Archive for May, 2012

Discussion and Conclusion With References (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.
6. Yu GV, Hudson JR. Evaluation and treatment of stage 0 Charcot’s neuroarthropathy of the foot and ankle. J Am Podiatr Med Assoc. 2002 Apr;92(4):210-20.
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.
8. Chantelau E, Richter A, Ghassem-Zadeh N, Poll LW. “Silent” bone stress injuries in the feet of diabetic patients with polyneuropathy: a report on 12 cases. Arch Orthop Trauma Surg. 2007 Apr;127(3):171-7.
9. Shibata T, Tada K, Hashizume C. The results of arthrodesis of the ankle for leprotic neuroarthropathy. J Bone Joint Surg Am. 1990 Jun;72(5):749-56

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

Brought to you by Charcot Awareness Education Foundation

Checklist & Case 3 and 4 (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.
6. Yu GV, Hudson JR. Evaluation and treatment of stage 0 Charcot’s neuroarthropathy of the foot and ankle. J Am Podiatr Med Assoc. 2002 Apr;92 (4):210-20.
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.
8. Chantelau E, Richter A, Ghassem-Zadeh N, Poll LW. “Silent” bone stress injuries in the feet of diabetic patients with polyneuropathy: a report on 12 cases. Arch Orthop Trauma Surg. 2007 Apr;127(3):171-7.

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

Brought to you by Charcot Awareness Education Foundation

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