Beware of Frostbite
Last month was diabetes awareness month. I talked about one of the complications from diabetes which was neuropathy. Neuropathy can some times be a loss of sensation or feeling of the foot. Besides neuropathy due to loss of sensation, there is something else called autonomic neuropathy. The autonomic nervous system controls things like sweating, the vascular sytem, and other things like temperature of the body. So what causes Charcot? What are some theories of Charcot deformity? There are two schools of thought, one is the French theory and the other is the German. One is that the losing feeling in your foot causes the bone to collaspe and start to fracture. The other is the autonomic theory in which due to neuropathy of the autonomic system there is an increase in blood flow to the area and the bones become weak and fracture and collaspe. Even the you can get Charcot in any part of the body, the most common is the mid-foot, then the ankle.
Charcot can present in 3 different stages. The 1st Stage is a presentation of a foot/leg with increase temperature, swelling, and redness(Erythema). Somtimes patients present to a doctors office or an urgicare and no x-rays and the foot is misdiagnosed as sprain. Usually on x-ray, the bones are not aligned and there is osteopenia( bones look washed out). The second stage is where the bones start to fracture and the foot becomes more misaligned. While the third stage the fracutres start to heal and become consolidated.
So how is Charcot treated? Intially any treatment should be directed in stabilixing the foot or ankle and decreasing swelling. The principal in treating any Charcot foot is stabilization usually with a cast. This will vary depending on how long it takes the fractures to heel. In the later stages of Charcot, a special boot is made called a crow walker. Sometimes a surgical reconstruction can be performed.
One ot the complications that can develop is a diabeti foot ulcer d/t one of the bones being out of alignment. Sometimes the only way the ulcer can heal is by removing the bone that is causing the ulcer. Having diabetes does not preclude you from not having surgery.
The importance of daily foot checks and yearly foot checks can help
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As a surgically trained podiatrist, Dr. Kimmel can treat any of your foot and ankle problems