Electric Callus Removers: Getting the Best Results

Rough, hardened skin on the heels and feet is the bane of so many lives it deserves a T-shirt slogan, but the solution has always been a rather dull pumice stone or a manual foot file. There are now electric callus removers available that cut down the time needed even further and offer improved convenience. These innovative electric callus removers provide a modern solution for achieving super-soft soles in no time.

How Do Electric Callus Removers Actually Work

Fundamental to these electric devices is a roller head that spins quickly; the principle is exactly like a rotating scrub brush but with a very fine abrasive grit on the roller head.

When applied lightly to thickened skin, the spinning roller quickly buffs away the dead, rough surface layer without the heavy manual effort needed with pumice stones and manual foot files.

The Roller Head Mechanism

Most come with a spinning roller that will turn somewhere in the region of 30 – 60 revolutions per second; a sufficiently high rate to scrape away dead skin very efficaciously but not so high as to risk cutting into the live tissue. Most use an inexpensive mineral grit or micro-abrasive on the head but replacement roller heads are widely available for contemporary brands and other models.

With use, the grit in the abrasive wears out, so replacing the head every few months keeps performance and effectiveness on target.

Battery Power or Rechargeable?

Battery powered devices work with AA batteries but a rechargeable battery and USB port required to often offer better long-term economics, more consistent motor power over a pedicure session and a neater device. Battery powered models are generally more portable and lighter than rechargeable units but are every bit as capable of delivering your desired results if it is only an occasional use. The decision really being one of how often you will use a foot buff.

Best Electric Callus Removers Buying Tips

When shopping for an electric callus remover device, the features can vary considerably in quality so acquainting yourself with some simple considerations can be a real long-term saving in disappointment.

The most pertinent considerations are roller head grit levels, variable motor speed settings, the ergonomics of the device and whether the device is designed for water immersion.

Grit Levels and Motor Speed

Most quality devices will include at least 2 different roller head coarseness grades on the device; one for regular use and a coarser head for more stubborn thickened skin. Some more advanced models will have 3 grade head options. Variable motor speed settings of a device allow for finer control over sensitive areas, with lower speeds being perfect for the ball of foot application and more abrasive higher speed settings ideal for the slimmer, textured area over the heel.

If unsure as to your needs it is better to start at a lower setting as a higher setting will cause the roller head to slip over the skin, rather than grip it, by suction.

Water Resistant Devices

If one intends to use the device in the shower or over a basin the abrasion dust that is created by the removal process needs to be sprayed up by the vigorousness of foot movements, so a water resistant device is very advantageous. If intending to use in the basin or a sink under running water the speed of the abrasive roller head can be controlled and the device swiftly rinsed under tap water.

Effectiveness and Safety in Use

Once acclimatized to a good electric callus remover, the results can be very impressive but over use and misuse can lead to redness and irritation and so care has to be taken while using the devices.

Applying a dose of warm water over your heels for about five to ten minutes before use can render the skin a little softer so the roller head can do its work more efficiently, however a good quality pumice stone used on thoroughly dried skin is just as effective. Pat dry the skin with a towel as this will prevent the head slipping in use. Post-treatment application of a section of a thick foot cream will sealed in collagen, moisture and hydration and the resultant softer feel to the skin is practically instant.

Usage considerations: people with reduced sensation and people with venous disease, neuropathy or open wounds to the feet should consult a healthcare professional before using an abrasive callus removal device; with reduced sensation it is often too easy to remove too much skin or overdue treatment leading to delay healing or other complications. Good practice for all users is to limit to no more than once a week repetitive abrasive treatment of the same spot unless redness or tenderness can be avoided.

This type of treatment is no longer a luxury, it is an everyday reality that can be easily incorporated into the weekly routine of most people. Its also safer, more comfortable and even more gentle on people who may have suffered for various reasons with aches and pains of hard to reach places. Regular good use of an electric callus remover in conjunction with the cream or lotion of choice and regular moisture sealing against skin dryness will prolong the time between treatments also.

Erythromelalgia in the Foot:

Erythromelalgia in the foot is one of those conditions that seems to fly under the radar until it happens to you – and then it can’t be ignored.

The sensation is like having your feet suddenly start to burn, throb, and turn bright red, with the skin feeling almost unbearably hot.

For sufferers, pain can become a part of the whole experience of just moving around on the bottom of their feet – every step, every step in shoes, and every shift of weight can bring pain.

This article will cover the specifics of what erythromelalgia does in the foot, explain some of the common causes, give tips on managing the symptoms, and talk about some of the things you can do if you experience this.

Understanding what the problems are is the first step in finding realistic ways to live with them.

Understanding Erythromelalgia in the Foot Causes

‘Erythromelalgia’ derives from Greek words—erythros meaning red, melos meaning limb, and algos meaning pain.

The simple translation is ‘pain in a red limb,’ which could hardly be more on-the-nose.

The basics of what kind of blood flow dysfunction this is

The core symptom of erythromelalgia in the foot, which involves burning pain, redness and warmth, occurs due to problems with blood flow regulation in small blood vessels close to the skin.

The body’s natural way to regulate temperature relies on blood vessels narrowing and dilating as needed in response to changing heat levels.

This process gets all mixed up in erythromelalgia.

Instead of keeping the blood vessels’ diameter in a steady range, they randomly dilate in response to certain triggers, like increased temperature or activity.

This causes excess blood to rush into the skin of the foot and makes the skin flush bright red, feel burning hot, and sometimes actually raise in temperature.

In addition to the redness and warmth, certain other symptoms arise: mild to severe burning pain, this can become quite intense, can be stinging or aching, and certain severity of the episodes can cause swelling of the foot and ankle.

The pain can seem as if you were standing on hot stones and can get worse with anything that increase blood flow to the foot—like walking on a hot day or hot drinks.

How the primary form differs from the secondary form of erythromelalgia

For the most part, whether or not an underlying cause is identified makes a huge difference in care for erythromelalgia.

If an underlying disorder causes the erythromelalgia (secondary case), treatment of the second condition can, in some cases, decrease or even eliminate the painful episodes.

The primary form will likely require different medications, since there isn’t a specific rheumatologic or oncological target.

While individual symptoms can vary, a good history and work up can usually tell you if an underlying cause is evident, which makes a big difference in how it is best managed.

Identifying Erythromelalgia in the Foot Symptoms

The symptoms, understandably, are unique in every case.

Sometimes symptoms will come and go very quickly, or in recurrent flares, but sometimes they hang around comfortably for hours.

The worst part is not knowing when they’ll occur or how long they will last.

Classic symptoms include a triad of burning pain, redness, and warmth spreading across an area of the foot, often the sole or the top.

The skin may look blotchy, be transformed into a bright shade of red, or have a “milkiness” to the hue, and the pain can be described as similar to standing on hot embers or having a cast iron frying pan resting on the foot.

In severe episodes, the swelling can be quite notable.

An additional symptom seen occasionally is allodynia, a heightened sensitivity to touch.

The symptoms can have numerous triggers.

Heat is a very consistent trigger, whether from hot weather, hot foods and drinks, socks made of non-breathable fabrics, or walking on hot sand.

Exercise is a frequent cause due to the heat produced by contracting muscles.

Prolonged elevation of the feet to above heart level can help symptoms decrease.

Increased circulation and increased body temperature contribute, conversely, to its triggers. Cold, on the other hand, gets rid of symptoms a little too well.

Using cold water to soak feet is often efficacious, though it’s important not to make this too much of a habit—excessive cold water exposure can have negative effects on skin even while bringing relief.

Treatment Options and Management Strategies

You can try a variety of medications, and lifestyle changes to actively manage symptoms.

The approach to treatment depends on whether the source of the erythromelalgia is primary or secondary.

If there is an identified underlying condition (despite the name, this may not just be due to a genetic mutation), then that condition can be managed or quelled and sometimes that gets rid of the erythromelalgia altogether.

In cases of primary erythromelalgia, finding the right combination of medications takes work and patience.

In some instances, Aspirin can make a tremendous difference, especially for patients whose erythromelalgia relates to increased platelet activity in the blood.

Some in select case studies have experienced relief with sodium channel blockers such as mexiletine.

Capsaicin cream, also used in neuropathy cases, can numb the local nerves and reduce pain during an episode.

Tricyclic antidepressants and anticonvulsants are also sometimes successfully implemented.

Most importantly, lifestyle modifications can significantly influence the severity, if not the frequency, of episodes.

Refining footwear to be lightweight, wear cotton or other breathable fabrics, avoid heat sources in the bathroom, find a comfortable sleeping room temperature, and allocate cooling fans during rest, all can take the edge off the episodes.

Job modifications may also be necessary: for instance, sitting with feet up as often as possible, not walking barefoot, avoiding long-distance travel, and wearing shoes with adequate room for the toes to breathe will become more critical.

Keeping notes on days and times where symptoms flare can help both patients and physicians treat it more effectively.

Social groups of erythromelalgia sufferers can prove very helpful for all involved.

This condition can be very frustrating to deal with on a day-to-day basis, but the more you understand about the triggers that aggravate it and the things you can do to avoid them, the better you are equipped to live with it.

If you think you have it, get checked out – because the quicker you get the right remedy, the sooner quality of life can change. You don’t have to suffer the burn.

Durlacher Corn in the Foot: What It Is and How to Treat It

Anyone who’s ever gone for a walk, or spent more than a moment on their feet, will tell you that foot pain has a way of making every step a little more difficult than the last. A Durlacher corn in the foot is one of those somewhat obscure but truly painful conditions that can make walking particularly uncomfortable. The corn is named after Lewis Durlacher (1792–1864).

Among the myriad of possible conditions that can bring discomfort underfoot, a Durlacher corn in the foot is one of those conditions you hopefully won’t encounter too often, but understanding it can help you identify and address it properly.

It was named after the 19th-century chiropodist Lewis Durlacher, who was first to describe this condition and relate it back to certain types of shoe wear and pressure.

This particular kind of corn is formed on a specific part of the fifth toe, and that’s exactly what makes it worse than other foot conditions.

In this guide, we’ll examine what a Durlacher corn is, what causes it, how you can identify it, and what treatment options are available to treat the pain involved.

Understanding Durlacher Corn in the Foot

A Durlacher corn is often also referred to as a “hard corn of the fifth toe” and occurs on the outside or lateral aspect of the little toe, often in the vicinity of the toenail or along the lateral surface of the toe itself.

Distinct from a more typical corn that appears on the top or tip of the toe, this is found in a place that is continually moving against the inside of shoes as you walk.

Essentially, this area is growing a normal response in a terribly awkward place.

How is it different from your average corn?

Most people are familiar with corn as hardened patches of skin that develop in response to repeated pressure and shearing forces, but the specific location of this and the relationship with the shoes makes this unconventional.

In truth, it’s an extension of the same skin-hardening process; it’s just happening on an area that is being repeatedly pushed in and shoved from the outside.

The foot skin there is quite a bit thinner, so the thickening presses quite aggressively onto underlying tissue and nerve endings, producing painful sensations with even light pressure.

Why is the fifth toe extra prone?

Outward projection isn’t usually your toes’ favorite thing, but the little toe just sits out a little farther from the rest and gets hit with more lateral shoe forces as a result.

Casual or overly tight shoes with high heels may also contribute to this, along with man-made materials or narrower footwear squeezing the toes laterally.

Repeated irritation causes thickening of keratin, which is the hard component of your skin cells, and this is how a corn begins.

Spotting Durlacher Corn in the Foot Symptoms

It’s unlikely you’ll miss this one if it pops up on your toe.

The consistently hardened patch of skin will feel roughly round, and it may be discolored slightly yellowish or grey due to the accumulated keratin.

You’ll also note that it seems to sit just below the skin surface without going through it, and relative to the rest of your foot it has a quite delicate texture.

Describe what kind of pain patterns you experience

Most commonly reported is a localized, sharp, stabbing sensation, from which many liken it to walking with something lodged like a small stone in the side of their small toe.

The pain is more likely to occur, or be intensified, when wearing enclosed footwear but ease when in sandals with an open toe area.

Touching the bump with a finger will generate a similar sensation immediately, and you may find that tapping or squeezing another part of your foot causes the pain to radiate to your toe.

When to contact a podiatrist

The good news is Durlacher corn is practically self-diagnosable, but the complex structures of your feet mean that visiting a podiatrist to get an expert opinion is always worth-while.

Of particular importance is that you have a podiatrists’ diagnosis if you are diabetic, you have increased symptoms of cellulitis, or you feel abnormal sensations such as numbness and tingling.

The podiatrist can confirm or exclude certain diagnoses and point you in the right direction for treatment options.

Treatment and management options

The key to successful long-term Durlacher corn treatment is twofold: Relief of the pain and solving the underlying problem preventing the occurrence re-occur.

Dealing solely with the immediate pain without addressing the underlying pressure contributors is a little more than a band-aid solution.

Immediate pain: what to do after diagnosis

A podiatrist will be able to relieve the bump pain by carefully and gently paring down the growth with a scalpel, causing just limited discomfort and a relatively quick healing period.

Over-the-counter anti-corn plasters (warts and verruca plasters can sometimes be used around the affected area for added protection, but caution should be taken) containing salicylic acid may help address the keratinous covering.

Constant abrasive pads can also wrap the area to prevent sole friction and pressure.

This type of treatment can be useful in reducing the granular kertain, but alone it is unlikely to prevent pumatic growth.

Focus on the footwear that caused it in the first place

Once a Durlacher corn has developed on a certain shoe, a substitute that is variable and accommodating as opposed to tight and stiff is a great amount of relief.

Knockers with a broad, rounded toe box that don’t squeeze the toes laterally are ideal, while highly variable shapes are best avoided.

Adding cushioning such as foam or silicone services helps put a handle on the friction and pressing experienced.

Supporting and realigning with shoe inserts, insoles, or custom orthotics is also a good idea, as is set, routine preventative foot care: such as launder and rotate your shoes and keep your toenails cut short to avoid injury or irritation to the surrounding tissue and skin.

If surmises persist regardless, a minor surgical procedure to excise the extra bony bump causing the pressure may need to be undertaken, which is also infrequently indicated on occasion.

If your footwear is causing issues, it will be apparent in this type of painful circumferential growth.

This is an overview of the causes, symptoms, how to treat it and prevent its recurrence.

Limited Joint Mobility in the Diabetic Foot

Diabetes affects millions of people around the globe, and much of the discussion centers around blood glucose regulation, but one complication is both silent and devastating and occurs at the feet.

Limited joint mobility in the diabetic foot is a condition that affects how freely the joints in your feet and ankles are able to move, and is far more serious than it sounds.

Stiff joints alter how pressure is distributed across the foot with each step, and this can lead to a cascade of problems including ulcers, deformity, and even amputation in some cases.

This article will give an outline of how this condition occurs, how it worsens foot health, and what can be done to address it.

How Limited Joint Mobility in Diabetic Foot Develops

An understanding of how diabetes can lead to limited joint mobility may not be immediately obvious, but the mechanisms involved are quite straightforward.

Prolonged elevated serum glucose results in a process known as glycation (in essence, attachment of sugar molecules to collagen fibers in the body), which causes a stiffening and cross-linking in the proteins.

The key tissue affected are tendons, ligaments, and joint capsules as they are all composed of collagen fibers.

Cross linking in these tissues becomes stiff, transmitting abnormal force within the tissues and limiting the range of motion.

The ankle joint and subtalar joint are most commonly affected, along with the terminal dorsals of the toes.

Connective Tissue Changes Lead to Reduced Range of Motion:

It takes time to develop glycation, where serum glucose levels are abnormal from elevated long term hyperglycaemia, this typically takes on the order of years so significant limited joint mobility occurs in those who have had diabetes ten years or more.

Advanced glycation end-products (above called AGEs) are laid down in the connective tissues giving them a leathery consistency and reducing their flexibility.

This process is not isolated to the foot however, and affects the entire body including hands, shoulders, and the rest of the joints. The feet however, bear the brunt of these changes due to the greater amounts of matter they support all day, and weightbearing forces involved walking and standing.

Impact of Ankle Dorsiflexion Deficiency:

The ankle joint is often the first area of deficiency. It is not just that the joint itself stiffens, but that ankle dorsiflexion as a result reduces.

Arthokinematic function is altered as the anterior tibia translates forward on the talus, reducing dorsiflexion of the ankle.

This change results in compensations through the gait cycle, increasing load on the forefoot.

The narrower the angle of dorsiflexion, the higher the loading on the forefoot and increased local pressure under the forefoot during walking.

Diabetic Foot Damage from Limited Joint Mobility

Knowing that forefoot pressure and ulceration is increased by restricted joint movement explains why clinicians pursue this so seriously. Limited joint mobility in the diabetic foot does not adequately receive impact forces from the ground on each step, as normal feet should do.

Instead, pressure in these feet is often focused on specific areas, most often the heel, area beneath the first meta-fora, and clawed toe tips.

Untreated pressure areas can convert into blisters, subsequent breakdown, ulceration, and then deep infection which can result in a potentially fatal charcot process. When nerve sensation is reduced, these pressure related injuries are insidious and prevent diagnosis until the damage becomes huge.

Deforming factors include Charcot, ulcer, and other structural changes:

Fortunately, not all who suffer from limited joint mobility in this manner will develope charcot – the process of diabetic neuroarthropathy (often called charcot foot) destroying the bones – and the deformity process is complex.

Increased pressure on the midfoot stimulates a breakdown in the subchondral bone which then weakens.

Socketing the deformity into a rocker-bottom shape reduces the pressure, but dramatically increases the loads elsewhere in the architecture of the foot and alters walking significantly. – which then predisposes to ulcer formation most commonly under the first met and lesser toes, corresponding to the areas with prolonged increased stress.15-17 The persistent thickening of the skin, called hyperkeratosis, results from pressure and shear forces, acting as a protective response by thickening of the epidermis.

Calluses over a bony prominence are a warning sign of underlying increased mechanical stress, whilst those over bony prominences can turn into ulcerated pockets under the callus and current or emerging infection.

Regular callus removal in the clinic has been shown to impact outcomes in the diabetic foot pathologically, as a treatment modality.

Practical Strategies to reverse or reduce joint stiffness:

While it is ideally best to prevent ligamentous calcification from happening in the first place, even small decreases in joint restriction can impact dramatically on forefoot pressure and risk of ulcer in the at risk foot.

By stretched, stretched with myofascial work, and an optimally fitted pair of shoes and custom insoles, reduced joint range of motion can be minimized. The earlier that the pain and clamp down on the joint can be addressed, the better the outcome both short and long-term.

Myofascial Stretches:

Importantly, calf stretching exercises including gastrocnemius and soleus stretches are some of the most effective stretching techniques for improving ankle dorsiflexion and decreasing abnormal joint range of motion long-term. Nine-patient case series have demonstrated that with adherence to this, significant decreases in ankle range of motion can be achieved within weeks to months.15-20 Successful therapy techniques can involve manual therapy from a physical therapist, deep stretches position for twenty seconds followed by ankle circles and toe flaps-27 repetitions and then held again for thirty second holds.

For these to be successful they need to be performed consistently, thereby enhancing the effectiveness of the stretch rather than one occasional stretch every 3 days in a week Long.

Shoes, Insoles, and Offloading:

The foot structure can be supported with extra depth shoes and then custom insoles to offload specific areas, alleviating pressure and will help limit hyperstatic tissue response.

Customized shoes, injection, or total contact casting may be necessary when a patient with a stiff joint lands on an ulcer or Charcot foot. These same support structures are the pivotal offloading moments for the at risk patient home, from the angle of ankle dorsiflexion to diminished.

Blood glucose regulation in this situation is still the overriding long-term basis for success.

Supply: limiting glycation by maintaining as near normal glucose levels as possible will slow the development of CTN and allow all other therapies to be more successful in controlling the diabetic foot.

Duchenne Muscular Dystrophy and the Lower Limb

Duchenne Muscular Dystrophy Lower Limb problems affect thousands of families throughout the world—and are perhaps one of the most visible and life-changing aspects of the disorder.

Whether it’s the first subtle signs of muscle weakness in young children or the gradual loss of walking ability in your teens, the involvement of the DMD Lower limbs impacts every detail of daily life.

Knowing what is really going on in the calves, hips and legs allows families, caregivers and those interested to better understand the jargon used in medical reports and research.

Here, the underlying principles are explained—how the lower limbs are involved, how this development progresses and how what we have today is translated into everyday management practice.

Duchenne Muscular Dystrophy Lower Limb Weakness Principles

Duchenne MD is a disease resulting from changes within the gene for the structural muscle protein dystrophin.

Without dystrophin there is increased degradation, and a greater rate of loss of muscle fibers.

The main affected areas early in the course of the disease tend to involve the hip flexors, quadriceps, calf muscles and the muscles around the pelvis—that’s why most of your child’s initial gait problems will be some degree of abduction, waddling gait and difficulty rising from the floor.

The significance of early gait changes and the Gowers’ sign

Early in the disease it is often the sign of DMD most likely to have been picked up by mothers and health professionals—know as the Gowers’ sign, children will ‘walk up’ their own legs, pushing on their hands as they come to the end of a sit to stand, to use the technique of one of the smartest and most able 3-year-olds.

This interesting lurch forward is a part of the struggle of the weak hip and thigh muscles; however, it clearly shows the weakness before later features develop.

Along with this, a waddling gait develops, as the pelvis rock from side to side with the step, because the gluteus medius cannot support the pelvis as well as non-affected children.

Calf pseudohypotrophicity—more than you think

Many people have been surprised when they realize how large the calves in DMD look—and this phenomenon is known as pseudohypertrophy.

It results from the loss of muscle tissue, and its subsequent replacement by fat and connective tissue.

The strength you can feel doesn’t match the size of the calves. If you notice the two in parallel, it can delay diagnosis.

You will feel the calves are quite firm, but the underlying strength will be weak.

The progression of walking and what happens after

Ambulation, the ability to walk independently, is usually lost at a mean age of 9.7 years in boys with DMD—for example, depends on the mutation involved, steroid use there.

For your son, the huge psychological and physical shift to a chair can be daunting.

However, this isn’t the end of the lower limb story—they can all offer a sigh of relief, because the subsequent loss of walking triggers many other important issues.

This is because skeletal deformities and contractures become significant once a child fails to ambulate on a daily basis.

Contracture formation affecting the hips, knees and ankles

Controls of length change will have been ongoing since the earliest months.

If a part of your child’s body isn’t being stretched through normal movement and whole body repositioning, this same process will affect muscle shortening and the formation of a contracture.

In legs, the problem most commonly develops in hip flexors, hamstrings and the Achilles tendon.

The tight Achilles can cause toe-walking before loss of ambulation has occurred, through to pressure areas and eventual saddle deformities with fixed hip flexion in the wheelchair.

Physiotherapy, orthotic devices and some surgical procedures all play their part in trying to delay the effects of this process.

Scoliosis and the link with the lower limb in DMD

Therefore, it is perhaps no great surprise, that once the active position of walking has stopped, the pelvic and spinal muscles no longer being used are unable to support the stresses that are placed upon the spinal column on a daily basis.

During the teenage years a curve of the spine develops between the hips and shoulders in over 90 of non-wheelchair dependent boys, and there is definitely a developmental link which directly involves the muscles of the lower limbs and pelvis.

Seating strategies in the wheelchair to maintain spinal balance become very important, and the monitoring of scoliosis as the child matures essential.

Managing Duchenne Muscular Dystrophy Lower Limb Problems

There is an important team involved in the management of children with DMD and their lower limbs—including physiotherapists, orthopedic surgeons, rehabilitation specialists and orthotists.

The objectives of management can be said to be, to maintain function as long as possible, reduce pain and discomfort and maximize quality of life.

Physiotherapy and orthotic devices

Physiotherapy is an element that should probably be introduced right from the start and remain a key feature throughout your child’s life with DMD.

Stretching exercises are prescribed in relation to the hip flexors, hamstrings (knee flexors) and ankle plantar flexors.

Ankle-foot orthoses (AFOs)—might be recommended at night to stretch ankle joints and slows down Achilles tendinal shortening by maintaining ankle dorsiflexion throughout the night.

Ankle AFOs have also been used during the day to support ambulation in suitable boys to support them when walking.

The size of any orthosis needs to be monitored frequently to ensure that they continue to fit properly and inappropriately fitted orthoses can be very damaging to already weak muscles.

The benefit of corticosteroid use on the lower limb

The use of corticosteroid medication, deflazacort or prednisolone, is thought to prolong the term of independent walking by around two to three years.

They have not been able to cure the problem of absent dystrophin; however, the inflammatory cycle that it appears to trigger and that precipitates your child’s loss of function can be affected.

This is important because an extra two or three years of walking can delay contractures by the minimum of a year, and often much longer, and make the presence of scoliosis less severe.

The side effects and risks are also under constant review, and weight gain, osteoporosis and sleep disturbance as well as the emotional effects must all be carefully monitored.

In the face of the investigation into the efficacy of the newer gene-based approaches to DMD treatment, glucocorticoid and steroid use has become a reasonably standard approach to ensure that the best of current management of lower limb advantage is achieved.

Duchenne Muscular Dystrophy explored—from the modifications of gait and pseudohypertrophy of the lower limbs in DMD initially, through to contractures, loss of ambulation and the means used currently.

Diabetic foot care: what you need to know to stay safe

Caring for your feet does not have to be complicated—but living with diabetes means managing a disease that quietly impacts almost every system in your body—including your feet.

Very few people understand how vulnerable their feet can become when blood sugars are elevated over a longer period of time.

Nerve damage (medically called peripheral neuropathy), poor blood flow, and immune suppression can turn a small blister or cut into a serious nightmare.

Diabetic foot care is not just important for rare, specialized cases; it’s necessary knowledge for each person living with the disease.

This article will detail the main points—including daily inspection methods, footwear tips, and when to consult your doctor – so you can care for your feet simply, confidently, and appropriately.

Essential daily diabetic foot care inspection routines

Keeping up with a daily inspection routine is crucial because nerve damage caused by the disease can leave you unaware of wounds.

A quick daily inspection doesn’t have to be complex, but it must be a daily routine, for life—because a wound that causes no pain can have just as serious of an outcome as one that does—and it can do so quite quickly.

How to properly inspect your feet

Sit in a brightly lit room and examine the tops, bottoms, sides, heels and between every toe.

Use a mirror if you have difficulty bending, or kindly request assistance.

Fingernails, toenails and skin should be checked thoroughly for redness, swelling, blisters, cuts, abrasions and cracks, any signs of abnormal warmth or any discolored areas.

What appears to be minor—such as a small scratch or dry patch of skin—must be investigated if circulation is impaired.

Proper washing and moisturizing

Feet should be gently washed in lukewarm water daily, and thoroughly dried—particularly between the toes—to lower the occurrence of fungi and yeast.

Moisture between the toes and around the nail beds is an often overlooked source of bacterial proliferation.

Apply a gentle, unscented moisturizer to the entire foot (but not in between the toes), and keep the toe nails tidy—cut in a straight line rather than a rounded foot.

This simple act of regular toe manicure can reduce ingrown nails and subsequent infection.

Proper diabetic foot care footwear selection

One of the most underrated aspects of diabetic foot care is selecting footwear.

Ill-fitting shoes, shoes with internal seams, shoes that don’t offer much support or evenly distribute weight may, over time, lead to pressure points that will turn into ulcers—while the patient remains pain free.

A shoe that is wrong can be a true concern to health, not just a matter of comfort.

How to choose appropriate footwear for diabetic feet

Choose shoes that are broad and high enough to fit comfortably, with a generous toe box.

Shoes should be made of breathable material, with no inside seams or rigid edges that could abrade.

Many podiatrists recommend therapeutic shoes (these are also called diabetic shoes), which are created to distribute pressure in a way that is more comfortable.

Much of the prescription comes through psychological work with the patient discussing some of the common issues that make a diabetic’s feet vulnerable.

These shoes are available through medical providers, and may be partly covered by health insurance for those with a diabetics diagnosis.

Inquire with your health plan.

How to properly select and wear socks

When it comes to undersocks, many people are unaware of the role the wrong choice can play.

Seamed socks, restrictive elastic top socks and synthetic materials are all potential irritants to the agitated diabetic foot.

Seamless and moisture wicking socks—whether made from the miracle fibers or a diabetic specific blend—provide a noticeable level of comfort a simple pair of socks cannot replicate.

That’s right, see a podiatrists regularly and wear shoes at all times. Never go barefoot—you’ll be surprised at how small a stone has to be to cause damage when you have impaired sensation and reactive adhesion.

In the long run, the typical 3 days to heal a minor wound may be more manageable than a wound it takes four times that long for your body to repair.

The signs to watch for, and when to call the doctor

Even with all the due diligence, complications can happen.

The real litmus test for the difference between trouble and catastrophe hinges on how swiftly intervention occurs with a given problem.

Effective intervention is one of the primary reasons major diabetic foot complications are so often where they are—and news reports of death and gangrene are so often what comes of what could have been minor issues.

When not to ignore symptoms

Certain foot symptoms should lead you directly to a doctor, rather than waiting to see if it gets better.

Redness that persists more than a day or two, an open wound that isn’t healing, a swollen foot (this also could mean infection or a circulatory problem), foul/discolored smell or discharge are emergency indicators and should be evaluated immediately.

A fever with a foot symptom indicates a situation more serious than you might realize and should be addressed with urgency.

The importance of regular foot examinations at the doctor

Routine foot appointments with a podiatrist form an important part of long-term diabetic self-care.

The American Diabetes Association recommends at least one analysis a year, though more regular appointments should be scheduled if underlying circulatory or neuropathic conditions exist.

A podiatrist will identify deformities such as bunions, corns, calluses, hammer toes and deformities before they manifest as wounds, and manage issues like calluses and toenails to promote comfort and stability.

Think of it as the balance of treating wounds versus preventing them; it’s probably best—and easier—to catch things early.

How to incorporate keeping your blood glucose levels in check as part of your foot care

Blood sugar levels control the ability of diabetic tissue to repair damages.

Too much sugar, beyond a certain level, slows healing, and suppresses your immune system—meaning that even when you do everything right and thoroughly cleanse you are likely to deal with a longer healing process.

Treatments that keep for your individual condition are important; however, keeping your blood sugar within safe limits plays a part in it all—the healing, the prevention, the long term management—and this includes protective, supportive foot care habits! With a little dedication, and some small steps every day, you’ll walk on stable ground for a lifetime.

Our feet are the foundation of our being. They are what move us from space to space and moment to moment. Your future health could hinge on how you take care of your feet now.

Does Duct Tape for Warts Actually Work? Here’s What You Should Know

Warts are nitt-loving little skin anomalies that seem to appear just when you don’t need them. Produced by some types of the human papillomavirus (HPV), all sorts of strains can manifest on fingers, toes, hands, and other areas – yet clearing them can be difficult. While some drugs are available off the shelf, dermatologist attention isn’t unheard of, but at some stage, an unorthodox home treatment emerged: duct tape for warts.

Yes, that metallic stuff in your shed.

It’s almost too weird to be real, but this remedy has been around for many years and not missed out on scientific trials.

This article explains how it works, what the evidence actually shows, and exactly how to use it properly if you feel inclined.

How Duct Tape for Warts Is Supposed to Work

It’s not exactly rocket science – place duct tape on wart, keep there for a few days, remove, repeat.

Yet, there’s some variation in the explanation of why this could work under the surface.

The Occlusion Theory

This is a popular explanation: occlusion – or covering up – the wart completely, restricting it from air and sunlight.

When skin is kept covered for long durations, conditions under the covering change.

Dampness increases, the outward layer of skin softens, and the immune system could potentially take a more forceful action to break down the infected tissue – a process that some think takes weeks with duct tape occlusion.

This isn’t an instant cure.

It’s a methodical, sequential breakdown of the wart.

Immunological Activation

Here’s the intriguing thing that makes the duct tape tactic genuinely scientifically interesting: some scientists postulate that the tape irritates the skin just enough to generate an immune response in the general vicinity.

It’s difficult for the immune system to recognize and attack the HPV virus causing the wart, as it abides primarily in the infected skin cells.

But if the immune system is prodded into doing its job then it might be aware of the virus in the aforementioned nearby cells and will try to eliminate them instead – it’s still up for debate how over-the-counter duct tape treatment triggers this localized immune reaction.

However, this theory has led many dermatologists to be reticent about denouncing duct tape occlusion as an effective treatment, even if they are cautious about endorsing it either.

What Evidence Shows About Duct Tape for Warts

The whole body of research surrounding duct tape has produced inconsistent conclusions, and deserves honesty as a result.

A group from the Archives of Pediatrics and Adolescent Medicine in 2002 affiliated duct tape occlusion with cryotherapy (freezing) of warts in children.

The outcomes were unexpectedly positive for the duct tape group – nearly 85% cure rate versus 60% in the freezing cohorts.

Such findings spurred a lot of speculation and led people to dig through their drawers.

Why the Evidence Is Often Cloudy

Subsequent research, for instance a 2006 Dutch trial, reported no real difference between placebo (moleskin without sticky stuff) and the duct tape.

Hence, the scientific conclusion on this is anything but clear cut.

The variable results are probably due to several reasons: the sort of duct tape used, the length of time that the tape was worn for, and the fact that at least in some instances, warts are expected to regress naturally over time.

In fact, the body’s natural immune response often clears up the infections supplied to its own devices.

Who Is Most Likely to Benefit From It?

Children and teenagers seem to respond more positively to this tactic than older people, perhaps owed to youthful immune systems being more reactive.

Fingers and other annoyingly transparent areas of common warts tend to do better with this method compared to the thicker plantar types on the soles of the feet.

People that have already had tried over-the-counter remedies based on salicylic acid without success sometimes consider duct tape an alternative, or an addition to others – but check with your doctor beforehand.

How to Use Duct Tape the Correct Way for the Best Possible Chance

Technique is important more than most imagine.

Applying duct tape and then ignoring it for eight weeks isn’t quite right, and the relative failure experienced by people may be due to lack of consistency.

The Basic Routine

The most often cited procedure goes like this: Cut a piece of duct tape of slightly larger size than the wart, roll onto skin and leave for six days.

Remove the wrapper from, soak in tepid water for three minutes, and gently file the keratinized layer with an emery board or pumice stone.

Keep the affected area without tape overnight, then place it with fresh sticky stuff the following day.

This should be continued for as long as eight to ten weeks.

If after two months there’s no evidence of improvement, then other options should be investigated.

Tips to Help

The habit of keeping duct tape firmly and reliably attached to the skin is genuinely irritating.

It doesn’t adhere well to sweaty skin, so if it is pressed against the area very firmly and then positioned, this appears to help the most.

In order to keep the tape in position during going about everyday activities, some try a bandage place over the top.

The trial2 research utilizing silver duct tape could have been construed to be using colored, transparent duct tape, but most clinicians support the use of normal silver duct tape.

The current methods shouldn’t be used on facial warts or

Those who are successful are likely to be those individuals using the protocol thoroughly over a period of several weeks rather than halfheartedly for just a few days.

If the wart is stubborn, enlarges, changes in appearance or becomes painful, then a visit to a dermatologist would be the logical next step.

Earth Shoes: What They Are and Why They’re Popular

Shoes are always about more than simply protecting your feet. For decades, footwear lovers have been on the hunt for shoes that mold around the body instead of sitting pretty on the shelf.

Earth Shoes stepped into this arena in a big way – first during the 1970s and again as part of a modern revival – offering footwear based on a concept fundamentally different from what most footwear has to offer. The notion behind the design was that the way your foot was seated by the shoe made a difference for overall bodily health.

This article will review the history behind Earth Shoes, discuss the science of their negative heel design, and help you decide if they belong in your wardrobe and foot health regimen.

A Short History of Earth Shoes

Interestingly, Earth Shoes didn’t emerge from a faceless conglomerate deep in the style labs.

The birth of the brand can be credited, in most part, to Anne Kalso, a yoga devotee who observed the difference in gait that was evident when people walked barefoot over natural terrain in New Zealand and Denmark.

She noticed that walking shoes that weren’t Earth Shoes put the heel considerably higher than the toes, pushing the body rather than pulling it into a misaligned position.

Kalso devised a shoe that would mimic the natural way of walking on soft sand or soil in the late 60s, producing a line that launched in 1970 in the US, at the height of the natural living movement in America. It was a hit!

How the original lineup of Earth Shoes knew what went into them even further.

During a period when societal consciousness was rising about environment and a more back-to-basics approach to life, Earth shoes launched right into the eye of the storm.

Long lines gathered outside the flagship New York City store. Sold-out remains the order of business still today…until the company was forced to shutter its doors in 1977.

A second incarnation was born years later, 2001, that rejuvenated the original idea and released a new generation of Earth Shoes that boasts both trendy and comfortable shoes, which still boast their negative heel concept.

The concept proved resilient in spite of skepticism on its lasting power.

Why Earth Shoes Feature Negative Heel Design

Least familiar to the average shoe consumer is what Earth Shoes refer to as the Kalso heel, or the negative heel.

In a typical shoe, the heel is designed to sit at the same level of the shoe as the toes, or slightly higher up. Earth Shoes can flip that relationship, with the heel sitting at a 3.7-degree angle below the ball of the foot.

That may not seem like much of a change, but to foot and body health, that elevation difference makes all the difference.

How the Body Responds

When the heel sinks below the toes and the heel, the body modifies its position accordingly.

Pelvis tips forward by a hair, spine elongates subtly, and the muscles of the calves, thighs, core swing into action every step of the way. This is claimed to be representative of the way barefoot walking is experienced on a natural slope…since this is the way our bodies developed to manage.

Certain physiotherapists have noted that the inherent muscles strength building effects of this form of energy expenditure can have long-standing, positive effects on postural health, but everybody’s kind of a different story.

What the Literature States

Perfect research alludes to benefits for posture and back issues, while mediocre research reveals little of any kind of difference at all compared to running barefoot barefoot.

There is an obvious consensus that newly introduced users to negative heels should ease into them slowly…an hour or two per day is sufficient at first in order to avoid muscle soreness…instead, one day of negative heel in a footsie is not going to cut it.

The transition is crucial, so if you can’t get through that period, it doesn’t matter how many wonderful benefits you hear about through testimonials.

Earth Shoes are one of the most unique, fascinating brands in footwear today. Built on a highly specific physiological concept, these shoes have endured both decades of skepticism about their novelty and fashion cycles that inevitably change. If back pain, health-forward footwear, or the thought of an alternative to traditional shoes intrigues you, they should be considered.

Begin gently, listen to your body, and select a style that most resemble your true routine rather than the way you would like it to be.

The right pair, worn on a regular basis, will change your mind for good about shoes.

Diabetic Foot: Key Information to Ensuring Your Wellbeing

Breathtakingly, there are millions of diabetics living with a complication that isn’t always given the attention it needs – diabetic foot problems.

Specifically, diabetic foot is an umbrella term used to describe any number of issues from nerve damage (neuropathy) or lack of circulation, to open wounds and dangerous infections.

These can creep upon you insidiously, sometimes without pain, and are incredibly easy to ignore.

What may seem trivial as a minor callus or blister can rapidly evolve into an extremely life-threatening situation.

Here’s a rundown of what contributes to diabetic foot problems, how to identify early warning symptoms and what every day actions can really make a difference to risk levels.

If you’v been told you have diabetes or have long-suffered without appreciating ground contact, knowledge is power.

Understanding Why Diabetic Foot Complications Develop

Diabetes messes with more than just glucose levels.

In the long term, uncontrolled diabetes can damage every blood vessel and nerve in the body, with the feet being most at risk.

Two main processes tend to be responsible for diabetic foot problems: peripheral neuropathy and peripheral arterial disease.

Peripheral Neuropathy: When You Can’t Feel What Must Be Noted down

The pathway of deadening the nerves in the feet and lower legs, peripheral neuropathy causes diminished feeling in that leg and those feet.

Many describe it as tingling, a burning feeling or numbness, but some won’t notice that they have anything wrong until something actually hurts–and even then, the warning has been missed.

When you no longer notice pebbles in your shoes, a squeeze of tight socks around your toes or a small developing sore on your skin, small damage becomes sustained.

The body’s natural defense, the person who ignores the fire alarm stops working.

A seemingly minor abrasion that would be addressed immediately in a non-diabetic, such as a small hole caused when stepping from shoe to sidewalk, may remain unnoticed for days with a patient who has neuropathy, allowing bacterial colonies to develop into a dangerous infection.

Poor Circulation and How This Slows Wound Healing

Even if the (neuropathic) wound is noticed early, slow blood flow caused by narrow arteries will result in a difficult healing process.

Healthy circulation supplies oxygen, nutrients and immune cells to the injured tissue, and if it isn’t present, wounds that would usually be straightforward may turn difficult.

Very thin skin tears often and bruises easily, even minor trauma sets back healing, and when infection occurs, the immune system fights the wound stubbornly rather than promptly.

This circumstance, short sensation combined with sluggish healing, is the basis of the unique challenge that diabetic feet present.

Spotting Diabetic Foot Symptoms for Early Intervention

Peripheral neuropathy can be identified in a variety of ways, in terms of the sensation in person’s feet and in the appearance of the skin.

Decreased sensation rather than complete insensitivity is far more common, and can be monitored as part of a home program.

Between the toes, on the soles, and on the top of your feet, check for dryness, cracks or soreness.

As your foot dryer or cracks form, cracks more frequently deepen and become painful, and calluses become thicker but less manageable without careful care.

Hard skin of any sort must be carefully managed, as the problem underneath the callus can be trapped if left unchecked, exacerbating existing damage.

Benign changes to the toenails are easily overlooked by the general public but in fact, very common signs of toe troubles occurring underneath.

Find a local podiatrist to help with trimming thickened nails and cutting into corns, and check in with your doctor or foot specialist without delay if you see skin that looks red, feels swollen and is warm, or feels different from the skin in other areas of the foot.

Ulcer severity can be classified by clinical guidelines (the Wagner scale being the most eminent), with grade zero involving only intact skin, and grade five showing entirely dead tissue to be considere for amputation.

The general guideline is the earlier this stage is recognized and addressed, the less likely a person is to have long-term problems following the issue.

Therefore, seeking professional intervention as soon as a problem develops rather than relying on the phrase “it will probably heal itself” will improve outcomes exponentially.

Actual Strategies that Effect Real Benefits

Managing diabetic foot health in general terms isn’t difficult but it does require motivation and discipline on the part of the patient.

Those quick “five minute a day” routines of one quick foot check followed by application of a moisturizer are proven techniques in prevention of foot issues on the long term.

The Minutiae of Daily Foot Inspection

Simple tasks add up.

Inspect both feet top and bottom at least once daily – use a mirror if bending forward is limited, and cover both feet using only a towel, likewise.

Wash from the toes up with warm water, but avoid burning by testing temperature with the hand first, and don’t dry using a rough towel – that will foster problems.

Dry between the toes, and apply a moisturizer daily to all areas–but make sure you don’t leave excess fluid between the toes, since this invites a yeast or fungal infection.

Cut the toenails flat and do not cut into the edges or point upward either.

Always wear comfortable socks sans constrictive elastic bands.

Always wear supportive shoes, never walk barefoot in the house if at all possible.

It’s not a matter of clearing slabs of floor space and tidying, but of minimizing injury potential and detecting problems early.

How Better Management of Diabetic Foot Can Improve Your Life and Prevent Problems

Regular check-ups with a podiatric specialist are invaluable, especially if you already experience neuropathy or circulation problems.

A good podiatrist is more acutely aware of any warning signs–such as a change in the structure of the foot or early skin changes–that might go unnoticed otherwise.

In addition to having appropriate foot care professionals on the care team the magic lies in both keeping blood sugar in range, which most definitely prevents nerve damage progression, and never smoking either!–Need we say more?

Six Determinants of Gait: How the Body Moves with Efficiency

Human walking may seem trivial, but in reality it’s extremely complex.

Each step involves a sophisticated choreography of muscle activation and joint rotations working together to create smooth forward progress.

The Six Determinants of Gait—the set of principles described by Saunders, Inman, and Eberhart in 1953—explain in a precise way why the body doesn’t waste energy during movement.

For clinicians, biomechanics researchers, and physical therapists, the Six Determinants of Gait are essential.

They guide our gait analysis, our rehab protocols, our orthopedic tactics.

Read on for a synthesis of the six determinants, the biomechanics behind each of them, and why we care about them today.

Understanding the Six Determinants of Gait: First Two Components

The body’s center of mass (CoM) moves in a wave pattern between the two extremes of each stride’s stance phase.

Exaggerated vertical movement would require a ridiculous amount of power, however, making walking an aerobic nightmare.

The first two of Six Determinants of Gait combat this trend by limiting vertical CoM travel through pelvic movements and hip mechanics.

Pelvic Rotation

Pelvic rotation refers to the pelvis rotating about the vertical axis during gait.

A transverse-plane swing of the pelvic socket occurs as the ipsilateral leg (either side) moves forward.

This rotation can be four degrees if normal, and efficiently increases leg length without taxing the hip flexors.

Pelvic rotation effectively causes the CoM to take a shorter arch, minimizing how high a person must vertically move to advance between steps.

Clinicians will notice pelvic rotation at the very beginning of a patient exam when the patient has lumbar stiffness or any gait waddle.

Pelvic rotation is also a key component of stance phase stability when a person becomes fatigued mid-walk.

Pelvic Tilt

The second sagittal-plane component of gait kinematics—the pelvic tilt—is also a key to relative stance phase stability.

This phenomenon occurs as the pelvis drops downward on the swing limb.

Typically the muscles that contract around the support limb lateral aspect—mainly the gluteus medius—unit into an eccentric control system to oppose the force of gravity acting to lower the unsupported pelvis.

This downward tilt, like the pelvic rotation, results in a smoother, more efficient swing.

Clinicians will see this action when a lumbar block is performed, or when a person develops gluteus medius weakness.

The drop in the pelvis causes a style of gait called the Trendelenburg gait that is characterized by one-sided drop-shifting of the torso.

Reinforcing the abductors dorsiflex the patients thigh to give a more stable limb.

The Second Half of the Body Operates to Control the Middle Three Determinants

The next 3 determinants (out of 6 for walking) deal with the action of the ankle and knee joints respectively.

Subtleties in ankle and knee movements greatly improve high- and low-foreword walking mechanics.

Knee Flexion During stance

The body purposely flexes the knees by about fifteen degrees.

Flexed knees serve to “absorb” some of the impact of the body’s weight, as well as lower the body’s center of mass during an important transition period.

Without flexed knees, each step would involve an abrupt, rigid vault over the support limb at an enormous expendature of energy.

Patients with weak quadriceps, knee pain, or knee replacements will advocate for a stiff-legged gait because it minimizes knee activity.

Elimination of this determinant can increase the person’s energy cost of walking 70 to 2.0.

Aspects of the Foot and Ankle; the 4th and 5th Determinants

The next determinant is the foot’s function as a rocker.

When the hind foot hits the ground at heel strike, the anterior tibialis works eccentrically to smoothly pronounce the foot and prevent the tibia from collapsing forward.

This active muscle control plus the powerful push off that occurs with ankle plantarflexion at terminal stance together round out the CoM.

Lack of strength or paralysis here will create a decrease in walking speed with an increase in McKernan’s cost of walking per meter.

The Last but not the Least of Six Determinants of Gait Provides the Final Piece of the Puzzle

The 6th and final determinant of gait is concerned with the mediolateral travel of the body’s center of mass.

This lateral motion is unaffected by the first 5 determinants of gait, but it still adds as much as 15 percent to a person’s energy expenditure.

Athletic performance experts are interested here—clinicians should be too.

Lateral Motion and the Lateral Trunk Tilt

The final determinant involves the inward angulation of the thighs.

If the thigh plus its femur glides inward, the foot lands closer to the body’s midline, lessening the mediolateral distance between the hip joints and the foot strap points.

However, the force is not solely an internal binarystional one, instead, the inward angulation takes advantage of a biomechanical aspect of the sit-to-stand transition to offset the net effect of lateral CoM travel.

This inward angulation of the femurs is known as the physiological valgus.

Good news for the women, who are naturally team “widespread” in this area: a comparative analysis of pelvis morphology in high versus low-efficient runners shows that women who run with a wider pelvis to start with tend to run worse overall.

Clinicians must be aware of this determinant when fitting lower limb prosthetics because it will have an effect on the mediolateral sway of the CoM.

Another subtle movement, the ipsilateral lean of the trunk—”swinging” the torso toward the stance limb—combats the mediolateral CoM excursion.

This line of action remains strictly controlled and is beneficial in healthy gait.

In this vein, however, if the person leans ipsilaterally more than expected, it can be indicative of a motor control problem.

Assessing this determinant is often useful when trying to analyze an abnormal gait.

Six determinants of gait can be summarized as a way of designing a “building diagram” for the most energy-efficient walking pattern.

Pelvic rotation, pelvic tilt, stance phase knee flexion, the anterior tibialis-anterior rocker ankle mechanism, the plantarflexion ankle pump, and physiological valgus create the ideal family of gaits and everyday walking patterns—smooth, functional, low-energy.

The clinician must be careful not to “throw out the baby with the bathwater,” however, because the above list of determinants is based on averages from healthy studies—and patients are thus individuals.

In each case, if just one of these determinants is compromised, the body adapts without global benefit, and there is an energy or mechanical expense (the voice in their head calling out to them to stop running) that slowly builds up in the system.