You have asked a complex question. I will try to explain this as clearly as I can. People who have diabetes have a lack of insulin in their blood. Insulin is made in an organ called the pancreas. Insulin is important to allow glucose (blood sugar) to get into the cells of the body. Put another way, insulin opens the door to let blood sugar to enter most cells in the body. Blood sugar is a food for the bodies cells. If insulin is low or absent in the blood then the cells don't get fed the blood sugar they need. If the blood sugar can not get into the bodies cells then it builds up in the blood stream and the sugar count increases on the blood tests that we do. Also, as the blood sugar increases and can not get into the bodies cells it has the effect of drawing water out of the cells and shrinks them up making them even less healthy.

The nerves in the body are affected a bit differently. Nerve cells will allow blood sugar in with out insulin, however without insulin present the sugar is not used by the nerve cell properly and the sugar accumulates in the cell. Over time this will damage the nerve cell and cause the nerve to die. This causes numbness and tingling in the feet and sometimes in the hands.Blood vessels are also made up of cells. As the sugar builds up in these cells it swells them up and this causes a narrowing of the blood vessel. This causes a decrease in the circulation to the feet, the kidneys and the eyes. This is why people with diabetes often loose their legs their eye sight and kidney function.

It is very important that people with diabetes learn about their condition, control their blood sugar, and exercise.

Shin splints are usually caused by exercise such as running, jumping, swimming, cycling, dancing or other sports.  The onset of shin splints is most common after exercise, caused by high impact training, excessive training, poor technique or biomechanical problems such as flatfeet or pronation.  Many cases of shin splints may be due to improper footwear, standing for long periods of time or wearing high-heeled shoes. 

How are shin splints treated?
Treatment for shin splints is as simple as reducing pain and inflammation and identifying training and biomechanical problems which may have helped cause the injury initially.  The following are tips to help treat shin splints:

• rest to allow the injury to heal
• apply ice in the early stages to reduce pain and inflammation
• stretch the muscles of the lower leg
• maintain fitness with other non weight bearing exercises such as swimming and cycling
• apply heat and use a shin and calf support
• take anti-inflammatory medication  

Shin splints are most commonly caused by inflammation of the periosteum of the tibia, which is the sheath surrounding the bone.  It is a slow healing and painful condition.

A Podiatrist, Doctor of Podiatric Medicine (DPM), is the only health care professional whose total training focuses on the foot, ankle and related body systems. After obtaining an undergraduate degree, the podiatric doctor spends four years in a college of podiatric medicine to obtain a doctorate degree. Many podiatrists further their education by participating in a post-graduate residency program at an approved hospital or university. Following their doctorate degree, each podiatrist must pass national and state examinations in order to be licensed by the state in which he or she will practice.

The podiatric physician cares for people of all ages. Common disorders of feet include bunions, heel pain/spurs, hammertoes, neuromas, ingrown toenails, warts, corns, calluses, sprains, fractures, infections, and injuries. If your podiatric surgeon is certified by the American Board of Podiatric Surgery, he or she has successfully completed a credentialing and examination process and has demonstrated knowledge of podiatric surgery. This includes the diagnosis of general medical problems and surgical management of foot diseases, deformities, and trauma of the foot, ankle and related structures.

In a great number of bone procedures of the foot and ankle, your doctor many tell you that they are going to fix the bone with screws to hold them in place. Screws are used to secure two bones or bone fragments together to allow for compression of the bone to promote healing. This not much different than when you screw two pieces of wood together to hold them in place. This compression of bone helps to secure the bone together to produce what is known as primary bone healing. This type of healing is different from secondary bone healing, in that secondary bone healing producers a bone callus while primary bone healing does not. Complete bone healing typically takes 6 to 8 weeks, but may take longer in some cases. Screws also allow for immediate weight bearing in some procedures after surgery or for movement of your foot and ankle to regain strength in your muscles, particularly after a fracture.

These screws are made out of either a high-grade surgical stainless steel or titanium. Screws used in the foot range in sizes from 1.5 mm to 7.3 mm in size and have many different applications from fixation of fractures to arthrodesis procedures.

One of the most commonly asked questions is Will the screws set off metal detectors? The answer is no. These screws are non-magnetic and will not set off metal detectors. Additionally, you with not pick up radio waves. These statements are myths and have no relevance. In having these types of screws in your foot, you can also have a MRI test with complete safety.

Another commonly asked question is whether the screws need to be removed. The answer is maybe. Most screws do not need to be removed unless the screws are have come loose, are causing irritation or you want them removed. In the majority of cases, the screw does not need to be removed and can stay in your foot or ankle forever.

There is only one thing that you need to inform your doctor about if they state they are going to use screws. If you have an allergy to jewelry or metal, particularly silver or costume jewelry, you need to inform your doctor about this before surgery. This is very important because some screws contain nickel, which is a common component of costume and some silver jewelry. If you have a true allergy to nickel or stainless steel, an allergy patch test may need to be performed to determine if you are allergic to titanium.

Callus build up on the foot is due to abnormal pressure and friction as you stand and walk. It is important that the callus not get to thick or the skin under the callus can break down and cause an ulceration. It is not uncommon for me, when treating a diabetic patient with calluses on the feet, to trim a callus and find an ulcer under the callus. If the callus is not trimmed, then the infection can progress into the bone or deep into the foot. Good nutrition and vitamin supplements will help with healing but the most important issue is adequate blood flow. If you have bad circulation ask your doctor about hyperbaric oxygen treatment.

You should also discuss with your doctor about obtaining a diabetic shoe and molded insole to protect your foot.

A fracture is a partial or complete break in a bone. Fractures in the ankle can range from the less serious avulsion injuries (small pieces of bone that have been pulled off) to severe shattering-type breaks of the tibia, fibula, or both.

Ankle fractures are common injuries that are most often caused by the ankle rolling inward or outward. Many people mistake an ankle fracture for an ankle sprain, but they are quite different and therefore require an accurate and early diagnosis. They sometimes occur simultaneously.

Symptoms
An ankle fracture is accompanied by one or all of these symptoms:

• Pain at the site of the fracture, which in some cases can extend from the foot to the knee
• Significant swelling, which may occur along the length of the leg or may be more localized
• Blisters may occur over the fracture site. These should be promptly treated by a foot and ankle surgeon.
• Bruising that develops soon after the injury
• Inability to walk—however, it is possible to walk with less severe breaks, so never rely on walking as a test of whether a bone has been fractured
• Change in the appearance of the ankle – it will look different from the other ankle
• Bone protruding through the skin—a sign that immediate care is needed. Fractures that pierce the skin require immediate attention because they can lead to severe infection and prolonged recovery.

Diagnosis
Following an ankle injury it is important to have the ankle evaluated by a foot and ankle surgeon for proper diagnosis and treatment. If you are unable to do so right away, go to the emergency room and then follow up with a foot and ankle surgeon as soon as possible for a more thorough assessment.

The affected limb will be examined by the foot and ankle surgeon by touching specific areas to evaluate the injury. In addition, the surgeon may order x-rays and other imaging studies, as necessary.

Non-Surgical Treatment
Treatment of ankle fractures depends upon the type and severity of the injury. At first, the foot and ankle surgeon will want you to follow the R.I.C.E. protocol:

• Rest: Stay off the injured ankle. Walking may cause further injury.
• Ice: Apply an ice pack to the injured area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
• Compression: An elastic wrap should be used to control swelling.
• Elevation: The ankle should be raised slightly above the level of your heart to reduce swelling.

Additional treatment options include:

• Immobilization. Certain fractures are treated by protecting and restricting the ankle and foot in a cast or splint. This allows the bone to heal.
• Prescription medications. To help relieve the pain, the surgeon may prescribe pain medications or anti-inflammatory drugs.

Treatment after fracture has healed:

• Supartz.  Joint lubricating injections to decrease stiffness and breakup scar tissue, this is done once fracture has healed
• Bracing.  Often long term bracing to decrease mechanical stress

When is Surgery Needed?
For some ankle fractures, surgery is needed to repair the fracture and other soft tissue related injuries, if present. The foot and ankle surgeon will select the procedure that is appropriate for your injury.

Follow-up Care
It is important to follow your surgeon’s instructions after treatment. Failure to do so can lead to infection, deformity, arthritis, and chronic pain.

Early treatment for bunion pain is the best course of action. Bunions are progressive and early intervention will help control the rate of progression. If bunions are treated early the liklyhood of surgery is reduced or delayed. 

Dr. Timothy Young and Dr. Brandon Nelson were named Top Doctors for 2011 by Seattle Metropolitain magazine and have a dedicated resource for those with bunions. Bunions are a common condition treated by the "Top Docs" in podiatry and therefore have created the Washington Bunion Center. Visit the website for more information about bunion treatments.

If you have have exhausted non-surgical methods including bunion splints, prescription orthotics (we are no longer perfroming casting for orhotics, we now use the latest in 3-D imaging to create digital images of your feet to make our prescription orthotics), or changes or modifications in footwear. Surgery is considered the last course of treatment for bunions at our clinic. However, when conservative therapy is not decreasing pain or discomfort anymore, surgery is an option.

For many patients bunion surgery is chosen when their bunion interferes with daily activities or when footwear becomes increasingly painful or difficult to deal with.

Cirsumstances will determine if bunion surgery will be recommended. Considering bunions are a progressive disorder, the likelyhood surgery will be a recommended course of action increases over time. Many bunion patients do not need surgery!