By Rehan Iqbal
If you have diabetes, you may be at risk for a rare degenerative disease known as Charcot foot. This complication of diabetes is frequently caused by vascular problems and made worse by nerve damage. Until recently, Charcot foot only affected about one percent of diabetes sufferers, but according to the American College of Foot & Ankle Surgeons, the rise in the instance of diabetes in the modern world is accompanied by a rise in the percentage of diabetics with Charcot foot.
What Are The Symptoms?
Sudden onset is one of the main symptoms of this disease. Early signs include inflammation, redness and swelling (which can also be symptoms of cellulitis, deep vein thrombosis or infection.) The bones of the foot may soften within a matter of weeks causing unexplained fractures of foot-bones, degeneration of joints, arch collapse and deformity of the foot. If left untreated, the sufferer may begin to feel tingling in the feet. Additionally, it may become hard to control foot movements.
What Can Be Done?
There is no cure for this degenerative disease, but early detection and treatment can help sufferers cope with the condition. Daily inspection of the feet is a very important part of good diabetic foot care. Diabetics must stay familiar with the condition of their feet and report any abnormalities to the doctor promptly. Protecting the feet with good diabetic footwear and a wise schedule of activity is a very important aspect of preventing Charcot foot. Diabetics with neuropathy often do not feel pain in the feet and may continue walking on an injured foot. This can only worsen Charcot and may lead to broken bones in the foot. When you examine your feet, look out for:
- Bruising or other discoloration around the joints
- Bones out of alignment around the joints
- Heat and inflammation
- Decreased circulation
- Bony protrusions
- Swelling and pain
- A strong pulse
Diabetics who notice an abnormality in the course of daily examination should stop all activity and call the doctor right away. Joint Collapse May Lead to Amputation The joints in the feet are at the most risk for collapse caused by Charcot. The joints of the forefoot and midfoot (tarsometatarsal, metatarsal and midtarsal) are especially at risk. If these joints collapse, mobility is severely impacted, and amputation may be necessary. Are All Diabetics at Risk of Charcot? Diabetics who do not take care of themselves are at great risk from all manner of complications; however, those at the greatest risk of developing this disease are those 50+ years of age who already have neurological complications. Additionally, those who have stiff Achilles tendons seem to be at greater risk. Diabetics who take risks with their feet are also at greater risk of developing this degenerative disease because it can begin with an injury.
This is why it is so important to avoid going barefoot and always wear the right diabetic footwear for all activities. Good Personal Care Can Help Prevent Charcot Diligent examination and good foot care can go far toward preventing the development of this disease and/or slowing its progress, but these tactics alone are not effective. Attention to diet and regular, light exercise also help prevent this and many other complications of diabetes. Keeping blood sugar levels stable, maintaining a strong cardiovascular system and keeping muscles, joints, ligaments and tendons (especially the Achilles tendon) strong and flexible can help safeguard overall good health for diabetics and others.
How is Charcot Foot Diagnosed and Treated?
To determine whether or not a diabetic patient has developed Charcot, doctors and podiatrists perform standard exams including an interview regarding diet, activities and medical and family history. Additionally, various diagnostic tools may come into play, including:
- Magnetic Resonance Imaging (MRI)
- Computed Tomography (CT)Scan
- Nuclear Bone Scan
The doctor will use all of the information gathered in the exam and interview, along with test results to make a final diagnosis. Diabetics who receive a diagnosis of Charcot disease should take great care to discuss these important questions with the doctor:
- How can I change my environment or habits to avoid worsening this condition?
- How can I choose the best shoes for diabetics to protect and support my feet?
- What changes should I make in my diet and lifestyle?
- Should I take vitamins or other supplements?
- What activities will worsen this disease?
A diabetes/Charcot treatment plan that is the result of close collaboration with the doctor is far more likely to be effective than one handed down from the doctor without proactive patient involvement. How is Charcot Foot Treated? Once a diagnosis is in place, a schedule of regular testing will follow. It is very important to maintain a stable schedule of exams. The doctor will look for foot abnormalities and may aspirate fluid samples from the joints of the affected foot to look for cartilage and bone fragments. The podiatrist or doctor will prescribe diabetic footwear or possibly a brace to help stabilize the affected foot. If the condition is very severe, complete immobilization of the foot and use of crutches or a wheelchair may be required.
Neglected Charcot Foot Results in Surgery In very advanced cases, surgery may be required. When this is the case, two types of surgical procedure are most common:
1. Ostectomy: This is the most often used Charcot foot surgery. In this outpatient procedure, a small incision is made in the foot’s sole. Abnormal bone growth and loose bits of cartilage and bone are removed via this incision. After the operation, it is important to support the foot with a brace or a cast throughout the recovery period.
2. Arthrodesis is an in-hospital procedure that seeks to realign the ankle with the mid or hind foot. In the course of this procedure, bony growths can be removed and collapsed arches can be repaired. Once all corrections are made, plates and screws are inserted into the foot and screwed into place to stabilize the joints and bones. Patients typically spend a night and a day in hospital for monitoring and recovery. After the procedure, the patient must wear a non-weight-bearing cast for three months and a prescribed brace or orthotic footwear and inserts for as long as the doctor mandates it.
Is Charcot Foot Inevitable?
A proactive approach to diabetes treatment and maintenance is key in avoiding all manner of complications, including Charcot. By following doctor’s orders, maintaining a healthy, active lifestyle, keeping up a regular schedule of foot inspections and foot care and wearing well-designed footwear for diabetics, a wide variety of complications can be entirely avoided. Shoes for people with diabetes are specially designed to protect and cushion the feet. These shoes are made of special, soft materials that are designed to accommodate problems such as:
- Compromised circulation
- Foot deformities
Wearing the right footwear can help prevent problems with pressure and friction, which can lead to blisters, ulcers, calluses, infection, gangrene and ultimately, amputation.