Humans are on their feet most of their life. So why wouldn’t you want a proper pair of shoes?

Specifically, look for footwear that’s wide enough to prevent two common toe issues: bunions and hammer toe.

Marc Leonard, DPM, an OSF HealthCare podiatrist, sees these ailments frequently but stresses they are treatable without surgery when caught early.

Bunion

A bunion is when bones move out of place to form a bump on the toe joint, drawing the toe inward. Bunions are mostly seen on big toe, but they can happen on the pinky toe, too. This is called a bunionette or tailor’s bunion. Dr. Leonard says bunions are often caused by joint hypermobility, and they can also be genetic.

If pain from a bunion is not impacting your daily life, getting wider shoes or using a splint may do the trick. When the discomfort becomes intolerable, a doctor will discuss surgery.

“We make a cut in that bone, bring it over back into alignment and put some screws in,” Dr. Leonard explains. “Then we protect the area during post-operative course.”

The surgery is outpatient, and you typically can walk out of the doctor’s office. But beyond daily household activities, you should be off your feet for a month.

“We find the more people rest and elevate the foot, the better they feel. There’s less swelling and less potential for complications,” Dr. Leonard says.

Six to eight weeks after surgery, the person can resume exercise.

Hammer toe

Hammer toe is when a toe (usually one other than the big toe) contracts up, resembling a hammer.

“They make very prominent knuckles that can rub in the shoe and get red, irritated and sore,” Dr. Leonard describes.

Like bunions, splints and wider shoes are a short-term treatment, and outpatient surgery is possible for more severe cases.

“We remove some of the bone which allows the toe to reduce the contracture. Then, typically, we stabilize it in that new position with a wire for four weeks,” Dr. Leonard says. “Then that wire comes out. The toe should be more stable, straighter and hopefully not rub and cause the same pain it did prior to surgery.”

Recovery time is like bunion surgery but may be a little quicker.

 Finding footwear

The common link between bunions and hammer toe? A big step toward prevention is picking the right footwear.

“Cheapest is not best,” is an understatement, Dr. Leonard says.

“Things I recommend avoiding: flip flops, lighter weight canvas shoes or shoes that just don’t give you a lot of support,” Dr. Leonard adds. “Instead, I recommend a good, sturdy walking shoe. If you have to do a sandal or flip flop, get something that’s well-made with good arch support.”

Avoid wearing high heels all the time, Dr. Leonard also advises. You can also try an orthotic device, or a shoe insert to give you more support. Over the counter orthotics are just fine, Dr. Leonard says, but a podiatrist might recommend taking a mold of your foot to make a custom insert.

Learn more

Learn more about foot care on the OSF HealthCare website.

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A federal panel recently advised women get a mammogram every other year starting at age 40, rather than 50.

And the American Cancer Society estimates that in 2023, nearly 300,000 women in the United States will learn they have breast cancer. About 43,700 women will lose their life due to the disease.

The headlines are reminders to know your breast cancer risks. While many risks are out of your control, there’s just as much you can control, says Heather Thompson, a breast health navigator at OSF HealthCare.

Major risks you can control

• Active lifestyle and healthy eating: Thompson puts it plainly. If you eat junk, you’ll feel like junk. And any exercise will give you more energy and burn fat. Fat produces estrogen, which feeds cancer cells.

“You want to make sure you’re well-maintained with your weight, even after menopause,” Thompson says.

• Taking hormones: This impacts your ovaries, reducing or adding estrogen. Whether you’re at a routine appointment or you have been diagnosed with breast cancer, talk to your provider about what hormones you’re taking.

“We don’t encourage people who are having menopause symptoms [like hot flashes] to take hormones,” Thompson lists as an example. “We encourage other things to help treat those. It eliminates those estrogen cells increasing.”

• Alcohol and smoking: They are a risk for any type of cancer. But Thompson says one drink per day can increase a woman’s breast cancer risk by 12%. Alcohol is sugary, and that’s a fuel for estrogen.
   
• Night shift work: Thompson says our body expects to sleep when the sun goes down. Night work throws that off.

                “You’re getting artificial light all night. That changes the melatonin that the body naturally makes,” Thompson explains. “When your melatonin is off, it increases estrogen.”

                If you don’t work the traditional day job, see if you can work different shifts so you are not up all night all the time.

Risks you can’t control

• Age: Thompson says women generally develop breast cancer at age 50 and above. 
   
• Family history and genetic mutations: A family history of breast cancer puts you at a higher risk. Thompson says the higher risk is often seen on the person’s mother’s side of the family. For example, your mother and her sister (your aunt) may have breast cancer, and so you’d need to talk to your provider about your risk.

              Some women diagnosed with breast cancer and who have a family history may undergo a genetic test.

“Those tests can tell us if this is something being passed down from generation to generation,” Thompson says.

• Reproductive history: Young women who develop menstruation before age 12 and women who go through menopause after age 55 have an increased risk.

“That gives them a longer time with their ovaries working. They’re producing estrogen,” Thompson says.

• Dense breast: More tissue and less fat mean a dense breast and an increased cancer risk, Thompson says. Usually, the younger you are, the denser your breast is. The density of your breast is something that will be noted on every mammogram result. Thompson says mammogram technology is getting better at finding cancer in dense tissue. An early diagnosis may mean a better outcome.

Takeaways

Make sure your health care provider knows about your circumstances so they can decide on the best preventive care, like a different schedule for mammograms. Some of the information to have handy: a family history of cancer and any physical change you noticed during your monthly breast self-check.

Learn more about breast health and breast cancer care on the OSF HealthCare website.

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A significant amount of these cases is due to genetic mutations from parents passing defective genes down to their children.

"We inherit DNA material from our parents, both mother and father, and sometimes these genes can have a defect," says Jamin Addae, MD, a breast surgeon with OSF HealthCare. "This means the gene would not work very well, like a normal gene would." 

A significant family history of breast cancer is found in about 25% of patients with the disease. Up to 10% of all persons with a new diagnosis of breast cancer will have an “identifiable genetic mutation” that caused or increased the risk of developing breast cancer, Dr. Addae says.

"For women with male relatives who have prostate cancer, these women in the family may have an increased risk of developing breast cancer. The gene mutation could increase the risk of several types of cancer, for instance in the case of BRCA 1 mutation, it increases the risk of breast, ovarian, pancreatic and prostate cancers,” Dr. Addae says. “Males in the family may not develop any cancers ("silent carriers) or may develop prostate cancer if they have the gene mutation. They can then pass this defective gene to their daughters who would later develop breast cancer. The disease itself is not what is passed down to the child, it is the defective gene that increases the risk of breast cancer that is passed down"

Several gene mutations can be passed down from parent to child.

• BRCA 1: Angelina Jolie carries this mutation, which she has spoken publicly about. This increases the risk of breast and ovarian cancer.
• BRCA 2: Increases the risk of breast, prostate and other cancers.
• PTEN mutation, which can lead to PTEN Hamartoma Tumor Syndrome (PHTS). PHTS increases risk for breast, endometrial, thyroid, and colon cancers.
• TP53 mutation
• STK11 mutation: Linked to Peutz-Jegher's syndrome
• PALB2 mutation: Very rare. Linked to a higher risk of breast cancer and hereditary pancreatic cancer.
• CD81 mutation

These gene mutations can increase your risk of developing breast cancer significantly over an 85-year lifespan, Dr. Addae says.

So how do you know if you have a gene mutation? Most of the time, you wouldn’t.

"With BRCA1 and BRCA2 mutations, you might have people in your family with prostate cancer, breast cancer or ovarian cancer. With this combination of cancers and young people developing these cancers, that serves as a red flag, which tells you with this strong family history, there might be something going on,” he adds.

To qualify for genetic testing, Dr. Addae says medical professionals must follow specific guidelines first. 

• You don't have breast cancer, but you come to your oncology team with a strong family history of cancers. 
• There are people with known mutations in your family.
• You come with a diagnosis of breast cancer under the age of 50 (some guidelines say 65).
• You have triple-negative breast cancer.
• You have Stage 4 breast cancer. Genetic testing might show your cancer team certain types of helpful treatment that are only available for people with that type of gene mutation.
• You have other family members with breast, prostate or ovarian cancer, and you develop breast cancer. 

Additionally, Dr. Addae says there are modifiable risk factors, or things we can control, that increase the risk of breast cancer. 

• Waiting longer to have a child
• Taking oral contraception
• Post-menopausal women receiving hormone replacement therapy
• Radiation for certain cancers (like lymphoma): Dr. Addae notes that if the medical team deems radiation for lymphoma necessary, it’s important to receive the treatment
• Post-menopausal weight gain

There are proactive things you can do to decrease your risk of breast cancer as well

• Cut out smoking
• Decrease the amount of alcohol you drink
• Know your family history

Making an appointment with your doctor for a screening, along with self-examination of your breasts, are good ways to keep an eye on things, Dr. Addae adds.

For more information on breast cancer and programs and services available, head to the OSF HealthCare website.

Video Interview Clips

Diabetes: a recap

Aminat Ogun, MD, a family medicine physician at OSF HealthCare, recaps Types 1 and 2 diabetes and where Type 1.5 fits in:

• Type 1: Dr. Ogun says the body’s immune system attacks insulin-producing cells in the pancreas.
  
  “Insulin is a hormone that brings glucose from food from the blood to the body’s cells for energy. So in Type 1 diabetes, the pancreas isn’t producing insulin,” Dr. Ogun explains. “This type of diabetes is usually seen in childhood and adolescence. It’s sudden onset. Symptoms are increased urination, increased thirst, weight loss and blurry vision. A lot of these people are dependent on insulin shots.”
   
• Type 2: The pancreas is producing insulin, but the body doesn’t recognize it. Dr. Ogun says these patients are typically age 40 and up, and the disease has a gradual onset.
  
  “Management is lifestyle modifications, like a healthy diet and physical activity,” Dr. Ogun says. “And there are medications to help control blood sugar like Metformin and Jardiance®, plus insulin shots.”
   
• Type 1.5: This is also called latent autoimmune diabetes in adults (LADA).
  
  “It’s a slow progressing form of Type 1 diabetes. It’s autoimmune like Type 1, but it’s usually seen in adults,” Dr. Ogun says. Symptoms are similar to Type 2 diabetes: fatigue, nausea and vomiting. Or, Dr. Ogun says some people may have little to no symptoms.

More on Type 1.5

So, if Type 1.5 diabetes can mimic Types 1 and 2, how do providers pin down a diagnosis?

Dr. Ogun says it’s something providers are learning more about and getting better at. She says providers will take a blood sample to look at your blood glucose and antibodies. Providers can also sample your blood or urine to look at your C-peptide level. C-peptide is a byproduct of insulin production, and if it’s low it’s cause for concern.

Treatment is similar to Type 2 diabetes: oral medication or an injectable GLP-1 medication like Ozempic®.

“But eventually once the autoimmune destruction happens, the person will need regular insulin,” Dr. Ogun says. “One good thing is that if you are aware the person might have Type 1.5, starting insulin earlier is a little bit better. Maybe that can preserve some of the cells in the pancreas and preserve some pancreas function.”

Shoring up your diet and exercise can also help.

Prevention

Dr. Ogun says since Type 1.5 diabetes is an autoimmune disease, there’s no bonafide way to prevent it. She adds there is a genetic component, meaning a child of someone with Type 1.5 is at a higher risk to get in themselves.

But, Dr. Ogun says sometimes education can be the best prevention. She says she’s happy Lance Bass has spoken out. Bass is active, fit and has diabetes – a sign that it can happen to anyone, and you should be aware of the disease.

Learn more

Read more about preventing and managing diabetes on the OSF HealthCare website.

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