How can diabetes deform my foot ?

Collapse of my foot and diabetes:



Charcot neuroarthropathy is a common cause of morbidity in persons with diabetes mellitus and sensory neuropathy. Although Charcot neuroarthropathy is a clinical diagnosis, recent advances in diagnostic imaging have eased the clinical challenge of deciphering infection from Charcot changes. Bone infections should be ruled out entirely before this can be said to be the diagnosis. Advances in surgical treatment have demonstrated new options for limb salvage.




There are several proposed mechanisms, but mainly it is most acceptable to believe that uncontrolled or difficult to control diabetic blood sugar levels lead to nerve damage which allows numbness to replace sensation. This allows bones to break naturally over time which go unnoticed by the individual, and the bones become inflamed and eventually break down and collapse with extensive fractures and swelling. This is a simplified description of the deforming process of Charcot foot.




Then and now.

In the recent past, the best treatments have been said to include below the knee amputations, and cumbersome braces which need to be consistently maintenenced and refurbished.

"Surgery on a diabetic is dangerous".




This was a common theme which precluded the possibility of reconstructive procedures to minimize deformity and were largely not based on evidence based medicine. Today it is known that in the vast majority of patients who develope these deformities, circulation is not compromised on a macrovascular level, but instead may be such in a microvascular setting. That means essentially that the small vessels may have glycosylated end products which impede wound healing. This usually is not on it's own a contraindication to reconstruction either, as the most common driving force for wound healing complications in this patient population may be more directly related to the abnormal bone prominences formed by the collapsing foot.

Today's current outlook on this disease process:




At FFLC, we treat all stages of this disease. Initially, we will order several important tests and imaging studies to assess the structural deformity and assess the body as a whole to come to the conclusion which is best for each patient. Newer external treatments such as multiplanar external fixation with either Achilles tenotomy or gastroc recessions, and immobilization have been a mainstay in the acute stages of the disease over the last 10 years. For chronic stable deformities, medial beaming techniques are utilized to realign the foot and ankle to a more straight position to offload centrally located ulcers.

A team approach is also essential for treatment of this complexity. Diabetes is a difficult clinical beast to slay, and whenever this systemic concern is not maintenced well, recurrence of Charcot (along with many other deletarious concerns) is likely. Usually reconstruction of the foot and ankle is performed on the presumption that multidisciplinary functions are well coordinated, such as endocrinology referral, infectious disease, vascular surgery, home health care nursing, physical therapy, and primary care are all significant parts of the entire process.

It literally takes an entire team of healthcare professionals to save a limb.