August 2009

Out on a Limb: Thinking big

Jordana Second Headshot LERObesity is a big problem, one that seems to just keep getting bigger. But you can be a big part of the solution.

Maybe you’ve memorized the statistics: more than one-third of adults in the U.S. are obese and two-thirds are overweight, double the prevalence of just 25 years ago. Or maybe you’ve noticed a shift in your practice patterns—more cases of osteoarthritis and diabetes, wounds that take longer to heal, orthotic devices that seem to need replacing more often than they used to.

Nearly every aspect of the lower extremity can be adversely affected by obesity. Extra pounds mean extra loads on bones, joints, ligaments and tendons. If those extra pounds stem from a sedentary lifestyle, that can lead to bone loss and atrophied muscles that are even less able to protect the joints from excessive loading. Obesity in conjunction with a poor diet can contribute to diabetes, which in turn puts patients at risk for peripheral neuropathy, foot ulcers, osteomyelitis, Charcot arthropathy, and amputation. And impaired circulation can compromise healing in the lower extremities, particularly in the most distal areas.

Lower extremity practitioners have dealt with the consequences of obesity for years. But any good practitioner knows that no disease can be eradicated with treatment that focuses only on the symptoms and ignores the underlying cause. That’s why, increasingly, lower extremity specialists are taking a more holistic approach to managing their obese and overweight patients.

In addition to treating foot ulcers, they’re advising patients about insulin levels. Rather than just brace a painful knee, they’re encouraging patients to accelerate the offloading process by dropping a few pounds.
As described in this month’s cover story, evidence suggests that weight loss is one of the most effective early interventions for knee osteoarthritis. Not only does weight loss decrease loads on the knee, reductions in adiposity may also help combat chronic inflammation

When former Arkansas governor and presidential hopeful Mike Huckabee gave the keynote speech at the annual meeting of the American Podiatric Medical Association in July, much of his address dealt with his own struggle with diabetes. But Huckabee wasn’t there to talk about foot ulcers and amputations. He was there to testify that, after losing 100 pounds through a combination of diet and exercise, his diabetes had been cured.
And over on the APMA exhibit floor, a nutritional foods company called Ideal Protein was handing out samples of the high-protein chips, smoothies and vegetarian chili that are staples of its dietary plans. The company had never exhibited at a podiatry conference before, but had a sense that the time was right.

Often, a patient will have no idea that their weight and related co-morbidities are contributing to their lower extremity problems. They just know they have pain, or that there’s a lesion on their foot that won’t go away. So they don’t go to a nutritionist, or an endocrinologist, or even a primary care physician. Instead, they come to you.

Of course you can refer them to another specialist, and you should. But it’s never too soon for that patient to start thinking about a lifestyle change.

And that can only help your clinical outcomes. In a big way.

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