Archive for September, 2012

Charcot Diagnosis Part 1

Courtesy of Valerie Schade DPM, AACFAS

Brought to you by Charcot Awareness Education Foundation

Amputee Needs & Other’s Perceptions

If you have been following Bonnie’s story, you know she has had her foot amputated to the ankle. I will share some of my research with you. Both Fishman and Goffman are highly revered in the field of psychology.

Fishman identified seven human needs common to amputees.

• Physical function with a prosthesis
• Visual and auditory considerations for the prosthesis
• Comfort of the prosthesis
• Energy expenditure in using the prosthesis
• Achievement in various activities with the use of a prosthesis
• Economic security
• Status and respect of one’s peers.

Fishman affirms these needs cannot be completely satisfied, and the consequences of the frustration that arises can result in psychological conflict and varying behavior

Obviously, an amputee would like the prosthesis to perform somewhat close to what the normal appendage would do. One would also like it to look fairly realistic, or, at least, not be too noticeable. It is great if it is comfortable, relatively easy to put on and after a short period of time, seem like part of your body. If it isn’t too heavy, it won’t take any more energy to use than normal. Thus, making it easy to go about one’s normal activities.

Try to put yourself in an amputees place. How would you feel? Would you want to share your experience, or hide it from everyone? Or would you avoid the situation?

How do you view an amputee when you meet, or see them in public? Do you stare? Are you surprised to see them leading normal lives? Do you feel sorry for them? Do you wonder what happened that lead them to have an amputation? Do you wonder if they are in pain? Do you reject them, or avoid them? Do you ever take the time to talk with them? Do you know someone who is an amputee? Are you their friend? Do you socialize with them? If so, where do you go? What types of things do you do with them?

Goffman states that the amputee often feels less respected, or accepted as a human being and often fears rejection. They can have pain even a ghosting pain. They also have anxiety of anticipated rejection.

Take time to be sensitive to those around you.

Charcot Foot seems to attack the older adult who does not adjust to amputation or physical change as quickly as someone in their 20’s or 30’s. I have heard from several who are well into their careers who are diagnosed with Charcot Foot. They have had to leave active physical lives working outside and been reassigned to a desk type jobs, or told they would have to go on disability.

Most were given very little time to think about it, or adjust to it. Bonnie woke one morning with a bone that had gone through the bottom of her foot. To the hospital she went, they couldn’t save her foot. They removed her foot to the ankle and some time later, because of a complication, she had to have a second amputation resulting in a BK cut. (amputation just below the knee) Though an amputation is not life threatening, it is still “abig deal”

Brought to you by Charcot Awareness Education Foundation

Amputation Is A Big Deal

My name is Bonnie and you have been following my story as a diabetic with sever foot pain which was diagnosed as Charcot after a bone broke and punctured my left foot which led to amputation, then wheel chair existence. I have been asked to write about a day in my life. First, I must tell you that I feel I am so blessed to be able to do the things I do in my life, and that I am able to live in my own home with my companion Tuk (a 7 year old pug).

My day usually starts at 6 am, or earlier. I live in western Nebraska and the mornings are beautiful and cool. I love to check out the sunrise right after saying a prayer of thanks for the day – glorifying God and Lord Jesus for their wisdom – guidance and discernment for the coming day in my life. Getting out of bed takes about 10 minutes, as I must put on my left leg prosthesis and the right foot boot (Crow boot). Then I transfer to my power wheel chair. I go to the living room and open curtains to watch the sunrise and play with Tuk. Of course first things first -Tuk wants his breakfast and fresh water. Next being a diabetic I must check my blood sugar and give myself an insulin shot. Turn on the TV to listen to Good Morning America while fixing my coffee and breakfast.

While drinking coffee, I turn on the computer to check out the news – temperature (which has been very hot here as we are in a deep drought). Then check out my morning e-mails – another blessing I keep in touch with my late husband’s family, three of his sisters, and I send good morning messages everyday, a true enjoyment and keeping up with each others lives.

At 8 am – turn off the TV and play Alan Jackson’s “Precious Memories” CD of old religious songs. I sing along and clean up the kitchen – make my bed get laundry started then take my shower. Taking a shower is time consuming also as I have to remove both the prosthesis and boot transfer to the chair in the shower. When the shower is completed, then I must get dried off very well put legs back on – transfer to wheel chair, then get dressed, do my hair and be ready for the handy bus by 9:30 am. (this is only on Tues./Thurs) I go to a senior function at the Carpenter Center for lunch and playing pinochle. We have a great time and a wonderful meal. At 2 pm the handy bus picks me up to go home. Depending on the day of the week I may go grocery shopping before going home, or on Tuesday afternoon our minister stops by for a visit and prayer, a very comforting time. But I have been known to get home and sit in the recliner with Tuk for an afternoon snooze.

I spend a lot of time on the interment with friends/relatives, or playing games. I do not go out in the evenings much, so between – movies -computer – telephone the evening passes fairly good. I do love football – Nascar – movies – Fox News, I do not watch any of the major, TV channels, too much garbage.

Bedtime is usually bout midnight and that always takes a good half hour or longer.
I must wash the prosthesis liner, so I have a fresh one in the morning. I transfer to bed after plugging in the electric power for my wheel chair. I clean both legs and foot and apply ointments to keep the skin healthy from wearing the prosthesis. Before shutting off the lights, I spend time reading “The Daily Bread,” a daily publication of bible worship and special bible passages that apply to our daily lives. Then my prayers of thanks for the day and its blessings upon me and my time to pray for special requests for family/friends – military families and guidance for our country.

(I really admire Bonnie as she has stayed very independent and as you can tell carries on a very normal life. She is always very positive. She, like all of us, has regular appointments whether medical or otherwise. She merely researches what is necessary to do and schedules the handy bus to get her where she needs to be. She always takes a book or some thing along with her in case she needs to wait. She is a good conversationalist and this helps. She has had her ups and downs getting to this place I’m sure. Unfortunately, most people in her situation would never live alone and many of them feel sorry for themselves and don’t enjoy life, their surroundings, or friends and families. Amputation IS a big deal as it changes your life and the way things are done. Annita )

Bonnie’s continuing story

Brought to you by Charcot Awareness Education Foundation which reminds you that, “Your Feet Are Your Foundation”

Charcot Symptoms

Often a person finds out they have Charcot Foot before they even know what the symptoms are. 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, or claw toes. You’ve had an x-ray. You may have been told you have arthritis. Looking back in time, you most likely have had a trauma to the foot. If you have Neuropathy, you have a loss of sensation.

Because this is all very gradual, you may not be aware of the changes in your foot or feet. You may realize that you are not as stable when walking, your feet bother you more, but, Oh, well, it just seems like it’s part of a normal aging process.

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.

Unfortunately, it seems, many doctors, podiatrits and surgeons come across with the attitude amputation is no big deal.

Brought to you by Charcot Awareness Education Foundation