Archive for March, 2010

Living With Charcot Foot

Over the next few weeks I will tell you the story of the Charcot Foot events in my life from it’s discovery through surgical correction to the present.

As a country kid growing up in western Nebraska I loved to lie on the grass and watch the clouds go by.  Trying to envision imaginary animals and people in them, dreaming dreams.  Never once, however, not once, did I think I would be a founder of a foundation that would deal with a medical condition.

Nita on Pat copy

I was adopted at the age of three days.  No record of medical history was passed on to my new parents. Growing up on the farm, I rode horses and at the age of about ten I was thrown from one landing on my feet and dropping to my knees.  This may have been the trauma that started my Charcot  Foot.  Through the years I fell a lot, often unexpectedly.  It always seemed to be a turned ankle.  Playing basketball, walking across the street, or just walking with friends.  It was embarrassing, but one soon learns to get up brush yourself off and continue on.  You also learn to fall without hurting yourself when you do it so much.

I really didn’t think too much about the falling as I got older.  My feet bothered me, so I didn’t do a lot of walking or running. When I taught elementary, I played games with the children and fell just like they did. I discovered  seeing me get hurt upset them.  Eventually, I moved to the junior and senior high level of education.  No recesses.

In 1995 I was diagnosed with type II diabetes.  In order to keep my blood glucose at a normal level (giving up Pepsi helped) I began walking.  I was walking three miles a day.  Because my feet hurt, I went to my doctor. He checked my feet for Neuropathy.  I really didn’t understand the purpose.  He didn’t explain it either.  Soon I had an ulcer and the big toe had developed an infection.  He didn’t want to deal with it so, he sent me to a podiatrist.  This was in 2003.

The podiatrist had me change to walking shoes because the others were too tight causing my foot problem.  Unfortunately, the walking shoes made my feet hurt even worse.  I realized the right foot was getting worse so I went to the doctor when the podiatrist was on vacation.  He wouldn’t deal with me and I ended up with the new podiatrist in the office.  That ended up being a blessing as the new podiatrist was able to take care of the ulcer and infection in a relatively short time.

My husband retired from the military and because of this my podiatrist sent me to Madigan Army Medical Center (MAMC) to have orthotics made.  These really helped and he let me go back into my tight shoes.  While at MAMC the man who was fitting my feet for the orthotics said, “Mam, you have a very serious foot problem and you need to go to the Limb Preservation Clinic”.  I asked him Why? He said he couldn’t diagnose, but he had seen enough feet in his life time that he knew my situation was serious.  I didn’t think I was that bad.  I didn’t need to take up space that was needed by those coming back from Iraq and Afghanistan.

I couldn’t believe I could possibly be a candidate for an amputation.  I knew diabetics often had them, but I didn’t think my feet were that bad. My blood sugar was under good control. I decided I would just watch my feet and note any changes.

Amputation

As a diabetic person with Neuropathy, one is concerned about foot health and the possibility of amputation. Statistic’s note the number of diabetics at 23.6 million and lower-limb amputations per year some where between 71,000 and 86,000.  This is scary considering there are other diseases and conditions that warrant amputation.

Because of a foot problem, have you gone to a doctor and found they really didn’t help?  Mine sent me to a podiatrist  because he didn’t want to deal with my situation.  I had no idea what my problem was.  The podiatrist didn’t seem to think it was serious  and it could be taken care of by changing the type of shoes I wore.  Unfortunately, I found it more difficult to walk and my feet hurt worse.  I went back to my tight fitting shoes.  The very type that a diabetic shouldn’t wear. My feet felt better.

You can read most anywhere that infections and Neuropathy can lead to amputation, but rarely do you hear anything about Charcot Foot and its devastating effects, or that it is responsible for amputations.  Why?  Because it isn’t being diagnosed.  If it were, many feet could go through surgery and be saved.

Doctors don’t often see a patient until the problem is too serious.  In fact, so late that amputation may be the only option.  The problem may be an ulcer or infection that won’t heal.  Because of the impaired circulation system, the body can’t heal the amputation either and another amputation maybe in order until the entire leg is amputated.  My doctor and several articles  stated that, on average, a person over the age of 60 who has a foot amputation has a life expectancy of about five years unless they have a positive attitude, a good support system and a comfortable place to rehabilitate.

Amputees are often diabetic, are often a racial minority, poor, fat, old and often ignored (paraphrased from government data).  According to a March 24, 2009 article in the LA Times, “…the  U.S. health-care system is poorly designed for what diabetics need most, preventive care; instead it doles out money for expensive urgent care such as amputations,….”

Break-through

Check out the article “REBOOTING the BODY” by Catherine Price in the March 2010 issue of Popular Science.   It is very promising for the Type 1 Diabetic.
Jeffrey A. Bluestone, Ph.D. is the director, UCSF Diabetes Center and Immune Tolerance Network.  He has worked for nearly 30 years trying to find out how to keep the immune system from attacking the body itself.  They used a control group of newly diagnosed Type 1 Diabetics and the results are very promising.

“If everything goes smoothly, an anti-CD3 drug could win FDA approval in as little as two years, making it the first approved treatment ever that targets the cause of type 1 Diabetes.”

Remember amputation is a complication of Diabetes.

Be Proactive

A friend of mine said she didn’t understand how her sister ended up with bloody blisters on her feet and didn’t feel them. Have you ever had the doctor check the sensation of your feet with a small monofiliment line? Did he explain the test, or results, or the reason for the test? Mine may have, but it didn’t mean anything to me. I left feeling that everything was normal. It wasn’t. Like many with Neuropathy you don’t feel the pain or sensation you should. So you really need to be proactive with your foot care.

Keep your feet healthy. That means you do need to check your feet daily. Pay attention to the fact you may have stepped on something and check. Keep them clean and free from ulcers, calluses and infection. If you need medication to control blood sugar, or other conditions, take it correctly and get regular check ups so your healing is at its maximum. If you have Charcot Foot, having a healthy foot is extremely important because a healthy foot means you will be able to keep the foot and not likely to have it amputated. It may mean orthotics, custom shoes, other type of bracing, but you will be able to walk.

Even if walking is limited, you can maintain your independence and quality of life. Remember your feet are your foundation.