine the best course of treatment to get you back on your feet as soon as possible.

Schedule an appointment with a podiatrist if:

  • You have severe pain and swelling near your heel
  • Severe heel pain after an injury
  • Inability to bend your foot downward without pain
  • Inability to rise on your toes without heel pain
  • Inability to walk without heel pain
  • Heel pain that continues when at rest
  • Heel pain that lasts more than 1 week

How to treat heel pain at home

Rest, Ice, and Elevation. Ice packs on the heel reduce inflammation, especially when paired with over the counter anti inflammatory medicine like advil or aleve. Rest and elevate the sore foot whenever possible.

Change your routine. If heel pain is the result of an athletic injury, change your routine. Training the same way, on the same surface, with the same shoes, will only make things worse.

Stretch before working out. Stretching your feet, raising yourself on your toes, even walking, will help warm up the plantar fascia and achilles tendon, reducing the risk of injury. When muscles, tendons, bones, and joints are gently warmed up before a workout, they're much better at handling the load you demand of them.

Are you wearing a quality pair of shoes? Whether athletic shoes or dress shoes, your footwear must fit your feet correctly and give ample support and padding. You may save money with cheap shoes, but the pain will be expensive.

How a podiatrist may treat your heel pain

  • Custom orthotics to support your feet and relieve pressure on the heel
  • Shoe modifications
  • Prescription medications
  • Steroid injections to relieve pain and inflammation
  • Immobilization in a walking boot
  • Physical therapy
  • If conservative measures are unsuccessful, surgery may be recommended

Read more: Does your child have heel pain?

Friday, 09 January 2015 13:24

Pain In Your Big Toe? You May Have A Bunion

You have pain in your big toe, the joint below your big toe is sore and stiff and a bump protrudes from the side of your foot, frequently ruining your footwear. You may have just discovered a bunion.

[caption id="attachment_5040" align="alignleft" width="360"]bunion pain bunion treatment podiatrist lehigh valley allentown bethlehem easton The protrusion at the base of the big toe is a bunion.[/caption]

Do shoes cause bunions?

It's commonly thought that high heels and other non-flat footwear are the cause of bunions. While these shoes aren't the primary reason for developing a bunion, they definitely contribute to their severity.

The truth is, some women can wear high heels their entire lives and never develop a bunion. Others can make all the right choices in footwear and still develop them. That's because the foot structure which contributes to a bunion is an inherited trait, especially common in men and women of European descent (but especially women). Any podiatric surgeon will tell you that he/she has treated bunions in multiple generations of the same family - usually mothers and daughters.

Our feet are designed to carry our body weight evenly across all planes of the foot. When we inherit the faulty biomechanics which lead to a bunion, and then stuff our feet into high heels and other shoes which don't support our feet correctly, a bad situation gets even worse. Shoes with heels shift our body weight onto the front of the foot, placing stress on an already weakened joint. Other factors which may contribute to bunions are obesity, spending lots of time on hard surfaces (like factory floors), jobs that demand a lot of time on your feet, and hormonal changes.

Will a bunion get better on its own?

What you see protruding from the side of your foot is a deformity of the joint at the base of the toe. The first metatarsal bone (the longest bone in the foot) has turned outward and the big toe has been pulled toward the other toes, causing the head of the metatarsal to protrude. As footwear rubs against this area, or body weight is shifted onto this joint via shoes with heels, the bursa which cushions and protects the joint becomes inflamed and sore, and the joint becomes stiff. The misalignment and compromised foot structure also causes pain on the side of your foot or in your arch, and pain and discomfort in the adjacent toes.

Unfortunately, a bunion is a progressive condition, which means it won't get better on its own. The longer you wait to treat the bunion, the worse it will become. There are stretching exercises and other therapies you can use to reduce the pain and progression of the bunion, but the only way to restore your foot to its pre-bunion condition is with bunion surgery.

What to do when you discover a bunion

  • Stop wearing high heels or any other kind of shoes which don't support your feet correctly. This also includes inexpensive dress shoes (don't cheap-out in this department, guys!)
  • When at all possible, wear a high quality pair of athletic shoes which cushion your feet and provide proper arch support
  • Don't wear shoes that are too tight or pointed at the toes - opt for a wide toe box and a wider shoe in general
  • See a podiatrist right away to establish a baseline. A podiatrist can treat your bunion with non-surgical measures like stretching exercises to reduce bunion pain, bunion splints, toe spacers or custom orthotics.

The faulty biomechanics that cause a bunion also contribute to other foot conditions as well, such as hammer toes, overlapping toes, corns, and ingrown toenails.

Hypoglycemia is a medical emergency and a dangerous condition for type 1 and type 2 diabetics. Sometimes referred to as insulin shock or an insulin reaction, hypoglycemia occurs when blood glucose levels have fallen well below the normal range. Hypoglycemia is rare in those without diabetes.

hypoglycemia causes, low blood sugar

Patients who have been newly diagnosed with diabetes should learn to recognize the early symptoms of hypoglycemia, as this condition can accelerate very quickly and put the diabetic patient at risk of an accident. One may go from being light-headed and feeling a little "woozy" to involuntary muscle twitching, poor coordination, blurred vision, slurred speech, and possible seizure in a matter of minutes. In severe cases, hypoglycemia may cause coma or death.

What is hypoglycemia?

Technically, hypoglycemia is present when blood sugal levels drop below 60 mg/dl. However, diabetics may start to experience some of these symptoms before their glucose levels fall to that point. The severity of symptoms depends on how long diabetes has been present, and the patient's individual blood glucose target as recommended by their health care provider. Drinking alcohol when diabetic may also cause low blood sugar, as well as certain prescription medicines when taken with your diabetes medication.

Each patient's reaction to hypoglycemia can be different - some exhibit mild symptoms and some quite severe symptoms in a matter of minutes. The early symptoms of the condition may also be confused with those of other illnesses like flu. If any symptoms of hypoglycemia are present, check blood glucose levels as soon as possible.

Symptoms of hypoglycemia:

  • Sweating and chills
  • Lightheadness or dizziness
  • Trembling
  • Rapid heartbeat
  • Hunger or nausea
  • Weakness or fatigue
  • Headache
  • Sleepiness
  • Nightmares (hypoglycemia can occur when you sleep)
  • Blurred vision / double vision
  • Sudden mood swing
  • Anxiety
  • Irritability
  • Confusion
  • Poor coordination
  • Poor concentration
  • Difficulty speaking
  • Irrational behavior
  • Tingling or numb senasation in lips or tongue
  • Seizure
  • Unconsciousness (which may lead to diabetic coma)

hypoglycemia symptoms, low blood sugarIf you are diabetic and experience any of the above symptoms, check your blood glucose levels immediately. If your meter isn't close at hand, opt for caution and treat for low blood sugar by consuming 15-20 grams of glucose or simple carbohydrates by any of these methods:

  • Glucose tablets (as per package instructions)
  • Gel tube (as per packege instructions)
  • 1/2 cup (4 ounces) of fruit juice or soda (not diet)
  • 1 tablespoon of honey held under the tongue for a few minutes (glucose is absorbed faster)
  • 1 tablespoon of sugar or corn syrup
  • 1 cup (8 ounces) of non-fat milk
  • 2 tablespoons of raisins
  • ***Do not attempt to give liquids to a person who is unconscious, as this may cause choking. Call 911

After treatment, wait 15 minutes and check blood glucose levels. If hypoglycemia is still present, treat again. Once blood sugar returns to normal, eat a small meal or small snack as recommended by your diabetes health care provider. If hypoglycemia persists after a second treatment, call 911.

Read: The impact of diabetes on your feet

What causes hypoglycemia?

When your body digests food, it is broken down into various sugar molecules, including glucose, the primary source of energy for your body. This energy is needed not only for physical activity, but for cell function, brain function, and organ function as well. Glucose enters your bloodstream right after you eat, and with the assistance of insulin secreted by the pancreas, enters your cells. In the case of diabetics, insulin production or utilization is compromised, and glucose remains in the bloodstream, causing high blood sugar.

A normally functioning body deals with blood sugar very efficiently. When blood sugar rises after a meal, it signals beta cells in your pancreas to release insulin. Any glucose unused by your cells is stored in the liver and muscles as glycogen. When you skip a meal and your blood sugar level drops, a different hormone in your pancreas, glucagon, signals your liver to release the stored glycogen into your bloodstream as glucose.  This two-fold process keeps glucose from becoming too high or too low at any time. As an added safeguard, your body also creates glucose in your liver and kidneys in a process called gluconeogenesis.

If you have type 1 diabetes, your pancreas does not produce enough insulin. If you have type 2 diabetes, your cells do not respond properly to insulin. To regulate insulin levels, you either take synthetic insulin or an oral medicine to help your cells utilize glucose. Hypoglycemia can be caused by taking too much insulin relative to your blood sugar levels. It can also be caused by taking your oral medicine and not eating a sufficient amount of food to maintain your blood levels. Hypoglycemia may also occur after exercising when not ingesting sufficient glucose to replace what is used by your muscles.

When Hypoglycemia occurs, your glucose blood levels have dropped below what is required for proper brain, cell, and organ function. The brain is particularly sensitive to low blood glucose levels, because sugar is its main energy source.  This is why a diabetic suffering hypoglycemia becomes confused, may have blurred vision, or may display poor coordination.

The body first responds to a fall in the level of glucose in the blood by releasing epinephrine from the adrenal glands. Epinephrine stimulates the release of glucose from body stores but also causes symptoms similar to those of an anxiety attack: sweating, nervousness, shaking, faintness, palpitations, and hunger. More severe hypoglycemia reduces the glucose supply to the brain, causing dizziness, fatigue, weakness, headaches, inability to concentrate, confusion, inappropriate behavior that can be mistaken for drunkenness, slurred speech, blurred vision, seizures, and coma. Severe and prolonged hypoglycemia may permanently damage the brain. Symptoms can begin slowly or suddenly, progressing from mild discomfort to severe confusion or panic within minutes. Sometimes, people who have had diabetes for many years (especially if tightly controlled) are no longer able to sense the early symptoms of hypoglycemia, and faintness or even coma may develop without any other warning.

-Merck Manual Home Edition

How to prevent hypoglycemia

  • Check blood glucose levels on a regular basis
  • Follow your diabetes management plan
  • Learn how to detect the early symptoms of hypoglycemia
  • If you experience hypoglycemia, consult with your diabetes health care professional
  • Eat meals on schedule which contain foods recommended by your diabetes health care provider/nutritionist
  • Avoid drinking alcohol. Alcohol blocks your liver from releasing stored glucose into your bloodstream
  • Eat carbohydrate-rich food before exercising
  • Be prepared - carry glucose tablets with you and your blood glucose meter at all times
  • Advise friends, family, and colleagues of your condition. Explain to them the symptoms of hypoglycemia and what to do if they suspect you're suffering an episode of low blood sugar.
  • Wear an ID bracelet identifying you as diabetic. This will help emergency responders diagnose your condition in case of an accident.
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