Archive for March, 2011

Good Morning! As many of you know diabetes affects the health of your feet.  Many of the patients that we see daily are suffering from diabetes.  So, today we wanted to share some important information with you from our friends at the American Diabetes Association.  TODAY (Tuesday, March 22nd) is Alert Day and Americans are encouraged to take the risk test to see if they are at risk for developing diabetes.  We encourage you to take a few minutes out of your day today to take the test.  Here are more details from the American Diabetes Association:

Take the Risk Test TODAY!

Tuesday, March 22, 2011 is the 23rd annual American Diabetes Association Alert Day, a one-day, “wake-up” call  asking Americans to “Join the Million Challenge” by taking the Diabetes Risk Test and find out if they are at risk for developing type 2 diabetes and if they are at high risk, to speak with their health care provider.

At the end of 2010, the American Diabetes Association surpassed their goal of inspiring one million Americans to join the American Diabetes Association’s movement to Stop Diabetes®.  To continue this momentum, the Association is asking the public to “Join the Million Challenge” by rallying one million people to take the Diabetes Risk Test and find out if they are at risk for developing type 2 diabetes, beginning on Diabetes Alert Day on March 22, 2011 and ending April 22, 2011.

Diabetes is a devastating disease that affects nearly 26 million Americans including. A quarter of those affected by diabetes are not aware that they have the disease.  If current trends continue, one in three American adults will have diabetes by 2050. In addition, approximately 79 million, or one in three American adults have prediabetes, which means that their blood glucose (sugar) is higher than normal but is not high enough to be classified as diabetes.  Without intervention, individuals with prediabetes are at a much higher risk for developing type 2 diabetes.  Seeking to change the future of diabetes, the American Diabetes Association is using Diabetes Alert Day to help identify the undiagnosed and those at risk for type 2 diabetes by educating people about diabetes risk factors and warning signs.

Unfortunately, people with type 2 diabetes can live for years without realizing that they have this serious disease. While some people with diabetes exhibit noticeable symptoms (such as frequent urination, blurred vision and excessive thirst), most people diagnosed with type 2 diabetes do not experience these overt warning signs at the time that they develop the disease.  Often, type 2 diabetes only becomes evident when people develop one or more of its serious complications, such as heart disease, stroke, kidney disease, eye damage or nerve damage, which can lead to amputation.

2011 Diabetes Alert Day

“Studies have shown that type 2 diabetes can be prevented or delayed by losing just 7% of body weight (15 pounds if you weigh 200) through regular physical activity (30 minutes a day, five days a week) and healthy eating,” said Gina Perales Hethcock, Director of Communications and Hispanic Initiatives for the North Texas office. “The American Diabetes Association hopes that this American Diabetes Association Alert Day will encourage people to ‘Join the Million Challenge.’ By understanding your risk, you can take the necessary steps to help prevent the onset of type 2 diabetes.”

To help people determine their risk for type 2 diabetes, the American Diabetes Association provides the Diabetes Risk Test, which entails answering simple questions about weight, age, family history and other potential risk factors for diabetes. People at high risk are encouraged to speak with their health care providers.  You can “Join the Million Challenge” by getting your free Diabetes Risk Test (English or Spanish) at, 1-800-DIABETES (1-800-342-2383) or text JOIN to 69866 (Standard data and message rates apply).  Although Diabetes Alert Day is a one-day event, the Diabetes Risk Test is available year round.

The Association is also encouraging the public to help spread the word about Diabetes Alert Day by sending out messages on Facebook and Twitter.  You can download a Diabetes Alert Day application to post on your Facebook page or you can tweet about the importance of understanding one’s risk for type 2 diabetes and provide a link to the Diabetes Risk Test at

The primary risk factors for type 2 diabetes are being overweight, sedentary, over the age of 45 and having a family history of diabetes.  African Americans, Hispanics/Latinos, Native Americans, Asian Americans and Pacific Islanders are at increased risk, as are women who have had babies weighing more than nine pounds at birth.



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Team Blue Ridge Foot and Ankle

March 10th, 2011 by Dr.Chang

One of our Charlottesville team members, Amy, coaches soccer and cheerleading for her county parks and recreation department.  This Spring, we are very excited to sponsor her soccer team.  We will be posting more photos throughout the season but wanted to share the jerseys for now.  Go Team Blue Ridge Foot and Ankle!

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What Makes Amy Sweat?

March 7th, 2011 by Dr.Chang

Hopefully you caught our blog post last week about partnering with Amy to help keep her feet healthy as she trains for an upcoming race.  In that post, we mentioned that Amy does a lot of her training at Clay Fitness in the Belmont area of Charlottesville.  They were featured on ‘Make Dan Sweat’ last week so we thought we would share the story with you to give you an idea of the type of training Amy is doing (in addition to her running). Click on this image for the full story:

Coincidentally, we fitted Dan for orthotics on a past episode of ‘Make Dan Sweat’ as well and hope they helped him out during that intense work out!





Helping Amy Find Amy Again

March 3rd, 2011 by Dr.Chang

This week we had the pleasure of meeting with Amy (you may know her as Suzy from SuzySaid) about some problems she is having with shin splints as she adds running to her current exercise routine.

For the past 9 months or so Amy has been focusing on finding herself again through exercise and a healthy lifestyle.  To keep herself motivated, she is documenting her journey on her blog, Finding Amy Again.

The things that she is experiencing are very similar to the plight of many of our patients.  They are well intentioned thirty and forty something’s who have lost their youthful athletic prowess and are now returning to the sports arena only to get injured in the process.  We have partnered with her to keep her feet and ankles healthy and we will document her progress on our blog in hopes that it will inspire other people who are in the same ‘shoes’ as Amy.

Our meeting began with a conversation about her exercise routines.  Amy trains at Clay Fitness and has more recently started added running to her routine.  She shared with us that she really wants to train for a local race (she has already done a 4 miler!) but her shins are making it very difficult to complete more than 2-3 miles without a lot of pain. She exercises in shoes fitted to her by local running shoes experts at the Ragged Mountain Running Shop.  Her running shoes are neutral positioning shoes and are not worn.

The pain that she experiences is inside and outside on her anterior shin bone (tibia) and comes with high intensity activity.  It shows up when doing her Clay Fitness circuit training after about 20-30 minutes or when running at about 3 miles or so.  The condition resolves slowly after stopping activity.  The recovery day that follows bring about substantial soreness in the same areas.

We did a quick evaluation of Amy’s foot structure and stance.  She has an upright rectus Cavus foot structure.   We must emphatically note that the cavus foot is a poor shock absorber and rather unforgiving foot. It does not accommodate the ground or uneven surfaces very well.  We immediately suspected this may be a root of the cause of her problem. You can find more information on cavus foot here .

Our conclusion: Amy has classic signs of shin splints (listed below).  This is a fairly common condition for an individual who is beginning a new exercise regimen and has an existing foot structure prone to it’s development.

So what are shin splints exactly?
The term shin splints is a name use often to describe any pain in the front and lower leg.  However, the “true” shin splint is reserved for pain, arising from a number of causes, at the front inside edge of the shin bone (tibia).  The most common cause is inflammation of the periosteum (sheath of tissue surrounding all bones) of the tibia.  This inflammation is a result of repetitive traction forces of the muscles of the lower legs that arise at these locations on the bones.  The tern Medial Tibial Periostitis is often used for shin splints.

Amy has some of the classic signs for shin splints:
1.    Pain over the lower half of the shin bone
2.    Pain at the beginning of exercise which settles as the session continues, but returns when fatigue levels are reached.
3.    Pain returning after activity and may worsen next day
4.    Swelling
5.    Focal “lumpy/bumpy” tissue on inside of the shin bone
6.    Pain on range of motion toe and feet in downwards position.
7.    Redness on inside of shin bone, usually present with swelling if occurs.

Causes of shin splints are centered around abnormal biomechanics (patterns of movement) and errors in training.  Some common causes are:
1.    Over pronating (flattening)  feet
2.    Over supinating (arching) feet
3.    Inadequate and unsupportive shoes
4.    Increasing training too soon
5.    Running on uneven surfaces
6.    Inappropriate warm-up/cool-down and stretching

Treatment Strategies
The most important element in long term management of shin splints is to control the abnormal mechanical issue.  The most immediate problem to address is the acute inflammation at the muscle bone interface.

Acute inflammation is resolved with R.I.C.E. principles (Rest ice compression and elevation.  ) and anti-inflammatory medication.

Biomechanical problems are addressed with taping, appropriate shoes, and well designed  shoe orthotics.

When shin splints are active.  Cease the causative exercises and start cross training to rest the injured area.

For Runners, avoid hard pavements and uneven surfaces.  Tarmac, grass and trail runs can reduce shock to the legs and feet.

As a rule of thumb with running, distances should not increase by more than 10% per week.  This help to prevent over use injuries.

Shin splints can be caused by tight posterior lower leg calf muscles (gastroc, soleus, and posterior tibialis).  Regular regimented stretching daily and deep muscle massage can improve flexibility

So what did we do for Amy?
1)    Prescribed over the counter inflammatory medication e.g. ibruprofen
2)    Performed analysis of foot in stance.  We will evaluate her gait next visit.
3)    Applied a plantar rest strapping (tape) to her feet and instructed on how to accomplish this on her own at home.  She should wear while exercising and when in next day recovery when she is sore.
4)    Advised patient to do deep tissue massage on the the posterior leg muscles, avoid inflamed areas of pain.  Do calf muscle stretching daily and pre/post exercise.

We will see how our initial treatment plan for Amy helps to resolve her symptoms over the next two weeks.   We expect the results to be good.  If plantar rest strapping (tape) helps, this is an excellent signal to us that orthotic therapy will help.  We will then proceed with manufacturing some custom orthotics for her.  The goals of orthotics therapy will be cavus foot shock absorption and subtalar joint stabilization and control.  Keep checking back to see how it’s going! We hope we can help Amy find Amy again.



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