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Caring for body from the bottom up

Dr. John Hurley is familiar with many of the issues he sees in his Excelsior Orthopaedics and Sports Medicine practice.

The Hamburg native ran track and field at Frontier High School, played soccer all four years at Canisius College and took up distance running to ease stress while in a residency program in Atlanta.

He had to stop running in 2000, a decade after he returned to Western New York to open his first practice.

“It was from wear and tear,” he said. “I inherited my father’s genetically unstable knees.”

Both his parents also have Type 2 diabetes, as do many of his patients.

Hurley, 61, a podiatrist, and his wife, Ellen, live in Snyder. Their children Patrick, Christopher and Meagan, bought their dad a stationary trainer for his road bike for Christmas. He’s been riding in the garage until the weather breaks and he and his wife can hit the Northtowns bike paths.

Q. What are you doing to prevent Type 2 diabetes and take care of your feet?

I wear good shoes and trade them out when I need them. I typically get two pairs a year. I work out a couple times a week on an elliptical trainer or stationary bike. I try to stay active, watch what I eat and exercise on a regular basis. Those are the things a doctor would regularly recommend.

Q. Why feet?

Unfortunately, I had a number of ankle and foot injuries while I was playing soccer and it was kind of a natural progression of what I was interested in as far as sports. I’d visited with a friend’s father who was a podiatrist to see what it was like. My friend and his twin brother are podiatrists, too.

Q. What are three key pieces of advice you wish all your patients would follow?

Inspect your feet regularly for any open sores or swelling. Diabetics need to be mindful of their blood sugars. And call before things get worse.

Q. How does the workload break down?

I see a wide variety of foot problems: some of the foot fractures that walk through the door, the toe fractures. I’ll see some of the heel fractures. Now that (orthopedic surgeon) Dr. Matthew Mann has joined the practice, I interact with him for something that might need a surgical approach. I see a lot of the foot sprains, a lot of the diabetic ulcers. I also do general podiatry care for diabetics and those with vascular issues. I handle plantar fasciitis, calluses, ingrown toenails, athlete’s foot. What I like about podiatry is you get a wide variety of patients during the day. You work with skin, with trauma, bunion surgery, hammertoe surgery.

Q. Outdoor running season is almost upon us? What injuries will you see more often in coming weeks?

We see a lot of stress fractures. It may be from people who had a layoff and ramp up their mileage too quickly. Tendinitis, as well. So we’re going to see overuse injuries. Every now and then, we’ll see someone who will trip while running and injure something. I’ll usually tell people if they’ve had a long layoff, start with low mileage, easy pace, and a Monday, Wednesday, Friday, or Tuesday, Thursday, Saturday schedule. Give yourself rest days and after five or six weeks, add a fourth day and increase time.

Q. Why is it important for people to take good care of their feet?

There are 26 bones and numerous joints in the foot. They have to function in harmony in order for the foot to operate efficiently. If you think of your foot as a lever, there’s a tremendous amount of work that goes in to walking every day. If there’s an infection in your foot that alters that, you can lose part of your foot or cause it to do extra work and that can have detrimental effects.

Q. Why have the number of diabetes cases exploded during the last quarter century?

Because Americans have become more sedentary. We’re in an epidemic of Type 2 diabetes in adults and we’re seeing cases in children. It’s unfortunate. A patient with Type 2 diabetes tends to be overweight. That is the predominant cause. There are dietary reasons and there’s a genetic predisposition. As people get older and don’t watch their sugar levels, the complications start to creep in. The two biggest complications are going to be peripheral neuropathy – or numbness in the feet – or peripheral vascular disease and circulation disorders. Those are the major complications in the foot and legs that cause people to lose parts of their feet and their legs. The neuropathy is a polyneuropathy, which means it affects muscles, blood vessels and skin texture, in addition to the sensory loss. You’re going to see people with a less mobile foot, with dry skin that tends to lead to calluses and breakdown of the skin. That leads to secondary infection. The vascular disease in diabetics tends to be below the knees more than above the knees, and tends to be in both legs. If you don’t have good inflow of circulation, it does tend to lead to circulation disorders.

Q. What are the best ways to prevent and treat foot ulcers?

Tompson Reuters and Duke studies completed about four years ago found that a once-a-year visit to a podiatrist by a patient with diabetes resulted in an almost 50 percent decrease in diabetic foot ulcers and amputations. So it’s important for diabetics to see a podiatrist or have a primary care doctor look at their feet. The diabetic should have a baseline foot exam and lower extremity examination on at least a yearly basis. Diabetics with peripheral neuropathy or circulation or nerve disorders should see a podiatrist a couple times a year. There are patients in that population who come and see me three times a year for nails and calluses.

Q. How can a diabetic prevent foot ulcers?

Most foot ulcers are going to come to people with diabetes who have the nerve disorder and don’t feel pressure from a callus building up on their foot. I usually try to get those patients to shake their shoes out every single day. I can’t tell you the number of people who have come in with things in their foot and had no idea: screws, other things. They can’t feel them. Calluses should be treated. A callus acts almost like a stone on your foot. After a time walking on it, it will cause a sore on the bottom of the foot underneath the callus that may not be evident until it’s cleaned off, and then you have an ulcer underneath the callus. That’s a common occurrence in every podiatrist’s office in this area. Some people feel that taking the callus off causes the ulcer when actually the ulcer is being hidden by the callus. That’s a misconception that’s hard to change for some people.

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