Diabetes Awareness- Lonnie Kaplan DPM

As you may or may not know, November is national diabetes month. Unfortunately national diabetes month is not as well known as breast cancer awareness month or heart health awareness month. Diabetes affects millions of people in the United States and unfortunately the lower extremities are greatly affected by this condition.

Advice for Diabetic Patients:

  1. Check feet daily: Many diabetics cannot feel their feet due to neuropathy (nerve damage) It is common for a patient with diabetes to step on something (a tac, needle, etc.) and not even know they stepped on it. Be sure to use your eyes to inspect feet daily. If unable to do this easily, you can use a mirror or a mirror on a pole to see the bottom of feet. Report any abnormalities to your podiatrist immediately.
  2. Don’t walk barefoot: Diabetic patients should never walk barefoot (even going from the bed to the bathroom at night)
  3. Soaking feet: Don’t soak your feet in hot water. Diabetic patients cannot feel the temperature of the water as well as the general population. If you are going to soak your feet, have someone feel the water before you put your feet into it in order to make sure its not too hot.
  4. Check the inside of shoes before putting them on: It is common for diabetic patients to have pebbles, tooth picks etc. in their shoes that they do not feel due to neuropathy. Check your shoes with your eyes before putting them on and remove any foreign objects.
  5. Don’t remove corns or calluses on own: If you have corns or calluses, see a podiatrist for evaluation and treatment. Removing on own predisposes you to cutting yourself leading to infection. Also NEVER use over the counter medicated corn/callus remover as this can burn the skin and cause ulceration

All diabetic patients should establish care with a podiatrist. It is recommended that a diabetic patient without any complications should see a podiatrist yearly. A diabetic with neuropathy or other complications should see a podiatrist more frequently.

If you are a diabetic or know someone who is a diabetic, the doctors at Quality Foot Care of Doylestown would be happy to evaluate you. Call 215-230-9707 to make an appointment with Doylestown’s community podiatrists.


VACUUM to Heal Wounds?? Lonnie Kaplan DPM

Sometimes foot ulcerations still do not heal despite all of the previous discussed options and your podiatrist needs to discuss other possible treatment options. For very deep wounds and wounds with ligaments, tendons and muscle exposed, negative pressure wound therapy (NPWT) is an excellent modality. It is commonly used on wound after amputations where the skin is not stitched closed due to infection etc. Negative pressure wound therapy is a vacuum system (yes you read this correct) that creates negative pressure within the wound to remove fluids, drainage, allow for a moist healing environment, and remove infectious materials in order to help in the healing of the wound. The vac can also help the wound edges pull together.

The application of the wound vacuum starts with a foam dressing over the wound followed by an adhesive dressing that forms a seal around the periphery of the wound. At this point a small hole is made in the adhesive dressing and a drainage tube is placed which is connected to a vacuum suction. The vacuum can either be on continuous (constantly on) or intermittent (turns on and off at set increments) There are both portable wound vacs as well as larger wound vacs that are kept at bedside in home bound patients. The portable ones have an arm strap and they are worn similarly to a shoulder bag and of course have a canister that collects the drainage. The podiatrist will usually change the foam dressing three to four times a week depending on the amount of drainage in the canister. One major goal of the wound vac system is to fill in the wound enough to apply a skin substitute. This treatment option has become more and more popular over the last 5-10 years due to its efficacy in helping to resolve difficult to heal wounds.

Call Quality Foot Care Today at 215-230-9707 to visit with Doylestown’s community podiatrists. We will be happy to discuss the above in detail and help you stay on your feet.

Skin Substitutes for Diabetic Ulcerations: Lonnie Kaplan DPM

As you now know from my previous posts, diabetes is a common cause of foot ulcerations. If the ulceration is not colonized/infected, nutrition and blood supply are adequate, and there is adequate offloading you may be thinking, what is the next step if a wound still will not heal. A treatment that can be used are skin substitutes. These products can be used when there is less than 50% improvement in size of wound in a 30 day period using standard of care. Some of these products contain stem cells which allow tissue to differentiate into cells that allow for better healing of wounds. (most of this is taken from placental tissue) Others are just made up of an extracellular matrix with different growth factors that aid in the healing process. There have been many studies recently including head to head comparisons of different products showing excellent results. It is important to differentiate these products from split thickness/full thickness skin grafts which are harvested from another part of the patient’s body in an operating room setting.

Application of these products are completed either in the office or in a wound care center. Most of the time, the product is applied and adhered either with steri-strips (form of tape) or with stitches or staples. Normally after applied, a large sterile dressing is applied to the patient’s foot. The patient will usually keep the area clean and dry for a week after which they will be seen back in the podiatrist’s office or wound care center where new measurements will be taken and reapplication will occur. Good improvement/ healing has been seen in very difficult to heal wounds using the above skin substitutes.

Call Quality Foot Care today at 215-230-9707 to visit with Doylestown’s community podiatrists. We will be happy to discuss the above in detail and help you stay on your feet.


Diabetic Foot Ulceration

One of the major complications of diabetes that is seen in the lower extremity is diabetic foot ulceration/ wounds. There are many risk factors for ulceration in diabetics—the biggest risk being a lack of sensation in the bottom of the feet that can be experienced by diabetic patients (Neuropathy). Peripheral vascular disease is another major risk factor for the development of ulcerations.

Unfortunately, diabetic foot ulceration are one of the leading causes of non-traumatic amputations in the U.S.  Early recognition is key in preventing this dreaded complication. Diabetic patients should check their feet daily and use a mirror to inspect the bottom of their feet.  If areas with increased redness or areas of high pressure are seen, it should be evaluated immediately by a podiatrist. Another thing to keep an eye out for is cuts/scrapes that are not healing.  Many times what appears to be a simple cut on the foot, can turn into a major problem without appropriate treatment. Diabetic patients should never walk barefoot, as they may not be able to feel it if they step on something that cuts the bottom of their foot.

Call Quality Foot Care  today at 215-230-9707 to visit with Doylestown’s community podiatrists. We will be happy to discuss the above in detail and help you stay on your feet.

Stay tuned for more blogs on this topic including treatment options for diabetic foot ulceration that we are using in the office today!

Neuropathy: That Strange Burning & Tingling In Your Feet



Br Dr. Ken Lefkowitz

Have you ever experienced burning, numbness, tingling, or stabbing pain in your toes? A condition called peripheral neuropathy could be the cause of your discomfort. This type of neuropathy is defined by damage to the peripheral nerves in your toes (or fingers, but we’ll focus on the feet). When these nerves become damaged, they don’t function properly, causing decreased or abnormal sensation. In certain cases, it can even become difficult to move the toes.

The most common cause of peripheral neuropathy in the U.S. is diabetes. The American Diabetes Association reports that between 60 and 70 percent of people with diabetes will develop peripheral neuropathy at some point. Other causes include certain drugs, heredity, advanced age, arthritis, alcoholism, and acute injury to the peripheral nerves.

Anyone who has peripheral neuropathy should visit a podiatrist. There is no known cure for the condition, but your podiatrist will give you treatment to slow the progression of the disease and decrease pain. If you have diabetes, maintaining blood sugar levels with diet, exercise, and medication can prevent peripheral neuropathy from progressing.

The main concern for people with peripheral neuropathy is decreased sensation in the feet. Sometimes, they can have serious infections or injuries without knowing it because they are unable to feel the pain which indicates that something is wrong. This is why it is important to inspect your feet on a daily basis and visit your podiatrist often when you have peripheral neuropathy.

If you have any questions or concerns or would like to schedule an appointment at our Doylestown office, call Quality Foot Care at 215-230-9707.