The Diabetic Foot

Type two diabetes has become so common, it is almost as though we have become complacent regarding it. The incidence is rising in most places despite public health strategies are attempting to take care of the obesity crisis that is supporting the diabetes challenge. Diabetes has a number of complications that all combine collectively to put the feet at significant risk from complications. These complications vary from a mild infection to the more critical complications like a need to amputate a leg a result of a spreading infection or deceased tissue. The complications associated with diabetes have an effect on a wide variety of tissues in the body.

In relation to the feet, diabetes affects the blood supply and therefore any injury to the foot is more likely to be serious as there is insufficient good blood flow allowing healing to occur. Diabetes also damages the nerves, so that if there is some injury, either major or minor such as a blister, then no pain is felt, so the foot continues to be damaged resulting in the complication a great deal more severe. The body has numerous functions to fight infection, but in diabetes the response to an infection is much more sluggish than in those without diabetes. Diabetes can also affect the eye and while the eyes are a long way from the foot, ample vision is needed to see any issues that may have occurred to the foot so it may be dealt with. Even the renal disease that frequently occurs in diabetes impacts wound healing after the injury has been done and the presence of disease in the kidney can affect what medicines, for example antibiotics, may be used and sometimes that range can be quite restricted.

It is for all these complications, and others not brought up, that those with diabetes have to take additional care of their feet. They need to check them routinely to make sure that there is no injury and if there is an injury they must get medical help quickly. Most importantly, they must be regularly managed by a foot doctor.

Cuboid Syndrome

The cuboid is a smaller cube shaped bone on the lateral side of the foot around about the center of the foot. The bone is a bit bigger than a common gaming dice. The bone takes part in three joints and functions as a pulley for the tendon of the peroneus longus muscle to pass under. Because this is a powerful muscle it can move the cuboid bone too much if it is not steady and overload those joints that this bone is a part of producing a disorder known as cuboid syndrome. This is probably one of the more frequent causes of pain on the lateral side of the foot, particularly in athletes. The pain typically starts out quite mild and is located around where the cuboid bone is on the outside of the foot. The discomfort is only to begin with present during exercise. If the exercise levels are not lowered the problem will generally advance and then show up after exercise in addition to during. Occasionally the pain may radiate down into the foot. Although this is the commonest reason for pain here, there are others such as tendinopathy and nerve entrapments.

The main management of cuboid syndrome is pain relief. This is generally achieved with a decrease in exercise levels and the using of strapping to immobilise and support the cuboid. Mobilisation and manipulation is often used to fix the symptoms. Over the long run foot supports may be needed to control the movement and aid the lateral arch of the foot. This helps make the cuboid more stable so it is an efficient fulcrum or pulley for the tendon to work around. Generally this approach works in nearly all cases. If it doesn’t there are no surgical or more advanced methods and a further reduction in exercise levels is often the only alternative.

Cracked Heels

Splits in the epidermis at the back of the heel are frequent, are uncomfortable, and do not look very good. This occurs if the fat pad beneath the heel stretches out sideways beneath the foot and the dried-out skin cracks or splits to create a heel fissure. A good way to understand them is to use the analogy of a tomato being compressed. As you apply force to the tomato to squash it, the skin of the tomato cracks as the insides pushes outwards. So it is with the heel. As bodyweight squashes the fat under the heel it expands out laterally from under the heel, it attempts to tear the epidermis around the perimeter of the heel. If this succeeds or not is going to depend on how flexible and strong that the skin is. If the skin is dry, thicker or callused, it is going to tear quickly. If the skin is thicker with a layer of callus, that skin will crack easily and place stress on the good skin below that will become very painful, even bleeding. Each step that is taken with even further open the crack which will help prevent it from healing. Cracked heels are more common in those who wear open heel type footwear, as a closed in shoe should help keep the fat pad under the heel in position and help prevent or reduce the effects of this.


The most efficient short term management of cracked heels is to have the callused skin removed by a podiatrist and then use strapping to hold the sides of the split together so that it can heal. The long term prevention of cracked skin around the heel should be apparent from the mechanism that was described above. To start with, weight reduction will help lessen the problem, but this is a long term issue. To help stop the fat pad under the heel from expanding out sideways and trying to split the skin, a closed in shoe needs to be worn and frequently the use of deep heel cup insoles can help. A foot doctor should be consulted on a regular basis to debride any dry callused skin. Emollients really should be applied regularly to keep the skin flexible so that it does not fissure. The use of pedicure files to maintain the callus under control could also be used.

Chinese Foot Binding

There is a old process from rural China that involved the binding of the foot of female young people to stop them from growing. It was a barbaric practice and was painful and disabling to the feet. It was done as a small foot was thought to be an attractive characteristic in the female and a greater dowry can be demanded by the family for the bride-to-be if the feet had been bound. There was a substantial market in these rural communities for the ornamental and finely crafted shoes that these people would need to wear because of the smaller and misshaped feet. Around 100 or so years ago societal pressures did start to mount to ban the practice and this largely was successful and it is not carried out nowadays. The practice needed to stop as it was so debilitating and painful for the girls. When they became a grownup, the harm had been done and there was very little that might be done to deal with the pain and disability. Having said that, you can still find many older woman alive that had their feet bound when they were young children.

There are apparently commonalities to this practice of chinese foot binding that could be seen these days. Several commentators like to link the practice these days of females who push their feet inside the high heel footwear as being the same as the practice. In rural China the technique was all about the female performing something which pleases the male, no matter the outcomes in terms of discomfort and deformity. The practice today of using tight fitting high heel shoes by females has outcomes in the terms of foot deformity and foot problems. It is also apparently done in the perspective of the female doing something which is agreeable to the eye of the male. There is some argument if the connection between the two practices really do justify the kind of exploration that they have been subjected to.

Running Barefoot vs Running in Shoes

Running without running shoes had been very popular not long ago however interest in it and the number of runners doing it have decreased substantially. It was a fad which went on for several years and was mostly influenced by social media discourse. This was a short lived trend towards barefoot running which began around 2009 with an increase of interest in running free of running shoes. It was stated in numerous books, websites and magazine content that barefoot running was more natural, that it was a more economical technique to run and that you got a lesser amount of injuries running barefoot. Many runners tried out barefoot running instead of using running shoes and fascination with it peaked about 2013. The sales of minimal or barefoot running shoes furthermore peaked about that time, achieving almost 10% of the running shoe market.

After that initial interest and peak interest in barefoot running and minimalist running shoes were gradually decreasing. Runners lost interest in running barefoot. The sales of the minimalist running shoes have been dropping steadily since about mid- to late 2013. The promoted advantages for it did not eventuate to most runners that tried barefoot running but, naturally, those who publicized barefoot running just are convinced that those runners were doing it incorrectly. When the scientific research was published, the benefits were not just there. All of the running injury epidemiology reports were showing that the risk of injury was the same had you been running in footwear versus running without running shoes and most of the running economy investigations were also demonstrating that generally there weren’t any systematic advantages.

While some runners, that are rather vocal, still do their running barefoot the big trend has now been towards maximalist running shoes with the Hoka One One running shoe being the innovator in that category of running shoes. It has now reached the stage where that brand now outsells the entire group of minimalist running shoes which provides a clear indication of the popularity of cushioned running shoes compared to running barefoot.

Austin Bunionectomy

Bunions, or more precisely, hallux valgus or hallux abducto valgus occurs in many shapes or forms. The disorder is one of an enlargement of the big toe or hallux joint of the foot (bunion) and an angling over of the big toe or hallux laterally in the direction of the smaller toes (abduction and valgus). They become sore because of arthritis like symptoms from the deviation of the great toe or hallux and from stress on the enlargement of the bunion from the shoe. They’re one of the most frequent causes of pain in the feet and are caused by a combination of inherited features, weak biomechanics and also shoe fitting problems. Even though there are conservative options such as pads, splints, better shoe fitting, exercises and pain alleviation medicine which you can use, they don’t make the bunion go away nor straighten the hallux over the longer term. Often surgical treatment is the only permanent answer to bunions or hallux valgus. Nevertheless, unless the specific reason for the bunion had been attended to at the same time there’s a possibility that it may occur again.

There are various joints and bones involved in the development of bunions and each situation differs as differing amounts of each bone and joint are involved. Because of this the surgical repair must be directed at the bone or joint which is involved. If the great toe or hallux joint is just involved, then a straightforward chopping off the enlarged bone is perhaps all that is needed. If the angle of differing bones are a issue, then a V is going to need to be taken out of the bone and the bone reset. There are many different ways of carrying out that and it has been believed that this condition has more surgical options for it compared to all other problems!

The Austin bunionectomy is only one kind of procedure. This procedure entails removing the enlargement of bone and taking a v out of the head of the 1st metatarsal to realign it and hold it in position using a screw so it can heal. A special shoe or boot needs to be worn through the first few weeks following the surgery and go back to your typical footwear after about 4 weeks. It generally takes about 8 weeks to return to full activity levels following this surgery.

New Running Shoe from Asics


Asics is just about the most well-known and widely used athletic shoes available on the market. Like any athletic shoe brand they will continue to innovate to keep that market leading position. Asics currently have a variety of running shoes with different versions to try and meet the needs of a wide range of runners. Each of those versions is frequently updated. Asics recently announced a different model to the range, the Metarun. Not much was initially known about the footwear, simply a taster video clip on the Asics website and a countdown clock ticking down to a launch on November 12 2015. When the clock reached zero a tweet was dispatched by Asics to a video which revealed more details and the web page was updated with more on the running shoe. They are certainly declaring that this is their best ever running shoe.

The Metarun shoe goes against the current tendencies of fewer gadgets and features in athletic shoes, adding several features which have patents associated with them. The midsole, labeled FlyteFoam, is their lightest and most sturdy midsole material. They mention “organic fibers” for the best level of cushioning. The shoe gets its stability from the patented AdaptTruss which is a carbon strengthened adaptive stability product. The “Sloped DUOMAX” is a dual density midsole which is meant to adjust efficiently to dynamic movement of the athlete. The upper features a glove-like, one-layer Jacquard Mesh as well as MetaClutch exoskeleton external heel counter with a built-in memory foam. There’s also a X-GEL hybrid high-tech gel in the midsole to aid cushioning.

Is it their finest running shoe ever? Time will tell. Athletes will vote with their feet after they test the Metarun. There was a bit of discussion in social media prior to the release. These shoes won’t be obtainable until late November plus they are likely to be expensive and just obtainable in restricted release.

The Springblade from Adidas

adidas springblade

The Adidas Springblade athletic shoes are quite a different and strange running shoe. It has only been in the market for about a year to varying opinions. The main feature of the Springblade are, as the brand suggests, individual blades that produce a spring action for both cushioning and energy return to move the runner ahead while running. The footwear was developed over the 6 years and had been put through extensive evaluation for the resilience, comfort, and energy in order that the different versions would fit runners of all types. They just do not match all runners and weren’t actually designed for running long distance which is what some of the critics of the shoes have tried to use the shoe for. They are probably more suited to runs on the track or trails, with shorter runs on the road.

There are various types of the Springblade out there. You have the Adidas Springblade Drive that is created to be there all-rounder running shoe form this range. It offers the ESM-mesh technology which is supposed to help improve the breathability as well as comfort while at the same time staying very conforming to the form of the feet. The Drive is suggested to be the best option for those seeking a more all purpose cross-training shoe and simply want one shoe that addresses all of their requirements. The next shoe in the line-up is the Adidas Springblade Razor which is more firm than the Drive so that it supports the foot better in place. It is devised for runners using the track alot more for faster training as opposed to the road. The last shoe in the selection is just called the Springblade. It is considered the workhorse of the Adidas range. The shoe features a tech-fit upper construction that does trade-off some levels of breathability for further flexibility and comfort. An additional different feature of this range is when you order the footwear through the website, you can personalize it by incorporating personalized reaches.

The Accessory Navicular

The accessory navicular is a supplementary bit of bone on the inside of the foot just on top of the mid-foot in the vicinity of its highest part. The bone is included within the tibialis posterior tendon that attaches to the navicular bone towards the top of the mid-foot ( arch ). The additional bone can also be known as the os navicularum or os tibiale externum. This is genetic, so is existing since birth. There are a few different kinds of accessory navicular and the Geist classification is most typically used. This classification divides the accessory navicular into 3 varieties:

Type 1 accessory navicular bone:
This is the classical ‘os tibiale externum’ and make up 30% of the occurrences; it is a 2-3mm sesamoid bone embedded inside the distal area of the tendon with no link to the navicular tuberosity and could be separated from it by up to 5mm

Type 2 accessory navicular bone:
This type makes up 55% of the accessory navicular bones; it’s triangular or heart-shaped and connected to the navicular bone through cartilage. It may well eventually join to the navicular to form one bone.

Type 3 accessory navicular bone:
Prominent navicular tuberosity. This could have been a Type 2 that has fused to the navicular

The typical symptom associated with an accessory navicular is the enlargement on the inside side of the mid-foot ( arch ). Because of the additional bone there, this impacts how well the mid-foot muscles do the job and may lead to a painful foot. Inflexible type shoes, like ice skates, may also be very uncomfortable to use because of the enlarged pronounced bone.

The treatment is geared towards the signs and symptoms. When the flatfoot is an issue, then ice, immobilisation and also pain relief medication may be required to start with. Following that, physical therapy and foot orthotic inserts to aid the foot are used. When the soreness is a result of pressure from the type of shoes which needs to be used, then donut type padding is required to get pressure off the painful region or the shoes might need to be modified.

If these non-surgical therapies fail to reduce the symptoms of the accessory navicular or maybe the issue is an ongoing one, then surgery may be a suitable option. This requires removing the accessory bone and restoring the insertion of the posterior tendon so its function is improved.

Abebe Bikila

Abebe Bikila was a marathon runner from Ethiopia, winning dual Olympic gold medals: Rome in 1960 and Tokyo in 1964. He died in 1973 at the age of forty one from troubles after having a car accident. There’s a arena in Addis Ababa named after him. Google recognized him with one of Google’s doodles on which would have been his 81st birthday on 7 August 2013.

Abebe Bikila

1960 Olympic Marathon in Rome:
Abebe was a last minute substitute in the Ethiopian squad for that Olympics. He had no athletic shoes to run in and Adidas, the official sponsor only had a few pairs left that didn’t fit him, and so he competed in the marathon without running shoes (he previously had been running without running shoes). He won the race in a time of 2hr 15min. After the marathon, responding to an inquiry as to why he ran without shoes, Bikila answered: “I wanted the whole world to know that my country, Ethiopia, has always won with determination and heroism.

1964 Olympic Marathon in Tokyo:
Forty days before the Olympics he was operated on for an serious appendicitis and at one stage it was believed that he would probably struggle to take part. Abebe went on to win this marathon in a world record time of 2hr 12min, being the first runner to win two Olympic marathons. Bikila was using Puma athletic shoes in the race (which he also competed in to finish 5th in the 1963 Boston Marathon).

Abebe is an easy to mild heel striker with some midfoot strikes as well. Despite that, he is not overstriding and did break a world record. Bikila is oftentimes held up by the barefoot running community as a idol for running the marathon without running shoes (as well as other elite athletes). Critics of that like to point out that he did compete faster and break a world record when using running shoes.

As part of Abebe’s legacy, the minimal running shoe maker, Vibram FiveFingers have the Bikila model of their range branded after abebe. Early in 2015, the descendants of Abebe Bikila announced they were beginning a law suit against Vibram for registering the ‘Bikila’ name without authorization.