| Diabetic foot complications are unfortunately a | | | | can potentially harbor bacteria more easily. This has |
| common occurrence. Of the many complications with | | | | the potential to lead to a partial foot or below-knee |
| which diabetes afflicts the body, few can be as | | | | amputation if the infection gets out of control. |
| disabling and potentially devastating for the foot and | | | | All of these complications can be prevented without |
| leg as Charcot neuroarthropathy. Named for a | | | | surgery if the disease is addressed quickly enough. |
| nineteenth century neurologist, this devastating | | | | Treatment started as soon as the first sign of |
| diabetic complication can cause spontaneous | | | | disease appears can protect the foot or ankle from |
| fracturing of the foot that can continue over the | | | | collapse. Without weight-bearing pressure, the |
| course of a few months. As suddenly as it begins, | | | | fractured bone may not move or collapse to any |
| the process will suddenly end and the remaining bone | | | | great degree, and with proper treatment the |
| fractures will fuse abruptly in the position in which | | | | anatomy of the involved joints can stay relatively |
| they collapsed. It occurs in up to 5% of diabetics. | | | | intact. This requires strict non-weight bearing on the |
| The word neuroarthropathy refers to nerve-related | | | | involved leg until the active fracturing phase of |
| joint disease. Numerous nerve-related causes have | | | | Charcot neuroarthropathy is over. The time required |
| been suspected for this sudden disease, which can | | | | for this is usually at 3 months, but can be longer. The |
| also affect non-diabetics with certain nerve diseases. | | | | only way to effectively reduce the pressure is to |
| One of two more popular theories believe that | | | | hold the foot in a hard cast, and use either crutches |
| increased blood flow, due to disease of the nerves | | | | or a wheel chair to assist in getting around. Even light |
| controlling the size of small blood vessels, washes | | | | pressure on the foot from standing on the cast can |
| away bone minerals. This results in bone that has less | | | | lead to bone collapse, so it is very important to keep |
| substance to it and can fracture more easily with | | | | strictly off the foot at all times. |
| little pressure. The other theory holds that poor | | | | The ability to walk can be drastically reduced if the |
| sensation from nerve disease results gradually in too | | | | collapse and resulting deformity of the foot or ankle |
| much focused joint pressure and eventually leads to | | | | is severe enough. Charcot of the ankle in particular |
| destruction of the joint, which cannot sustain such | | | | leads to a significant walking disability, as the ankle |
| pressure. Regardless of the actual cause, which is | | | | becomes arthritic and poorly functional. Foot |
| likely a combination of both the above theories, the | | | | involvement is more common, and can lead to a |
| end result of this disease is a devastating collapse of | | | | dysfunctional surface upon which one walks on. The |
| the joint involved. This can lead to numerous long | | | | foot can become twisted off to the side, upward, or |
| term complications. | | | | simply develop a rocker-style bottom shape. Special |
| The part of the foot most commonly affected by | | | | custom made shoes with specific molded padding |
| Charcot neuroarthropathy is collectively called the | | | | must be used to support the foot and protect the |
| tarsometatarsal joint. This is the general region of the | | | | skin from abnormal pressure, otherwise serious |
| connections between the long bones of the foot and | | | | wounds can develop. If this is not enough, or if the |
| the bones in the middle of the arch, and is not unlike | | | | deformity is too great, reconstructive surgery is |
| the mass of bones in the palm of the hand and wrist. | | | | needed to place the foot or ankle back into a |
| Another area commonly affected is the ankle joint. | | | | semi-normal position. This surgery is difficult, time |
| When the disease starts, the foot or ankle will | | | | consuming from a recovery standpoint, and usually |
| suddenly become red, hot, and swollen. Pain may or | | | | requires a device placed over the skin called an |
| may not necessarily be a part of the symptoms. It is | | | | external fixator. The bones must be re-broken with |
| all too frequent that this condition is mistaken for an | | | | precision and reset to restore proper positioning. Due |
| infection by medical staff who don't see it regularly, | | | | to the Charcot disease, the bone material itself will be |
| as the appearance of the foot on exam and on | | | | weaker and less able to hold more traditional internal |
| x-rays can resemble a foot and bone infection. If a | | | | screws and wires. Therefore, something else is |
| person who develops this continues to walk on the | | | | needed to hold the bones in a corrected position until |
| foot, the bone destruction continues and the joint | | | | they heal. This has to be accomplished externally with |
| continues to collapse irreversibly further. When the | | | | a series of external wires driven into the bone and |
| process ends a few months later, the collapsed foot | | | | held together under tension with an external metal |
| or ankle will then fuse in that position. After fusion, | | | | frame. This construction will keep the bones in the |
| the foot will be left in an abnormal position. In | | | | corrected position until they fully heal. Some surgeons |
| particular on the foot, the bones that were once part | | | | advocate doing this even while the fracture phase of |
| of the arch have collapsed into a concave position. | | | | Charcot neuroarthropathy is occurring, without |
| This can create a number of long term complications. | | | | waiting for the bones to fuse from the initial |
| The skin on the bottom of the foot is not | | | | fracturing. While this early intervention can limit the |
| accustomed to the pressure from the bones pushing | | | | amount of deformity that occurs in the joints, it is |
| further down towards the skin, and the additional | | | | very risky and can lead to more serious complications |
| pressure from the ground below will cause the skin | | | | like amputation. It should be done by those with |
| to callus in the middle of the foot as it protects itself | | | | great skill and experience in addressing Charcot |
| from the increased pressure. This will eventually lead | | | | deformity during the active phase. Other treatments |
| to a wound developing under this area of high | | | | have been studied that attempt to reverse the bone |
| pressure. Since fat padding is limited in the arch and | | | | loss seen in this condition, in a manner similar to the |
| the bone is brought even closer to the skin and | | | | treatment of osteoporosis. The results so far do not |
| wound surface by the joint collapse, bacteria on the | | | | translate well to real world application, and work |
| wound can easily spread into the bone. Bone infection | | | | remains on making this an effective early treatment |
| is a particularly serious complication, and the abnormal | | | | for Charcot neuroarthropathy. |
| bone left after Charcot neuroarthropathy has ended | | | | |