Diabetic mellitus is a disease that affects approximately 16 million people within the United States. Approximately 6 million of them are unaware that they even have the disease. Some of the hallmark symptoms of hyperglycemia or elevated glucose levels in the blood include: frequent urination, excessive thirst, extreme hunger, unexplained weight loss, tingling and numbness in the feet or hands and even wounds that are slow to heal.

Because diabetes affects many different body parts, including the lower extremity, it is important to have checkups on a regular basis by your podiatric physician. The podiatric physician is an integral part of the team that is needed for the treatment of diabetes and its manifestations. Regular checkups should include evaluation of the skin, evaluation and regular assessment of the blood supply or vascular quality to the lower extremities, evaluation of the toenails including fungal disease and ingrown nail problems, also assessment of the nerves and the ability to perceive sensations.

Ultimately, the goal is to prevent the lower extremity manifestations of diseases causes by diabetes mellitus.

Many people suffer with a complex disorder with varying degrees of symptoms known as the flexible flatfoot condition. However, not all flatfoot conditions are disabling, in fact some of the most athletic people have flexible flatfoot conditions without symptoms. However if you should have symptoms including:

    Pain along the inside part of the arch,
    Pain along the bottom of the heel, especially in the morning hours
    An ankle which might be rolled in and in a downward position
    Or overall weakness of your legs and lower back, especially after long hours  of
    standing
It may be time to have your lower extremities evaluated for appropriate treatment to reduce some of your symptoms.

    Treatment options do include alteration and rehabilitation of the lower extremities.
    The use of orthodic devices which is a device that is placed inside your shoe to 
    support the arch area during your activities.
    Anti-inflammatory medications such as Advil, Motrin or Aleve may also provide
    temporary but symptomatic relief.
    Shoe modifications including stiffer and more supportive heel counter and arch
    support innersoles
    In rare cases surgery may be a necessary part of the treatment options for the
    chronically painful flatfoot condition

A fracture is a disruption of the consistency of a bone. There are different types of fractures that occur within the foot structure. The foot consists of 26 bones which are susceptible to both traumatic and stress fracture type injuries. An example of a traumatic fracture is conceded when direct trauma is placed upon one of the bones of the foot, this as opposed to a stress fracture, which is a disruption of the osseous structure but usually happens over a repetitive amount of stress placed upon the bone.

It is important to receive appropriate and proper treatment of such injuries to prevent disruption of the normal architectural alignment of the foot. Also if the fracture should involve the joint surface (a moving part of the foot) then these are highly subject to development of painful arthritis. Additionally, improper treatment may lead to the inability of the fracture to heal or a delay in the healing of the disruption or fracture.

Most fractures can be treated by appropriate splinting and the widely accepted mnemonic RICE, or rest, ice, compression and elevation. However, in some cases, especially in fractures that involve joint integrity or misaligned fracture fragments surgery may be indicated. Additionally, the use of cast immobilization is helpful in treating some of the major fractures involving the foot.

Hammertoe deformities are characterized by contracture or a bending at the joint of the lesser toes. It is caused by an imbalance of muscle tendon along the top and bottom of the toe surface. This is a dynamic process and continues to progress, especially with inappropriate or ill fitting shoe gear over a period of time.

Symptoms of hammertoe include pain and difficulty wearing shoe gear, along with callus formation or corn formation at the joint surface as it becomes chronically irritated on the shoe wear.

Treatment includes removing the corn or callused tissue and then ultimately trying to protect the area as it rubs on the surface of the shoe. Padding may also be of benefit to offload, or remove the irritating pressure along the hammertoe surface. In some cases, especially those that are resistant towards these conservative methods of care, surgery may be indicated. The surgery is focused towards correction of the structural deformity through a more normal positioning of the toe.

Heel pain is a very common condition that affects most Americans at some part of their life. It is mostly caused by a condition known as plantar fascitis, which is inflammation around the tissue that extends from the heel bone to the toes. At its insertion into the heel bone the fascia becomes irritated and inflamed, resulting in pain; especially in the morning hours. The most common causes for such a condition include a poor mechanical structure of the foot. Examples of such structures include patients that have excessive flatfeet or excessive high arched feet. Additionally, non-supportive foot wear and walking on hard surfaces contribute to such symptoms. Other causes include stress fracture to the heel bone, tendonitis, arthritis, certain types of cyst formation and rarely nerve pain extending from the lower back.

Most heel pain patients are treated conservatively through the use of stretching exercises, supporting the arch area and more supportive type shoe wear, but ultimately the use of a custom molded orthodic is the long-term treatment plan for patient's suffering from heel spur syndrome. In very rare cases, surgical intervention may be indicated. Newer treatments do include extracorpereal shockwave therapy which is a noninvasive surgical procedure in which an ultrasonic sound wave is directed at the heel pain site. This treatment is very similar to the treatment of nonsurgical kidney stone treatments.

Ingrown toenails are a common condition, especially affecting the great toes. This occurs when the border of the nail invades the soft tissue and skin edges at the border of the nail. This common disorder is usually an inherited problem and is precipitated by improper trimming of the toenail. Additionally wearing shoes that may be too tight or too short contribute to the cause.

The treatment of ingrowing nail problems usually starts from a conservative treatment plan. This includes soaking, application of antibiotic ointment or cream and daily dressing changes. If this fails to correct the ingrowing nail problem then treatment such as removal of the outside or inside border of the nail may be necessary. Recurrent ingrowing nail problems sometimes require permanent removal of the offending nail border. This is performed by utilizing a special chemical which removes the nail root of the border that chronically becomes ingrown. These types of procedures are performed directly in the office setting and require only local anesthesia for patient comfort.