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Stress is Everywhere– Even in our Feet

April 2018 is National Stress Awareness Month. Earlier this month on our Foot Doctor Blog, we featured how stress impacts the entire body and gave ways to combat stress. Being specialists in foot and ankle health, this article will specifically detail how stress impacts the feet. Stressed Feet Stress affects all of us in many ways: it can heighten our level of excitement and it can weigh us down and even make us sick. Physical stress can take its toll on our feet in the form of excessive wear and tear of the nails and skin and show up as overuse injuries like tendinitis or bone stress fractures. Excessive emotional stress or anxiety can have more subtle symptoms and be felt all the way to our toes. Many people may endure restlessness of the legs that disturbs their sleep or tensing of muscles that may adversely affect their gait. An anxiety attack involving hyperventilation and a sudden release of adrenaline in the body moves blood away from your feet and may produce uncomfortable burning and numbness, cold feet and even hyperhidrosis (sweating). The mind-body connection is powerful and must be considered when dealing with all injuries and illnesses. Being over-stressed results in perceived hypersensitivity and more painful symptoms that would normally not elicit such a response. Negative stress can negatively affect treatment outcomes, resulting in poor compliance, more discomfort, delays in healing, and a higher rate of complications. Stress cannot be ignored. As podiatric physicians, we evaluate and consider the entire person, not only focusing on their foot problem in order to enjoy optimal results.  
Dr. Gina M. Saffo works out of two offices for your convenience: Annapolis, MD and Greenbelt, MD.
Dr. Adam K. Spector works out of two offices for your convenience: Rockville, MD (Shady Grove Rd) and Wheaton, MD.
  The information on this site is provided for your assistance only; this site does not provide podiatric advice. You should never diagnose or treat yourself for a podiatric condition based on the information provided herein, and the information is not provided for that purpose. Likewise, you should never determine that treatment is unnecessary based on this information. The information contained herein is not a substitute for podiatric care provided by a licensed podiatric professional. The information provided herein is not podiatric, medical or professional advice. This site does not create a doctor-patient relationship. Drs. Saffo and Spector and Foot & Ankle Specialists of the Mid-Atlantic, LLC expressly disclaims all warranties of any kind, whether express or implied, related to any products offered for sale on this web site. Drs. Saffo and Spector and Foot & Ankle Specialists of the Mid-Atlantic, LLC further expressly disclaims any product warranties of effectiveness or fitness for any particular purpose or use. You are solely responsible for your use of, or reliance on, any products offered for sale herein, and any consequences arising out of such use or reliance. In no event will Drs. Saffo and Spector and Foot & Ankle Specialists of the Mid-Atlantic, LLC be liable for any damages resulting from use of or reliance on any such products, whether based on warranty, contract, tort or any other legal theory. This website, and the information contained herein, is provided to you as a service for use at your sole risk.

Don’t Let Stress Get to You

April 2018 is National Stress Awareness Month. Health Care Professionals and Public Health Experts will promote public awareness of the causes, signs/symptoms, and treatment options for managing stress. Stress affects us all. It is defined as our body’s way of responding to a demand or threat, whether physical or emotional. Physiologically, our nervous system releases stress hormones, such as cortisone or adrenaline, that initiate a “fight or flight” response. This manifests as symptoms of increased blood pressure, faster breathing and heart rate, and muscle tightening. These physical changes can then increase strength/stamina, reaction time, and enhance focus. Causes of stress can include physical, such as chronic illness or injury, or mental, such as anxiety or fear. Emotional causes of stress can include work-related stress (losing a job), financial worries (paying off debt), and changes to interpersonal relationships (divorce or losing a loved one). Chronic physical or emotional stress, if not handled correctly, can lead to more serious health problems: an increase in heart attack or stroke, suppression of the immune system, weight problems, sleep issues, skin conditions, prolonged pain or fatigue, and digestive and reproductive issues. Chronic stress can leave a person more vulnerable to anxiety, depression, and feelings of isolation. There are simple ways to combat stress and these can be managed either through personal changes or by seeking medical attention.
  1. Exercise: Research has shown that just 30 minutes a day of cardiovascular exercise can help boost mood, reduce cortisol levels, and improve clarity and focus.
  2. Diet: Eat a diet rich in fresh fruit and vegetables, lean protein, and omega-3 fatty acids to reduce cortisone levels and boost the immune system and lower heart disease.
  3. Sleep More: Sleep allows our brain to re-charge, repair muscle, and improve memory. Adults who get at least 8 hours of sleep at night are more likely to have improved memory, energy, and motivation during the day to manage daily stresses.
  4. Relax and Connect: Practice yoga, meditation, and deep breathing to boost levels of joy, serenity, and calm. Ask for help from family, friends, community groups, or religious organizations to provide emotional and other support.
  5. Talk to Your Doctor: If stress is creating health issues, address them early on with a medical practitioner. Intervention can include prescription medication, nutritional support, counseling, and support groups.
  Dr. Saylee Tulpule works in two offices for your convenience- Silver Spring, MD (Fenton) and Washington, DC (I Street). The information on this site is provided for your assistance only; this site does not provide podiatric advice. You should never diagnose or treat yourself for a podiatric condition based on the information provided herein, and the information is not provided for that purpose. Likewise, you should never determine that treatment is unnecessary based on this information. The information contained herein is not a substitute for podiatric care provided by a licensed podiatric professional. The information provided herein is not podiatric, medical or professional advice. This site does not create a doctor-patient relationship. Dr.  Saylee Tulpule and Foot & Ankle Specialists of the Mid-Atlantic, LLC expressly disclaims all warranties of any kind, whether express or implied, related to any products offered for sale on this web site. Dr. Saylee Tulpule and Foot & Ankle Specialists of the Mid-Atlantic, LLC further expressly disclaims any product warranties of effectiveness or fitness for any particular purpose or use. You are solely responsible for your use of, or reliance on, any products offered for sale herein, and any consequences arising out of such use or reliance. In no event will Dr. Saylee Tulpule and Foot & Ankle Specialists of the Mid-Atlantic, LLC be liable for any damages resulting from use of or reliance on any such products, whether based on warranty, contract, tort or any other legal theory. This website, and the information contained herein, is provided to you as a service for use at your sole risk.

The Link Between Proper Nutrition and Wound Healing

As a former nutritionist (in my last life, prior to podiatry school), I worked in a hospital as a dietician and was exposed to the different nutritional needs of patients. Where as I can’t say I was well versed in wound care at that time, (was there even a discipline known as wound care back then??), I did counsel patients on proper dietary goals for the hypertensive patient, the diabetic patient, the renally impaired patient, the cardiac patient, etc. Even then it was challenging to motivate patients to be personally responsible for their dietary needs/ constraints let alone to understand the basics of nutrition. Now as a podiatrist, dealing with wound care day in and day out, and trying to educate people on obesity, effects of diabetes on the foot, the importance of exercise etc, the challenge is even greater.  

Why is Proper Nutrition Important?

Without proper nutrition, the intricate process of wound healing can be adversely affected. A poor diet can turn a “normal” type wound into a chronic non healing wound quickly. In one phase of healing (anabolic), new tissue is created by bringing stress hormones, carbohydrates, fats, and mainly protein into the wound. However, if the first phase (catabolic) drags on too long, a phenomenon known as PEM or protein energy malnutrition can occur. This begins a negative cycle whereby the body will send extra protein to the wound site, but as a negative consequence, other important organs do not receive enough protein or further, lean muscle mass begins to break down. This ultimately will cycle back to delayed wound healing.  

The Role of Protein, Fats, and Carbohydrates

Protein is by far the most important of the required dietary components for a healing wound because it helps repair damaged tissue and serves as the “building blocks” used to create new tissue. It is important to increase the protein in one’s diet while trying to heal a wound and not allow the loss of any lean body mass as this can be detrimental to one’s general health as well as to the wound healing process. A healthy adult requires .8 g of protein/ kg of body weight /day or about 60-70 g protein to maintain and patients with wounds require almost double that. Losing lean body mass will impair wound healing and substantial loss of lean body mass can lead to the development of spontaneous wounds such as pressure ulcers and even wound ruptures (dehiscences). Nearly all consumed protein is used for synthesis NOT for energy. Carbohydrates which have gotten a bad “rap” of late in the diet world are actually essential in the diet of someone trying to heal a wound. Carbohydrates fill the role for energy use and have other important functions. They work together with proteins to build structure and communicative properties. Glucose, which has many functions, is interestingly also used for inflammatory cell activity leading to the removal of bacteria and other harmful material. Fats from dairy products are essential in wound healing. Cell membranes are created with the use of fatty acids and one needs extra fats in order to propel wounds to heal. Lipid components are responsible for tissue growth and wound remodeling including collagen and extracellular matrix production.  

The Importance of Vitamins and Minerals

Vitamins and minerals are also key factors in wound healing. There are several vitamins and minerals which contribute positively in wound healing, but the three main ones are Vitamin C, Vitamin A, and Zinc. Vitamin C is an important antioxidant. It increases the strength of the wound as it heals and helps with the creation of collagen in the skin. It is important in the development of new blood vessels and also helps with iron absorption. As little as two hundred mg of Vitamin C daily can be significant in wound healing. Vitamin A is another crucial antioxidant. It helps fight infection and aids in controlling the overall inflammatory response. It should be noted that because Vitamin A is fat soluble and not water soluble, toxicity can actually occur if consuming too much. Red fruits, fish, eggs and dark green vegetables are good sources of Vitamin A. Zinc, a mineral, helps the body synthesize proteins and develop collagen. It is involved with DNA synthesis, protein synthesis, and increases the number of cells. Other minerals such as manganese, arginine and selenium in trace amounts can be helpful with wound healing.  

Lab Work as Indicators of Wound Healing

Clinical factors to be on the lookout for, would be checking for albumin (protein) in routine lab work, which if too low is an indicator of poor wound healing. Also a low body weight, less than 85% of ideal is a risk factor as is a 5-10% loss of body mass over 1 month. Lastly when obtaining routine lab work, a decrease in serum transferrin (iron levels) can also be a risk indicator for poor wound healing.   Hopefully by taking a few of these concepts into account, we can become better equipped to deal with the ever so omnipresent foot wound. Dr. Betsy Rosenthal works in our Hagerstown, MD office. The information on this site is provided for your assistance only; this site does not provide podiatric advice. You should never diagnose or treat yourself for a podiatric condition based on the information provided herein, and the information is not provided for that purpose. Likewise, you should never determine that treatment is unnecessary based on this information. The information contained herein is not a substitute for podiatric care provided by a licensed podiatric professional. The information provided herein is not podiatric, medical or professional advice. This site does not create a doctor-patient relationship. Dr. Betsy Rosenthal and Foot & Ankle Specialists of the Mid-Atlantic, LLC expressly disclaims all warranties of any kind, whether express or implied, related to any products offered for sale on this web site. Dr. Betsy Rosenthal and Foot & Ankle Specialists of the Mid-Atlantic, LLC further expressly disclaims any product warranties of effectiveness or fitness for any particular purpose or use. You are solely responsible for your use of, or reliance on, any products offered for sale herein, and any consequences arising out of such use or reliance. In no event will Dr. Betsy Rosenthal and Foot & Ankle Specialists of the Mid-Atlantic, LLC be liable for any damages resulting from use of or reliance on any such products, whether based on warranty, contract, tort or any other legal theory. This website, and the information contained herein, is provided to you as a service for use at your sole risk.