Introduction & Case 1 and 2 (Poster)

References

1. Armstrong DG, Todd WF, Lavery LA, Harkless LB, Bushman TR. The natural history of acute Charcot’s arthropathy in a diabetic foot specialty clinic. J Am Podiatr Med Assoc. 1997 Jun;87(6):272-8.
2. Lee L, Blume PA, Sumpio B. Charcot joint disease in diabetes mellitus. Ann Vasc Surg. 2003 17(5):571-80.
3. Foltz KD, Fallat LM, Schwartz S. Usefulness of a brief assessment battery for early detection of Charcot foot deformity in patients with diabetes. J Foot Ankle Surg. 2004 Mar-Apr;43(2):87-92.
4. Pakarinen TK, Laine HJ, Honkonen SE, Peltonen J, Oksala H, Lahtela J. Charcot arthropathy of the diabetic foot. Current concepts and review of 36 cases. Scand J Surg. 2002;91(2):195-201.
5. Wukich DK, Sung W, Wipf SA, Armstrong DG. The consequences of complacency: managing the effects of unrecognized Charcot feet. Diabet Med. 2011 Feb;28(2):195-8.
7. Chantelau E. The perils of procrastination: effects of early vs. delayed detection and treatment of incipient Charcot fracture. Diabetic Med. 2005 22:1707-1712.

Research Poster information provided by Dr. Valarie Shade DPM AACFAS Chief Limb Preservation Service

Brought to you by Charcot Awareness Education Foundation

Acute Charcot Neuroarthropy: A Diagnostic Challenge

I, recently, had a problem with my right foot that I had had Reconstructive surgery on. It was a callus on the fifth metatarsal. I went to see Dr. Schade. (She had assisted Dr. Roukis with surgery on my left foot for Charcot a few years back.) While there, I asked her if she had anything she could help me with for my foundation (Charcot Awareness Education Association) website postings. She said she had created a poster that explained some Charcot case research that had been done and would share them with us.

My Charcot was misdiagnosed for about 10 years. I was continually told I had arthritis “Live with it.” This is not uncommon. It is usually undiagnosed, or misdiagnosed. If this happens for too long a period of time, the end result is a badly deformed foot which is had to shoe and will need a brace, or often an amputation results.

Dr. Shade’s poster titled Acute Charcot Neuroarthropathy: a Well Known Phenomenon to the Foot and Ankle Specialists Which Remains a Diagnostic Challenge to the Medical Community At Large, presents a checklist of factors meant to heighten the clinical awareness of practitioners towards the diagnosis of acute Charcot Neuroarthropathy. She shows four cases in which the diagnosis of acute Charcot was delayed.

Dr. Valerie L. Schade, DPM, AACFAS; is Chief, Limb Preservation Service: Vascular/Endovascular Surgery Service; at Madican Healthcare System; Tacoma, Washington

I have broken the poster into three parts and will present these over the next three weeks. Hopefully, the illustrations, photos and checklist will bring better understanding to our readers about this devastating disease. I will then conclude with her list of references.

Brought to you by Charcot Awarenes Education Foundation

Depression

January 2004, the diabetic doctor told me that Charcot was rare and not mentioned much in medical school. That’s why it was missed. The type of surgery performed was just taking the foot to the ankle as it was not infected. This was, sort of, a rare surgery for Charcot, but new procedure. The physician said I was a good candidate.

Though the surgery was a success and was healing well, I developed what was determined as gout. I was allergic to the prescribed med. Vioxx. This was like 4-5 days after surgery. Within 24 hours I started swelling up.

I wound up in ICU. After many tests it was determined my kidneys had failed. I was placed on continual dialysis for 5 days. After the five days, they had removed 100 Lbs. of fluid. I was still taking an antibiotic drip for eight hours, every 3 days to fight the MRSA. I was then transported by ambulance to their health care unit. My kidneys did not operate for eight weeks. So, I was placed on dialysis 3 times a week, 4 hours each session. Normally, it is a three hour session. They transported me to the Dialysis Facility (which had many, many machines) every Monday, Wednesday and Friday evening. The session began about 7 PM and it was normally midnight before getting back to the care center. This lasted, just, over four weeks.

During this process, I developed pneumonia. So in March, I was taken back to the hospital as this was my second bout with pneumonia. I was on oxygen for a few days each time and had to use the little breathing apparatus to clear my lungs and expand them. The surgeon had to place a port in my left side about three inches down from my shoulder so all meds were given to me went through it. They were constantly giving me something. After kidney failure another port was placed on the left side just to the right of the left breast so I could be hooked up to dialysis machine. I just about forgot, during the first bout with pneumonia, I was not eating, or would not eat and a tube was inserted through my nose to my stomach for the propose of feeding. I had that in from first part of February 2004 until end of February when I was moved to Providence Health care (Rehab and Senior Living housing)

Before Vioxx shut down my kidneys, I had been given an antidepressant. The doctor and nurses kept asking me questions after surgery. I thought I was doing OK, but they determined from my answers to their questions, and the fact that I was not eating, I was depressed. Again I really don’t remember much about the hospital and the pneumonia bouts. I really feel my poor body had been given so many drugs it revolted and said enough already.

Bonnie’s continuing story

Brought to you Charcot Awareness Education Foundation

Kidney Dialysis And Pnumonia

January 2004, the diabetic doctor told me that Charcot was rare and not mentioned much in medical school. That’s why it was missed. The type of surgery performed was just taking the foot to the ankle as it was not infected. This was, sort of, a rare surgery for Charcot, but new procedure. The physician said I was a good candidate.

Though the surgery was a success and was healing well, I developed what was determined as gout. I was allergic to the prescribed med. Vioxx. This was like 4-5 days after surgery. Within 24 hours I started swelling up.

I wound up in ICU. After many tests it was determined my kidneys had failed. I was placed on continual dialysis for 5 days. After the five days, they had removed 100 Lbs. of fluid. I was still taking an antibiotic drip for eight hours, every 3 days to fight the MRSA. I was then transported by ambulance to their health care unit. My kidneys did not operate for eight weeks. So, I was placed on dialysis 3 times a week, 4 hours each session. Normally, it is a three hour session. They transported me to the Dialysis Facility (which had many, many machines) every Monday, Wednesday and Friday evening. The session began about 7 PM and it was normally midnight before getting back to the care center. This lasted, just, over four weeks.

During this process, I developed pneumonia. So in March, I was taken back to the hospital as this was my second bout with pneumonia. I was on oxygen for a few days each time and had to use the little breathing apparatus to clear my lungs and expand them. The surgeon had to place a port in my left side about three inches down from my shoulder so all meds were given to me went through it. They were constantly giving me something. After kidney failure another port was placed on the left side just to the right of the left breast so I could be hooked up to dialysis machine. I just about forgot, during the first bout with pneumonia, I was not eating, or would not eat and a tube was inserted through my nose to my stomach for the propose of feeding. I had that in from first part of February 2004 until end of February when I was moved to Providence Health care (Rehab and Senior Living housing)

Before Vioxx shut down my kidneys, I had been given an antidepressant. The doctor and nurses kept asking me questions after surgery. I thought I was doing OK, but they determined from my answers to their questions, and the fact that I was not eating, I was depressed. Again I really don’t remember much about the hospital and the pneumonia bouts. I really feel my poor body had been given so many drugs it revolted and said enough already.

Bonnie’s continuing story

Brought to you by Charcot Awareness Education Foundation

Surgery And Complications

January 10, 2004, the day I arrived at Providence Hospital in Anchorage by ambulance, started a wild roller coaster of four months. I had already spent the past three months at home on the sofa with my foot elevated dealing with wound care and an infection.

Now, the Doctors had to get my immune system and sodium levels up to be able to do exploratory surgery on my left foot. There was the strong possibility of amputation. Amazing that it took 8 days of medications, antibiotic drips and blood transfusions to get me prepared. I can not remember much of that 8 days for some reason, but I just don’t.

Before I started writing this, I called friend Sharon and asked if she remembered how I was responding to all this. She says I was pretty calm and just ready to get it over with. The day of surgery, Tony came in to see me. Since he was owner and operator of his truck delivery business, he had to work. Sharon sat with me at the hospital reporting by cell phone to Tony so he knew how the day was going. The Orthopedic doctor, Dr. Chang, performed the surgery. When he came in to see me, after surgery, he told me he was sorry he had to amputate, but the good news was the amputation was just up to the ankle. So, of course, that made me very happy. (Seriously, I don’t remember how I felt, but don’t remember being happy.)

After surgery, about two days, they had me trying to set up. The room was spinning big time. I was very nauseous. It took a few days of practice to pull myself up with a pull bar. (can’t remember what it’s called) After a few days I made it to the edge of the bed. My muscles were so weak (from laying on the sofa for 3 months with foot elevated). Then the process to learn to use a slide board to get from the bed to chair and back again. This was quite challenging. Again a day or two process, but conquered it.Then about 10 days after surgery, the attempt to stand using my right leg and a machine to hold me up. My right leg was like a noodle. I could not hold myself up with the aid of the machine and fell to the floor hitting my stump. Boy, did everyone jump through hoops to get the screaming, hurting lady in bed. Of course, the wound started bleeding, but no sutures were pulled out (a blessing). Sharon asked me if her pastor could come to visit me and I had given her my OK. During this time Sharon was bringing her pastor, Pastor Suzanne Wood to visit and pray with me (note my December posting).

The wound was healing well, but since I had MRSA, the strong antibiotic drip continued. Any visitor had to wear a gown, or mask, even hospital personnel. I was receiving so many calls from relatives and friends wishing me well. My room was full of flowers, stuffed animals and cards pinned on a big board. It was overwhelming to think I deserved any of this. My wonderful friends in the airline industry were working behind the scene on a surprise.

The bandage was changed every day and healing going well. My pain levels were not too bad. Plans were being made for me to start thinking about rehabilitation, and going home to a three story condo. I was getting stronger and stronger. About the 10th of February, I awoke to incredible pain in my left thumb and forefinger. My right thumb was swollen, red and also, in tremendous pain. Now, a big rush to find out what was causing this. After tests, it was diagnosed as gout by Dr. Lee. She prescribed Vioxx, an inflammation reducing medication. Vioxx was fast acting. That’s for sure – pain subsided, as did the swelling. But in a matter of 24 hours, I was having major problems. I started swelling up, could not urinate, had a very high temperature, and listless. The heart doctor and kidney specialists called for all kinds of tests. They moved me to ICU without calling Tony, or Sharon. It took several days for them to realize it was my kidneys. The tests started rolling one after the other and the doctors not agreeing on what was happening. I don’t remember what was going on, but with kidney function gone, my body was filling with fluid fast. I remember being taken to a room with a huge machine and being hooked up to it, and all of a sudden feeling like I was freezing cold. I didn’t realize it was a Dialysis machine. I did not realize that those who loved or cared about me had not been told where I had been taken. It took the hospital staff awhile to figure it out as there had been a shift change. Needless to say Tony and Sharon were quite upset.

Continuing Bonnie’s story

Brought to you by Charcot Awareness Education Foundation

The Hole in My Foot

After reflecting on my writing of my awaking with the puncture in bottom of my left foot, I remembered more of what happened in 2003. Both feet were swollen and hurting all the time. The only shoes I could wear were wide sandals with Velcro straps.

Tony and I made two airplane trips that year. One was to Portland Oregon (approximately Feb./Mar.) to visit my younger brother who was dying from throat cancer. The plane trip was terrible. The airlines had just started the practice of having you take off your shoes for security. In Seattle, I was having a very difficult time removing my shoes. My swollen feet were hurting very badly as flying made them swell even more. Tony tried to help me, but security personnel would not let him. It was very embarrassing and frustrating, but I made it through the trip. Then the end of May, we traveled to Dallas, Texas for a Ribitzki family reunion. Travel was very difficult, and again, the swelling in both feet very painful. We had the same problems with security taking shoes off/on. I could receive no help from them, nor Tony, the process was very demeaning.

When I woke and discovered the blood, I was panicked. Tony was at work. I really don’t remember what all took place. I called my diabetic doctor. He was out of town on vacation I was frantic not knowing what to do. I remembered a podiatrist I had gone to at one time. I called him and went right in to his office. He took one look at me and said, “I know exactly what’s wrong, but let me take x-rays to verify”. He was right. It was Charcot. He sent me home to start the healing process. I could use a walker, but no pressure on the foot. I would have a nurse visit daily.

I went home. The garage was under the condo. The living room and kitchen were 20 steps up from the garage and the bedroom was 16 steps on up. Procedures were started to heal the hole in the foot. A nurse came daily to my home to flush the wound and apply antibiotics. I was to stay off my foot and keep it elevated above my heart. I also took oral antibiotics. This went on October, November and December. Thanksgiving and Christmas were not fun. We stayed home, me on the sofa, foot elevated. In January 2004, I became very ill with flu type pain. Having not moved for three months, I went down hill quickly. In fact, I was so weak I could not get up to go to the hospital. Tony called and I .had to be taken to emergency by ambulance. It was a very cold day and the streets were packed with lots of snow. Not a fun experience.

The emergency room staff told Tony that I was anemic. All the time I spent on the sofa with my foot elevated took its toll on my body’s muscles. They had begun to atrophy. I became pretty depressed in those 3 months. The antibiotics were very strong and not being used to them would cause me to have horrible dreams. One night, I woke seeing these huge spiders on our ceiling and walls. Tony was upstairs sleeping. I was so frightened. I could not call out to him. When I came to my senses, somewhat, I called him via his cell phone. It was not funny at the time, but later we could laugh about it.

The emergency room staff could not find exactly what was wrong, except that I was anemic with a low iron count. They really wanted to send me home and take iron pills. Tony said no way and stuck to his guns. Sharon, a friend, was in the emergency room with us and was not going to let me go home either I needed a blood transfusion. I was admitted to the hospital and immediately given the blood transfusion. After further evaluation, they decided I had gotten an infection in the break and the hole was not closing, or healing on my foot and was worse than originally thought.. I was placed on an antibiotic drip to control and get rid of infection (MRSA) which was a big part of the problem.

Sharon, became my taxi driver to doctors appointments to find what was causing all the swelling and pain. Plus, she started taking down notes from each doctor, so we could review discussions at doctors offices. You hear so much information, you can’t remember everything, or know the meaning of medical diagnosis.

The doctors were wanting to do exploratory surgery to see if the foot could be saved. First, they had to get the blood count up in order to do surgery, more transfusions, more antibiotic drips. This process took a week. The Orthopedic Surgeon performed the surgery and had advised me that if he felt my foot could not be saved, he would amputate at that time.

In reliving this now, by writing it down, . . . scares me all over again. It’s hard to put into words how I feel, but I know the Lord is helping me to remember and it’s okay, cause this may help someone else.

Continuing Bonnie’s story

Brought to you by Charcot Awareness Education Foundation

North To Alaska

It is with great pleasure that I will be able to share Bonnie’s story with you over the next few weeks. bonnie will share her experiences with Charcot Foot, how it changed her life and how she dealt with this devastating disease. It isn’t enough that Bonnie has to deal with Charcot Foot, but life becomes very complicated because of it and also because of news she and her husband, Tony receives.

NORTH TO ALASKA

Before I start my story, I need to acknowledge several people who helped me tremendously to continue living and not become a recluse. My dear husband Tony, mentor/friend Sharon McKenzie, dear friend Bonnie Jackson ( met her after my first surgery) and my extended family and friends, without them I would not be here today. The reason I mention these friends is because my immediate family lived in the lower 48, however I am living proof of the power of prayer for that was their gift to me, plus hundreds of cards and calls. I was raised in a Christian home and felt I was a Christian although had not been a practicing Christian since moving to Alaska in 1962. During this illness I renewed my faith and believe it is God’s will that I am able to have a very normal life.

I was born and raised on a western Nebraska panhandle farm. Being raised on a farm you normally have a few bumps bruises etc. Well, I was fortunate, no broken bones, but falls from riding horses many times. No major illness or surgeries, just tonsils and appendix.

My teenage years were great (1950′s), I attended the same school from kindergarten through twelfth grade. Graduating in 1959. Good old Lyman, NE., a town of about seven hundred population. The school had about 300 pupils. My graduating class of 1959 was 16 students. You knew everyone. You were able to participate in so many school functions. There was a place for everyone in multiple activities church and school. I participated in band (playing the clarinet) in marching band (I was drum majorette), chorus, school plays, county government days. Outside of school church youth leadership, Jobs Daughters (part of Masons). In my spare time (ha ha) worked on the farm with family. Never thought of this as a special lifestyle, but oh how I do now.

After graduation, I worked in a nearby town of Morrill, NE. (pop 900), started as bookkeeper at a local Pontiac car sales, where my father always bought his new cars. A year later (1960) became a telephone receptionist at Chester B.Brown CO, now Kelley Bean CO. (a dry bean company) .

May 1961, married my high school sweetheart, Gary Foland, from Morrill. He was working in Denver, CO. at the time. We moved to Denver. In November of 1961, Gary joined the Air Force. I stayed in Denver working as a bank teller. In March of 1962, I followed Gary to Wichita Falls, Texas. In June of 1962, he was assigned to Elmendorf Air Force Base, Anchorage Alaska. I stayed in Morrill until Gary could find an apartment for us. By August of 1962, I had prepared a pickup truck (which Gary had purchased and built a camper for carrying our belongings). My brother Jerry (age 18) and I drove from Morrill, NE to Seattle, WA. (Oh, yes, my little Pug, TyeTye, was with us). Quite an experience for two farm kids. Believe me, God was with us all the way. Brother Jerry returned to Denver on his first airplane ride and I flew on my first plane ride from Seattle to Anchorage, with dog in tow.

Bonnie a personal friend will be sharing her story over the next several weeks.

Brought to you by Charcot Awareness Education Foundation

Charcot Foot Requires Care Even After Surgery

Though I had surgery for Charcot on my right foot, it has now been hurting for about four months. I got a new pair of shoes 6 months ago with custom orthotics. They decided my old shoes were just a tiny bit too short and could create problems for my feet as I am a type II diabetic. I hadn’t had any problems with the old ones. My new shoes especially on my left foot felt really good, but my right foot seemed to slide forward in the new shoe.

As the months rolled on, the side of my right foot seem to become uncomfortable. About three months ago there seemed to be a welt on the outside middle of my foot that was getting really tender. I decided to go back to my walking boot so I didn’t put pressure on the sore spot. After a week, it seemed to be better. Back in the shoe, that was fine for a day or two then back to pain.

Though I was to wear hard soled shoes, I wore my slippers in the house most of the time and even in the car, keeping pressure off the outside of my foot. Wearing my shoe was just too uncomfortable, really painful.

Soon it was time for my regular podiatrist appointment. He trimmed my toenails and checked my feet. Everything seemed fine. Then I mentioned to him the bump on the side of my right foot and that it was really sore and really hurt when I wore my shoe. I asked if it should be x-rayed.

He sent me for x-rays. He called me later in the day as said it was scar tissue from all my surgery. He said to go back to the surgeon, or he could remove it for me. I chose to go back to the limb preservation clinic that had done the surgery. However, the following week I had my six month check up with my dermatologist and asked his opinion about my foot as I had been able to pull a scab or layer of skin off of it earlier. He thought it could be a problem with the bone and agreed that I should see my surgeon at limb preservation.

My husband called the clinic and I was in to see my doctor about two weeks later. It was good to see her after nearly two years. They took several x-rays of both feet. My feet were very stable, good blood flow and a good check up. The problem was the shoe and orthotics as they were rubbing a callus of the 5th metatarsal, mid foot. We then went to orthotics with the doctors recommendation. They modified the orthotics. It felt great for two days….now I have to go back for another adjustment until the callus is gone.

I will have an appointment every six months and more often if necessary. As I have stated before Charcot is a very serious condition and needs to be monitored continually. Please take very good care of your feet. Don’t wait until it is too late to save your feet and you end up with an amputation. If you can’t see your feet, have some one look at them regularly for you…or use a mirror.

Brought to you by Charcot Awareness Education Foundation

Sugery On My Left Foot

My left foot was in stage one of Charcot. My toes were becoming hammer toes and the Achilles’ tendon was not very flexible. My ankle and foot were exhibiting some of the same problems my right foot and ankle did. In that, they felt like they were not wanting to stay together.

Maybe I shouldn’t have been surprised, but I was, when Dr. Roukis said he would perform surgery on my left foot the next summer. I guess I didn’t think I needed it. After all I was not having major pain in that foot. Surgery made a lot of sense though. It did mean recovery time, but only about six weeks compared to years. It would also be an out patient surgery so no hospital stay. This is why it is so important to get this diagnosis in the early stages.

Surgery was June 13, 2008. Of course I went through all the physical and permission stuff. We arrived at MAMC at 5:50 AM, checked in and was sent to the area to prepare for surgery. Max took my shoes and clothes as I would be in the surgical gown. My anesthesiologist was excellent. I had no bruises. There was only a small entry point between my thumb and pointer finger. I also asked him if I could be awake when I went into the operating room as I was out for the other two surgeries. He said sure. He kept his promise. I was surprised at how large the room was and that there were so many people there. I’m sure some were Dr. Roukis’ students. As soon as they began to swab my toes, I was out like a light.

One rather funny thing happened while waiting to go into surgery though I’m not sure Dr. Roukis thought it was. He came rushing in to the waiting area right past us. Stopped quickly, backing up. Greeted me and introduced himself to my anesthesiologist. Then he asked him, “What operating room are we in?” He replied “A.” Dr. Roukis said “They told me C. When I went in there , looked around and said, “I don’t do this type of surgery” and left. ”

We discussed the type of anesthesia so I asked Dr. Roukis what he wanted for me. Apparently I could have had a spinal, but we decided completely out. (I really don’t think he wanted me to be able to talk.)

Recovery after surgery was very quick. No sore throat, so was able to dress, get in the wheel chair and to the van, back seat and packed in. This was quite awkward as I couldn’t use the foot I had depended on for so long and I wasn’t sure of the right one. We were back home by 11 AM. I slept most of the way home. All went well until about 2:30 AM. I thought I could get up on my own. I knew I should wake Max and have him help me, but he was sleeping so soundly. (Not for long) As I tried to slide my feet to the potty, my shoe caught in the carpet and I fell. I tried to save my feet, so my knees hit the walker and I hit the right side of my head when I hit the floor.

It took a while to gain my senses so I could roll, crawl and get up enough to sit on the small stool Max was holding so I could stand as I couldn’t put weight on the left foot. Need I say I asked for help after this. Was I afraid to tell Dr. R about this? Oh, Yes!

During surgery Dr. R straightened my hammer toes, lengthened the achilles tendon by slipping the calf muscle and placed a pin in my ankle like my right foot. They sent pain medication home with me and I only used a couple of the pills. One after the fall and another the next evening to help me sleep. That didn’t work. I didn’t take any more again I really didn’t have any pain.

Now I have to tell DR. Roukis about my fall three days after surgery.

Brought to you by Charcot Awareness Education Foundation

The Confession and Surgery Followup

My left foot was in stage one of Charcot. My toes were becoming hammer toes and the Achilles’ tendon was not very flexible. My ankle and foot were exhibiting some of the same problems my right foot and ankle did. In that, they felt like they were not wanting to stay together.

Maybe I shouldn’t have been surprised, but I was, when Dr. Roukis said he would perform surgery on my left foot the next summer. I guess I didn’t think I needed it. After all I was not having major pain in that foot. Surgery made a lot of sense though. It did mean recovery time, but only about six weeks compared to years. It would also be an out patient surgery so no hospital stay. This is why it is so important to get this diagnosis in the early stages.

Surgery was June 13, 2008. Of course I went through all the physical and permission stuff. We arrived at MAMC at 5:50 AM, checked in and was sent to the area to prepare for surgery. Max took my shoes and clothes as I would be in the surgical gown. My anesthesiologist was excellent. I had no bruises. There was only a small entry point between my thumb and pointer finger. I also asked him if I could be awake when I went into the operating room as I was out for the other two surgeries. He said sure. He kept his promise. I was surprised at how large the room was and that there were so many people there. I’m sure some were Dr. Roukis’ students. As soon as they began to swab my toes, I was out like a light.

One rather funny thing happened while waiting to go into surgery though I’m not sure Dr. Roukis thought it was. He came rushing in to the waiting area right past us. Stopped quickly, backing up. Greeted me and introduced himself to my anesthesiologist. Then he asked him, “What operating room are we in?” He replied “A.” Dr. Roukis said “They told me C. When I went in there , looked around and said, “I don’t do this type of surgery” and left. ”

We discussed the type of anesthesia so I asked Dr. Roukis what he wanted for me. Apparently I could have had a spinal, but we decided completely out. (I really don’t think he wanted me to be able to talk.)

Recovery after surgery was very quick. No sore throat, so was able to dress, get in the wheel chair and to the van, back seat and packed in. This was quite awkward as I couldn’t use the foot I had depended on for so long and I wasn’t sure of the right one. We were back home by 11 AM. I slept most of the way home. All went well until about 2:30 AM. I thought I could get up on my own. I knew I should wake Max and have him help me, but he was sleeping so soundly. (Not for long) As I tried to slide my feet to the potty, my shoe caught in the carpet and I fell. I tried to save my feet, so my knees hit the walker and I hit the right side of my head when I hit the floor.

It took a while to gain my senses so I could roll, crawl and get up enough to sit on the small stool Max was holding so I could stand as I couldn’t put weight on the left foot. Need I say I asked for help after this. Was I afraid to tell Dr. R about this? Oh, Yes!

During surgery Dr. Roukis straightened my hammer toes, lengthened the achilles tendon by slipping the calf muscle and placed a pin in my ankle like my right foot. They sent pain medication home with me and I only used a couple of the pills. One after the fall and another the next evening to help me sleep. That didn’t work. I didn’t take any more again I really didn’t have any pain.

Now I have to tell DR. Roukis about my fall three days after surgery.

Brought to you by Charcot Awareness Education Foundation