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The Agony of the Feet as You Get Older

Making foot care a priority as you get older is important for maintaining a healthy and active lifestyle.

WHILE PEOPLE OFTEN PAY attention to how their feet look once sandal season comes around, they give their feet little TLC the rest of the year. Meanwhile, we pound our feet on the pavement or place three to four times our body weight on them when we jog, and we often subject our feet to tight or poorly-fitting shoes or precarious heels. Given these stresses and strains, it’s a wonder the human foot – with its 26 bones, 33 joints and complex matrix of ligaments, tendons, and muscles – doesn’t launch a full-scale rebellion.

But sometimes it does, especially as we get older. Indeed, a study in a 2016 issue of Maturitas found that foot pain affects 1 in 4 adults after age 45, and it’s at least somewhat disabling in two-thirds of those cases. Even worse, foot pain in older adults is associated with a 62 percent increased risk of recurrent falls, according to a study in a 2017 issue of Gerontology. “As we get older, our muscles and tendons lose elasticity, which can contribute to foot pain,” says Beth Gusenoff, a podiatric surgeon and clinical assistant professor in the University of Pittsburgh Medical Center’s department of plastic surgery.

It’s important to make your foot health a priority, especially as you get older, because “a healthy foot is a catalyst for mobility and a healthy lifestyle,” Gusenoff says. “Your feet really are your base of support.”

Here are six things you may not know about your aging feet, but should.

Obesity can increase your risk of suffering from foot pain. A study in a 2017 issue of the journal Obesity Research & Clinical Practice found that as people’s body mass index (or BMI) increases from the normal range to obesity, so do the odds that they will have foot pain as they get older; this is true for men and women. With excess weight on the body, “the foot can’t handle the mechanical load that’s being put on it,” Gusenoff says.

Unfortunately, obesity can create a vicious cycle where excess weight increases the risk of foot pain, which makes people less likely to engage in weight-bearing physical activities, which can lead to more weight gain, and so on, notes Dr. Clifford Jeng, medical director of the Institute for Foot and Ankle Reconstruction at Mercy Medical Center in Baltimore. Consider this extra incentive to shed excess pounds.

Loss of fat in the feet can make you more susceptible to foot pain. We’re all born with a certain amount of fat under our feet, especially under the heels and the balls of our feet, which allows for shock absorption. “As we age, the fat padding under our feet can atrophy – some people’s gets thinner more rapidly than others,” Jeng explains. Overtraining and then getting cortisone injections to reduce pain and swelling in the feet can accelerate the fat pad loss. When this happens, people often complain that it feels like they’re walking on hard rocks or marbles, which can lead to pain and flattening of the feet. What’s more, “losing the fat pad can make you more susceptible to stress fractures, bruised bones and balance problems as you get older,” Gusenoff notes. Since fat can’t be transplanted from other parts of the body – at least not yet – “the only thing that we can do is to supplement the fat pad with external cushioning like silicone,” Jeng says. You can buy insoles or gel pads to put in your shoes wherever you need the extra padding, including under your heel, under the ball of your foot or next to a bunion.

Compromised blood flow to the feet can cause or worsen foot pain. Various factors can affect the quality of blood flow to the feet, including whether you smoke or have diabetes, peripheral neuropathy or blood clots. Poor circulation to the feet is a problem because “diminished blood flow may manifest itself as frank pain when the soft tissues are not being perfused with enough circulation,” notes Tim Swartz, Chief of Podiatry at Kaiser Permanente’s Mid-Atlantic region. “Wound and tissue healing can also be a problem if there is compromised blood flow” to the feet. That’s why it’s essential to tell your doctor about any numbness or tingling you have in your feet, as well as any chronic diseases, such as diabetes, arthritis or vascular disorders.

Different foot ailments become more common with age. Bunions, hammertoes, fungal infections, corns and calluses can occur at any age. Meanwhile, certain foot ailments become more common as people get older. These include plantar fasciitis (pain in the bottom of the heel that occurs when the band of tissue that supports the arch becomes irritated and inflamed), posterior tibial tendonitis (in which the tendon that attaches the calf muscle to the bones on the inside of the foot becomes torn or inflamed), Achilles tendinitis and big toe arthritis, Jeng says. Persistent pain or swelling in the foot, especially when accompanied by compromised mobility, should warrant a visit to your doctor.

“Sometimes foot pain in the aging population is dismissed as due to age and tired feet, but there may be a true underlying cause of the pain that can be treated,” Gusenoff says. “Improving pain and keeping a patient mobile and active can be a catalyst for healthier living and a better quality of life.” She recommends doing basic stretches for your Achilles tendon, foot circles and balance exercises, such as toe and heel raises or standing on one foot. In terms of cardio workouts, cycling and swimming are easier on the feet because they’re not weight-bearing activities.

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Optic Imaging to Understand the Healing of Diabetic Wounds

A team of North American researchers demonstrated a label-free and more direct way to observe and quantify microvascular and metabolic healing mechanisms, as well as the biological response to a topical treatment, utilizing a multimodal microscope equipped with optical coherence tomography (OCT) and fluorescence lifetime imaging microscopy (FLIM).

Diabetes affects more than 29 million people in the United States, and this number is projected to double or triple by 2050. This disease causes many physiological complications, such as diabetic foot ulcers. Such impaired wound healing in diabetic patients is caused by a variety of physiological abnormalities, one of which is poor microcirculation, which is essential for normal wound healing.

A team from the Beckman Institute for Advanced Science and Technology in the USA investigated the healing mechanisms of a novel topical ointment for diabetic wounds that is capable of promoting angiogenesis by inducing local physiological conditions that mimic hypoxia. Angiogenesis has a crucial role in many diseases and physiological responses, including wound healing. The topical treatment that was investigated mimics hypoxia via inhibition of prolyl hydroxylase, a key regulator of hypoxia-inducible factor (HIF).

Currently, characterizations of wound healing and associated treatments rely heavily on visual inspection, digital photography, and ex vivo analysis. In recent years, several optical imaging techniques have proven beneficial in observing key biological events, both in vivo and ex vivo, in processes such as wound healing, at resolutions unparalleled by conventional techniques.

In this study, phase-variance OCT (PV-OCT) and FLIM were utilized to track the regeneration of the microvasculature network and the change in cellular metabolic activity, respectively, in wounded and healing skin in diabetic (db/db) mice.

PV-OCT imaging and analysis showed that the ear wounds in mice treated with this angiogenesis-promoting agent demonstrated a significant increase in vessel density. While additional studies are required to further understand the larger number of complex healing mechanisms involved in the skin wound-healing process, the cross-modality correlation between PV-OCT and FLIM presented in the study successfully relates the increase in vasculature density to the relative changes in cellular metabolism in living animals.

“Insights gained in these studies could lead to new endpoints for evaluation of the efficacy and healing mechanisms of wound-healing drugs in a setting where delayed healing does not permit available methods for evaluation to take place” concludes team member Stephen A. Boppart.

Reference: https://www.advancedsciencenews.com/optic-imaging-to-understand-the-healing-of-diabetic-wounds/

How can D’OXYVA help?

In an ongoing multiyear, multi-country, multicenter, randomized clinical trial on patients with diabetic foot ulcers, D’OXYVA has demonstrated speeding up diabetic wound healing and ultimately wound closure to an average of 5 weeks**.

In addition, D’OXYVA eliminated pain and improved quality of life factors such as sleep, appetite, and mood in just a week in 100% of subjects. No adverse events of any kind were reported during, and years after, the studies.

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Blood, Oxygen & Wound Healing: How It Works

Most of us take our natural wound-healing abilities for granted. You scrape your knee, clean it and wait for it to heal on its own. It seems pretty simple, right? Not exactly. The truth is, what goes on underneath that Band-Aid is a complex process that requires healthy blood flow to deliver the oxygen and nutrients necessary to heal, and if this process is interrupted, it can slow or prevent healing entirely.

Wound-Healing Process

Every wound goes through a continuous repair and healing process, which typically takes a few weeks to complete. For a wound to heal properly, the four wound-healing stages must be completed:

Stage 1: Hemostasis

Hemostasis happens immediately after an injury to skin causes bleeding. Your blood vessels constrict and reduce the flow of the blood to the injury site. Blood clots form within the injured blood vessels to prevent further blood loss.

Stage 2: Inflammation

Once a blood clot has closed the wound, the surrounding blood vessels are able to open up to deliver fresh nutrients and oxygen into the wound for healing. This process triggers macrophage, a white blood cell, to enter the wound, fight infection, oversee the repair process and send messengers, called growth factors, needed to heal the wound. Macrophage is the clear fluid you may see in or around the wound.

Stage 3: Proliferation

Proliferation is the growth and rebuilding phase, where blood cells arrive to help build new tissue to replace the tissue and cellular elements that were damaged during the process of wounding the skin. At this point, your body’s cells will produce a protein called collagen, which acts like scaffolding, to support the repair process.

Stage 4: Remodeling

The last wound-healing stage is remodeling, whereby the inflammation is gradually resolved and the collagen is deposited. New tissue takes the form of the original tissue and fills the area of the wound. We call this scar tissue, and while the wound may appear to have healed, it does not have the same strength as the normal tissue previously had. It may take several months to a year for the healed wound to gain full strength.

Image result for wound healing process

 

When Wound Healing Is Interrupted

For healthy adults, the four wound-healing stages progress naturally. For others, however, certain factors – especially poor circulation – can interrupt the body’s natural healing process, causing a wound to heal much more slowly, if at all. These wounds are called chronic wounds (wounds that do not heal in six to eight weeks despite normal treatment) and are most common in people with diabetes, high blood pressure, obesity and other vascular diseases. If not cared for or treated by a doctor, chronic wounds can lead to pain, infection, disability and possibly amputation of the affected limb.

Tips for Improving Circulation

The oxygen and nutrients that new blood carries to the wound are crucial to the healing process. By improving circulation and blood flow, more healing nutrients and oxygen reach the cells.

Eat a healthy diet.

A healthy diet promotes proper blood flow and can even speed up the wound-healing process. Eat the following power foods to make sure you are getting the right nutrients for optimal circulation and wound healing:

Protein: Lean meats, low-sodium beans, low-fat milk and yogurt, tofu, soy nuts and soy products

Vitamin C: Citrus fruits and juices, strawberries, tomatoes, spinach, potatoes, peppers and cruciferous vegetables

Vitamin A: Dark green, leafy vegetables; orange or yellow vegetables; cantaloupe and fortified cereals or dairy products

Zinc: Red meats, seafood and fortified cereals

Quit smoking.

There are a number of reasons to quit smoking and better your health. Beyond increasing risk for cancer and heart disease, tobacco can cause poor circulation and delayed wound healing. If you smoke, consult your doctor to devise a smoking cessation plan.

Stay hydrated.

Dehydration and poor hydration can greatly reduce circulation of blood and body fluids. Dehydration can also lead to poor oxygen perfusion, a failure to deliver essential nutrients to the wound surface and draining inefficiency. Drink eight 8-ounce glasses of water each day to improve blood flow and wound-healing abilities.

Talk to a wound specialist.

If you have a problem wound that just won’t seem to heal, schedule an appointment with your doctor to identify the underlying issue, discuss your treatment options and devise a plan of action that works for your lifestyle and needs.

Start your D’OXYVA Therapy

D’OXYVA (deoxyhemoglobin vasodilator) has been clinically studied to SIGNIFICANTLY INCREASE BLOOD FLOW volume in the microcirculatory system  to parts where it is needed the most.

Reference: https://www.unitypoint.org/livewell/article.aspx?id=2d59582b-3594-4e51-95d7-10d3f735bcc7

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The role of carbon dioxide therapy in the treatment of chronic wounds.

 

Abstract

A wound is defined as chronic when it does not heal according to the normal repair times and mechanisms. This particular condition may be principally due to local hypoxia.

Carbon dioxide (CO2) therapy refers to the transcutaneous or subcutaneous administration of CO2 for therapeutic effects on both microcirculation and tissue oxygenation. In this study, we report the clinical and instrumental results of the application of CO2 in the therapy of chronic wounds. The study included 70 patients affected by chronic ulcers. The patients were selected by etiology and wound extension and equally divided into two homogeneous groups.

In group A, CO2 therapy was used in addition to the routine methods of treatment for such lesions (surgical and/or chemical debridement, advanced dressings according to the features of each lesion). In group B, patients were treated using routine methods alone. Both groups underwent instrumental (laser Doppler flow, measurement of TcPO2, clinical and photographic evaluation.

In the group that underwent subcutaneous treatment with CO2 therapy, the results highlighted a significant increase in tissue oxygenation values, which was confirmed by greater progress of the lesions both in terms of healing and reduction of the injured area. Considering the safety, efficacy and reliability of this method, even if further studies are necessary, we believe that it is useful to include subcutaneous carbon dioxide therapy in the treatment of wounds involving hypoxia-related damage.

Reference: https://www.ncbi.nlm.nih.gov/pubmed/20363999

 

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Smart bandage can monitor chronic wounds and dispense drugs

Researchers are hoping that this new technology might reduce amputations.

Chronic or slow-healing wounds are an increasing problem around the world. That’s why a team of researchers at Tufts University is working on a smart bandage that can keep track of what is going on with a wound and release treatments as necessary.

According to a recent article in the journal Small, researchers led by Pooria Mostafalu sought to increase the healing rate of chronic wounds by creating a smart bandage. “The wound environment is dynamic, but their healing rate can be enhanced by administration of therapies at the right time,” the article says.

The smart bandage can monitor the temperature and pH of the wound. If it detects a change, it can diagnose the problem and dispense drugs as necessary, thanks to a central processor, which a doctor can program to administer treatment if certain conditions are detected. “A stimuli‐responsive drug releasing system comprising of a hydrogel loaded with thermo‐responsive drug carriers and an electronically controlled flexible heater is also integrated into the wound dressing to release the drugs on‐demand,” the paper says. The bandage will also monitor treatment to determine if further steps are necessary. It can also provide real-time status updates via Bluetooth.

smart

“Chronic wounds are one of the leading causes of amputations outside of war settings,” author Sameer Sonkusale told Digital Trends. Flexible and responsive bandages that can monitor a wound and deliver real-time treatment could be key in reducing the number of these amputations because they can treat a chronic wound quickly to prevent infection and promote healing.

Introducing technology into bandages isn’t a new concept; there are quite a few of these smart wound dressings floating around. This idea does have a lot of promise, though, especially because the bandage itself can dispense treatment rather than waiting for a doctor’s response. It will be awhile before it is available for real-world application (and it’s quite possible that it never will be). According to the article, the next step for the smart bandage is to test the technology on chronic wounds in animals to see if it is as effective as it was in the researchers’ experiments.

Reference: https://goo.gl/ppc4tg