Blog - Foot Doctor, Podiatrist, Allentown PA 18104, Easton PA 18042, Northampton PA 18067, Lansford PA 18232

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.

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.

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 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

Contributing 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.

Every 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.

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.

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.

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

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.

The 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.

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.

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 fasciitis, you 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 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?

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"] 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.

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)

If 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.

Many of our podiatry patients remark on how thick their toenails become as they enter (and pass) middle age. Their toenails become notably tougher to trim, which makes the possibility of cuts to the skin around the nails a real possibility. Thickened toenails also splinter easily.

[caption id="attachment_4884" align="alignleft" width="300"] Toenails thicken due to aging, but other factors may also be at play.[/caption]

Unfortunately, thickening toenails are a by-product of aging, in most cases. As we age, our toenails - and fingernails - slow their growth rate, and the nails thicken because the nail cells, called onychocytes, sort of pile up. Fingernails appear to thicken less, probably because we tend to them more often with filing and buffing, which thins them.

But in addition to this natural thickening of the nails, other factors may be at play also. Among them are trauma, fungal infections, and impaired circulation. Feet are under constant stress from falling objects, stubbing injuries, poor foowear, closed-in footwear, and athletic activities. All of these conditions can alter the cells from which the nails grow, and if one tends to stub or injure the same toe, the nail plate can easily become thickened or disfigured.

Peripheral arterial disease, or P.A.D., a vascular disease which restricts blood flow to the extremities, can also cause thickened, brittle toenails. Fungus also plays a key role, as it thrives in the moist, dark interior of a shoe. Besides causing the toenail to thicken, a fungal infection may also cause the nail to yellow, become brittle, separate from the nail bed, and possibly emit a foul odor. In this case, your podiatrist may recommend trimming and cleaning (debridement) the toenail, a prescription topical creme or prescription oral medicine.

Reasons our toenails thicken

• Aging
• Fungal Infections (onychomycosis)
• Peripheral Arterial Disease
• Trauma
• Psoriasis (accompanied by red, scaly patches)

How to safely trim thickened toenails

**If you're diabetic, have peripheral arterial disease, or have diabetic peripheral neuropathy, a podiatrist should trim your toenails. Patients with these conditions frequently have a loss of sensation in the toes, and run the risk of wounding the skin or cutting too deeply when trimming the nails.

1. Soften your toenails by soaking them in warm water for 10 minutes, then dry thoroughly.
2. With a nail nipper, cut straight across the top of the toenail.
3. Use small cuts straight across the toenail to avoid splintering, which may cause an infection.
4. Do not round the toenails at the corner - this reduces your chance of developing an ingrown toenail
5. With an emory board or nail file, gently file the edges of the cut toenail to remove sharp corners or edges which may catch on your sock.

Besides debridement, there are few treatment options to alleviate the thickening of toenails due to the natural course of aging. If however, your toenails are thickening due to one of the other causes mentioned above, your podiatrist will discuss a course of treatment with you.