Sunday, September 15, 2013

High Heeled Danger!

Attention female shoe lovers- if your closet is packed with high heels, especially those with pointy toes,  you may one day find yourself dealing with a medical problem known as a Morton's neuroma. A Morton's what, you ask? Morton's neuroma- a little balled up group of nerve endings (perineural fibrosis, if you want the medical lingo) along the small digital nerve as it passes between your toes, most commonly in the space between your third and fourth toes.

This malady is most common among women in their mid to late 40's. High heels cause more weight to be transferred to the front of the foot, and the pointy toes squeeze in from the sides, pinching in on the nerve, causing inflammation. Often the patient first notices the problem as a sensation of a pebble in their shoe, but typically this progresses quickly to pain, cramping, numbness or shooting sharp pains of the area with weight bearing. Can you get a Morton's neuroma without high heels? Sure- anyone who "overuses" their feet- ballet dancers, basketball players, runners- can develop this problem, but high heels greatly contribute to this problem.

How is a Morton's neuroma diagnosed? Xrays might be obtained if there is concern of a stress fracture or other bony issue, but the neuroma itself does not show up on xray films. Often this condition is diagnosed based on your history and a thorough exam, but occasionally clinicians use ultrasound to further evaluate the problem. Ultrasound is very accurate at identifying neuromas (98% sensitivity) but not always accurate (65% specificity). MRI scanning is rarely needed to help with surgical resection, for resistant cases.

How about treatment? First and foremost, it's time for "sensible" shoes- wear flat shoes with a roomy toe box. Inserts such as metatarsal pads may help ease symptoms, as well as arch supports for those people with flattened arches. Taking NSAIDS (ibuprofen or naprosyn) often will ease the discomfort temporarily, and nearly half of patients (40-50%) will respond to these simple measures within three months. The primary treatment from the medical end when conservative measures are not effective enough, however, is a steroid injection into the top of your foot (just above where the pain is located). This injection may be repeated in 1-4 weeks if there is a partial response.  Another 40-50% of patients will respond to these injections. For those 20-25% who continue to have pain despite all these measures, surgery may be indicated to go in and remove the actual neuroma and free up some space (releasing a ligament) in between the toes, and happily around 96% of surgical patients obtain relief.

BOTTOM LINE: Once again, prevention is key! Enjoy your high heels in moderation, but consider a more generous toe box and wedge (less slope) for daily use if your profession calls for dress shoes. Also, go see your family doctor when you START feeling that "pebble"- don't wait for it to become intense daily pain!

Tuesday, September 10, 2013

Cigarettes- the Good News & the Bad News

Let's start off with the GOOD news- the CDC's anti-smoking TIPS campaign has turned out to be far more successful than they had dared to hope! Over 1.6 million smokers had a quitting attempt, and at least 200,000 smokers DID QUIT as a direct result of the shocking pictures and stories featured in this unique national program. The Lancet published a wonderful article this week summarizing all the findings: Effect of the First Federally Funded U.S. Antismoking National Media Campaign.

I have always maintained that stories are more powerful than statistics. Sure enough, this campaign is chock-full of stories from former smokers- people sharing extremely painful negative consequences from their nicotine addiction. Virtually every complication from smoking is shared: heart surgery scars, asthma, artificial limbs (from damage to blood vessels), artificial voice boxes (from throat cancer), COPD (chronic obstructive pulmonary disease) and of course, lung cancer, to name a few. Hearing from Terrie- a former cheerleader, points out the dangers of "social smoking" in college. Likewise with Michael, who smoked in the military. Click on the TIPS from Former Smokers 2013 to hear and see more...and share with any of your friends or family or co-workers who still smoke.

The campaign goals are to increase public awareness of both immediate and long term health risks of smoking- both first-hand, and from inhaling second-hand smoke. Note that for every person who dies from smoking, 20 more Americans are LIVING with a smoking-related illness. The CDC wants to encourage and support smokers who are ready to quit, as well as encourage them to limit other people's exposure to their second-hand smoke. 

So that was the good the bad. Just last week, Notes from the Field: Electronic Cigarette Use Among Middle and High School Students- United States, 2011-2012 was published in the CDC's Morbidity and Mortality Weekly Report. E-cigarettes are not a new cell phone app, they are true electronic cigarettes that are battery powered and deliver nicotine and other byproducts via an aerosol. Worse yet, they can add sweet "childhood" flavors- fruit, mint or chocolate. Really??? Does the industry have NO conscience???? Not surprisingly, they are portrayed as "safe smoking" (anyone else reminded of "safe sex" campaigns?) and teens are jumping on board. E-cig use doubled in this time period, yielding nearly 2 million (1.78, lest I exaggerate) students trying out nicotine in this delivery system last year. Please note that although we do not yet have long-term studies on the "pure" damage of these e-cigarettes, we know that nicotine is damaging to adolescent brain development and, hello- nicotine is ADDICTIVE. If you get addicted via e-cigs vs. dipping vs. "regular" cigarettes- the outcome is the SAME. You are ADDICTED to NICOTINE.

BOTTOM LINE: There is still NO AMOUNT of smoking that is GOOD for you, so please, help encourage your friends who are already smoking to QUIT, and parents, please warn your kids that e-cigarettes are NOT SAFE. NICOTINE is ADDICTIVE in ANY FORM.

Tuesday, September 3, 2013

Fruits Helping Diabetics?

Hooray! I was delighted to see a new study about the role of dietary fruit in diabetic patients, entitled
Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies, published this week in the British Medical Journal (BMJ).  Over the years, I have found that many of my diabetic patients purposefully avoid all fruits, fearing that the sugar in fruits will raise their blood sugar values and worsen their diabetes. However, fruits are a wonderfully nutritious part of a healthy diet, and I will forever attest that eating too many fruits or vegetables is NOT the major contributing factor to becoming diabetic or overweight.

This particular study reviewed diets (based on scheduled food questionnaires), and found that for every three servings per week of whole foods consumption of blueberries, prunes, grapes and raisins, apples and pears, bananas, grapefruit, and even peaches and apricots,  the risk for developing diabetes was significantly REDUCED!

Fruits are packed with wonderful nutrients, phytochemicals, vitamins and fiber, all of which have long been known to help prevent untoward health consequences such as heart disease and cancer. Hopefully this new study will help convince everyone that FRUIT belongs in the pre-diabetic and diabetic diet as well. The key to improving diabetes in overweight or obese people is weight loss: consuming fewer calories than you burn. Colorful diets packed with fruits and vegetables are the best way to get you moving that direction.

Of note, drinking fruit juices was actually associated with a slight increased risk of developing diabetes. Once again, we see that eating the WHOLE FRUIT is better than making it into a juice or condensing it into a pill...

BOTTOM LINE: Up your intake of whole fruits, especially blueberries, grapes, raisins, apples, prunes and pears, and decrease your risk of developing diabetes.