Archive for February, 2010

Charcot Symptoms

Often a person finds out they have Charcot Foot before they even know what the symptoms are. Even though you may have realized one foot was warmer than the other and that your foot was changing shape, maybe a bulge on the side, or the arch had fallen and the toes were now becoming hammer toes and you’ve had an x-ray. You may have been told you had arthritis. You most likely have had a trauma to the foot. If you have Neuropathy, you have a loss of sensation.

This joint destruction process has a classification scheme of its order created by Eichenholtz decades ago called the Eichenholtz Classification.

Stage 0 – Clinically, there is joint edema, but radiographs (X-rays) are negative.

Stage 1 – Development stage (acute)

  • soft tissue edema (swelling, fluid in cells)
  • joint fragmentation
  • dislocation

Stage 2 – Coalescent ( merging ) phase

  • edema reduction
  • bone callus proliferation (growth)
  • fracture consolidation

Stage 3 – Reconstruction phase

  • osseous ankylosis (bony joint stiffening)
  • hypertrophic proliferation (abnormal enlargement of growth)

Charcot Foot (joint or bone) is serious for if this pathological process goes unchecked, it could result in joint deformity, ulceration, maybe infection and loss of function. The worst thing that could happen is amputation. Taking care of the feet and having a knowledgeable professional working with you will help stop further joint destruction.

Who might have Charcot?

There are some 24 diseases that cause Charcot foot to become worse. The following list of diseases by Ali Nawaz Khan MBBS Riyadh, Saudi Arabia appeared in an article in emedicine on Feb.21, 2007.

  • Diabetes
  • Use of steroids
  • Alcoholism
  • Trauma
  • Infection
  • Amyloidosis
  • Prenicious anemia
  • Syphilis
  • Syringomyelia
  • Spina bifida
  • Myelomeningocele
  • Leprosy
  • Multiple scierosis
  • Congenital vascular disease
  • Charcot-Marie-Tooth disease
  • Cord compression
  • Asymbolia
  • Connective disorders, such as rehumatoid arthritis and sclerodema
  • Ehlers-Danlos syndrome
  • Raynaud disease
  • Adrenal hypercorticism
  • Thalidomide embryopathy (congenital arthropathy in offspring of exposed mothers)
  • Paraneoplastic sensory neuropathy
  • Cauda equina lipoma

Since diabetes heads the list, diabetics need to be aware that this article says15% of the diabetic population has Charcot foot and a 2004 University of Washington study states that 1/600-700 diabetics with diabetes mellitus neuropathy has Charcot Foot.

Charcot is, apparently, difficult to diagnose and is often miss diagnosed as arthritis. One needs to find a Charcot knowledgeable professional. A podiatrist DPM, or a foot and ankle specialist (surgeon) DPM, FACFAS who is able to diagnose correctly.

Since nueropathy is a loss of sensation in the foot, one is unable to detect painful sensations. A doctor once told me a patient came into her office unable to remove his shoe and couldn’t understand why. When she looked at the bottom of the shoe she found a nail. It had gone through the shoe and well into his foot. It was removed and the shoe taken off to reveal a traumatic situation. Because of Neuropathy much goes undetected that could save the foot and individual from pain.

If you don’t have someone to help you check your feet, place a mirror on the floor that can be used to check your feet daily. Also, avoid going bare foot.

What is Charcot?

charcot footCharcot foot (neuropathic osteoarthropathy) deformity is a serious progressive and disfiguring condition often unrecognized because of loss of sensation. The area of the foot most commonly affected is the mid arch. It can also develop in the rearfoot and ankle.

Neuropathy often masks damage and pain from a trauma to the foot as one lacks feeling or sensation. This makes a diagnosis difficult. The trauma, however, could happen years before any sign of Charcot is present. It could be as severe as fractures in the foot from a fall to a seemingly minor incident as a can falling out of the cabinet hitting the foot, or walking, or jogging.

The end results are:

  • a severely deformed and disabling foot that is difficult to shoe and brace properly.
  • recurrent infections and ulcerations.
  • amputation

Charcot Joint was discovered in syphilis patients in 1868 by Jean-Martin Charcot in France. Charcot and Charles Féré published the first scientific investigation of this condition in 1883. It wasn’t discovered in the diabetic patient until W. R. Jordan made the link in 1936. It is believed Charcot was not discovered earlier because diabetic patients didn’t live long enough. Some 24 diseases causes Charcot Foot to emerge.

The Charcot Awareness Education Foundation Begins

Founder Annita Shaw and husband MaxI was diagnosed with Charcot Foot after having diabetes for over 10 years. I had never heard of Charcot Foot (Charcot bone or Charcot joint, a bone deterioration disease). In researching, I found nothing, or very little information about the disease. As a teacher and quite social, I wanted to share this information with interested individuals and those who may have the disease. Our lawyer suggested we put together a foundation. Because I was in a wheel chair with an orbital fixator on my foot and leg after surgery, I had plenty of time to tell my story so that others could be diagnosed properly by qualified medical doctors in time to save their feet from amputation.

The Foundation’s first charge was to put together a tri-fold pamphlet. After handing out the pamphlets, we learned three million diabetics, most likely, have Charcot Foot and are not being diagnosed correctly. 23 other diseases cause Charcot Foot to get worse. The foundation, Charcot Awareness Education Foundation, received word July 9, 2009 that the nonprofit foundation was approved, back-dated to July 2008 as the beginning date. We are excited about the potential and the response to our efforts. We hope it will be a great educational resource for everyone interested in Charcot Foot and that those who have it can find help.

The Foundation is expanding by use of a web site, sharing information at gatherings for the ADA, health fairs and anywhere we can.