Diabetes and the Feet

Diabetics often have many problems with their feet. Neuropathy, damage to the nerve cells, is very common in diabetics, especially those whose cases have not been carefully controlled. Because of this nerve damage, they often lose sensation in the periphery. Many patients find that they do not notice damage to the feet. Poor circulation in the feet, another common feature of diabetes, can lead to complications.

Diabetics with neuropathy often injure themselves because they do not notice the pain. Because of the poor circulation, these wounds often do not heal very well. Infection may set in. Ulcers, calluses, and bunions are common. Another complication, less common but very dangerous, has been gaining notoriety lately.

Charcot Foot

Roughly nine percent of diabetics with major neuropathy, about one percent of patients in all, develop Charcot foot. Of those who do, another twenty-five percent go on to develop it in the second foot as well.

Charcot foot is a condition in which the bones of the foot abruptly become soft and may start to disintegrate. It can lead to broken bones, a collapsed arch, and deformity. The bottom of the foot may begin to bow outwards. As the bones become increasingly deformed, they push on the skin, causing ulcers. In many cases, the condition can result in a total loss of function.

The exact cause of the condition is unknown. One theory is that the constant buffeting and minor injury to which diabetic feet are subjected begin to damage the bones and ligaments of the foot. Then, one final injury sets off the Charcot. Many people remember injuring their foot through slipping or tripping or have had foot surgery right before the onset of symptoms.

Diabetes is a growing epidemic in the U.S. As more people become diabetic, more people are developing Charcot foot. Unfortunately, many health care providers are not familiar with this condition and are poorly prepared to deal with it. It is important for diabetic patients themselves to be able to recognize the signs and symptoms of this dangerous condition.

Symptoms

The initial symptoms of Charcot foot include swelling, redness, and heat. If the condition is allowed to progress, dislocation, misalignment of the bones, and severe deformity may develop.

Diagnosis

The diagnosis of Charcot foot can be tricky. The initial symptoms, redness, swelling, increase in temperature, mimic those of infection or deep vain thrombosis, common complications of diabetes. Because continued use of the foot can lead to irreversible damage if the cause is Charcot, it is recommended that all diabetic patients who present with these symptoms should be immobilized until the cause can be determined. A radiography can usually detect Charcot foot.

Treatment

There is no cure for Charcot foot. Immediately immobilizing the foot and keeping weight off it for the three to six months of the active phase of the condition can minimize deformity.

After this phase, the patient can begin using the foot again, although extreme caution is required. Protective footwear and daily foot care can help manage the ulcers that often occur due to deformed bones. Repeated flare-ups of the condition are extremely rare, but vigilance is required.

Depending on how far the condition has been allowed to progress, corrective surgery or amputation of the foot may be required.

http://www.aafp.org/afp/980600ap/caputo.html
http://www.acfas.org/press/press-releases/diabetes/charcot-trend.htm
http://diabetes.webmd.com/tc/diabetic-neuropathy-home-treatment
http://www.footphysicians.com/footankleinfo/diabetic-amputations.htm