Many
diabetic patients may have heard warnings to look out for “charcot
foot” but they may not know exactly what this means.
Different from diabetic charcot foot is an inherited disease with
another characteristic foot type called Charcot-Marie-Tooth disease.
As a part of September’s Charcot-Marie-Tooth (CMT) disease
awareness month, it is critical for patients to understand the
differences between these two neurological disorders.
CMT
Charcot-Marie-Tooth
disease is caused by a gene defect that is often inherited. If
CMT is seen in other family members, parents should be on the lookout
for the development of slowly progressing muscle weakness in the
lower extremities before age 20. Individuals with CMT have
nerves that lose their myelin covering, which normally allows signals
to be sent to and from skin and muscles at a normal speed allowing
sensation and muscle contraction. Patients will not usually
complain of any numbness because their sensation was likely never
completely normal. As a result of the weakness and loss of
sensation, first in the legs then typically seen in the upper
extremities, kids with CMT may seem clumsy and have difficulty
walking without tripping or rolling
their ankles. The feet will often have a high arch
appearance and may be prone to ulcers from
damage caused by lack of ability to sense pain.
Diabetic
Charcot Foot
Patients
with diabetes need to be concerned about charcot arthropathy when
they develop areas of the foot where they can no longer feel
anything. The combination of lack of sensation allowing damage
to the foot that patient cannot feel and an increased blood flow
supplying mediators of the inflammatory process allows a “charcot
joint” to develop. In the charcot joint, the repeated small
injuries occurring cause bones to gradually fracture and dislocate.
This causes deformity (often an extreme flat foot) which typically
places the diabetic
patient’s foot at a greatly increased risk of developing
ulcers and subsequent infection with
severe consequences. The most common signs of the development
of charcot arthropathy are swelling and
increased temperature of the affected area of the foot, redness, pain
and the feeling of a “loose bag of bones” when the joint is
moved.
In
both diabetes with loss of sensation, and Charcot-Marie-Tooth, foot
self-exams are immeasurably important in preventing
ulceration and further complications. Protective shoe gear
and custom
made orthotics can provide additional protective measures
for the foot. As shown by these two disease processes, loss of
sensation in the foot is a major problem that should always be
evaluated by your
foot and ankle specialists here in Naples Florida.
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