Archive for October, 2013

Charcot Foot 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.

Avoid Amputation! Seek treatment. Things to do.

* Keep your feet healthy, clean, free of calluses and ulcers by checking them daily.
* Take your medications to keep diabetes, or other maladies under control.
* Clear up infections
* Doctor recommendations:
* Surgery
* Immobilization
* Keep the foot non-weight bearing for proper healing
* Customshoes and / or bracing
* Maintain a positive attitude, keep an open dialogue, work with a support group.

Your feet are your foundation. Please take care of them.

This weeks article was contributed by Founder Annita Shaw

Brought to you by Charcot Awareness Education Foundation

Who Might Have Charcot Foot ?

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 corticosteroids
  • 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. One who has Charcot foot 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. Protect your feet. We were visiting my husbands mother. She had a shagg rug in her living room. I was barefoot. We were there a couple of days. We left and went to Carlsbad Caverns, by this time my foot was really hurting me. Walking was difficult. Inspecting the foot didn’t really reviel anything. However, after touring the cavern we noticed a swollen red spot. I squeezed the heel and out popped a piece of round tooth pick. We figured I had picked it up in the shagg rug, breaking part of it off in my heel.

This weeks article was contributed by Founder Annita Shaw

Brought to you by Charcot Awareness Education Foundation

What is Charcot Foot?

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.

After talking with my surgeon, it was decided my Charcot Foot came about because of being thrown from a horse at the age of 10. I landed on my feet and dropped to my knees. While in Jr. and senior high school, I often fell. This was always embarrassing, as I was usually with friends. Even after I was married, we were in Washington, DC sight seeing when for no apparent reason I fell. I was quite used to this and learned to fall with out hurting myself too much…..maybe a scratch, or bruise. It simply became part of my life.

It would have been wonderful if this condition could have been identified when I was young. The surgery would have been much less complicated.

This weeks article was contributed by Founder Annita Shaw

Brought to you by Charcot Awareness Education Foundation

A Diabetic? . . . /Check for Charcot Foot Part 2

Strict immobilization and protection of the foot (most often in a total contact cast) is the recommended approach to managing the acute Charcot process. If the diagnosis of Charcot Foot is a possibility, there should be no weight borne on the foot. A nuclear scan may be used to distinguish the Charcot Foot from infection, they are not routinely performed, however.I was fortunate as I had to wear a surgical boot on my right foot which was in the last stage of Charcot Foot. Many have to wear a CROW (Charcot Restraint Orthopedic Walker), or clam shell boot. These are to protect the foot from further damage and to keep it immobilized as much as possible.• A careful program of patient education, protective footwear and routine foot care is required to prevent complications such as foot ulceration. If your foot goes into a remissive state after being in the cast, or boot. You must protect it for the rest of your life. Foot deformity will always remain at risk for ulceration. Thus, you need to work with your primary care physician, or your podiatrist. This could include braces, special, or custom footwear.• Reconstructive surgery is reserved for patients who have recurrent ulcerations despite compliance with the previously mentioned regimen.The foot will be realigned through surgery to redistribute pressure more favorably. Most receiving this surgery are patients who cannot be managed successfully with aggressive nonsurgical measures.I had no ulcerations, or wounds, I did, however, have some calluses and some evidence of rough skin. My doctor had me use lotions to smooth the skin and sent me to have orthotics specially made for my shoes to protect my feet from improper impact when walking. I recently met a woman whose son was diagnosed with Charcot and has just undergone foot surgery. He has none of the diseases that contribute to Charcot. Most of the bones in his foot were broken and the surgeon was able to reconstruct his foot and not amputate.Remember, if you choose to improperly manage your foot care, foot ulceration, subsequent infection and ultimately amputation are common occurrences.

This weeks article was contributed by Founder Annita Shaw

Brought to you by Charcot Awareness Education Foundation

A Diabetic?. . . Check for Charcot Foot Part 1

The following is an article based on a handout from the AAFP in about1994 concerning Charcot Foot in the diabetic.patient.

Charcot Foot is going undiagnosed in the diabetic patient especially in the early stages. It is usually diagnosed at a later stage when there are severe complications. At this time it is usually too late to easily correct the problem. You need to manage this disease early in order to save the feet and avoid amputation.

Immediate immobilization and a life long program of preventive care will help to minimize the morbidity connected with the potentially devastating complications of diabetic neuropathy. The first x-rays may be normal which makes it hard to diagnose Charcot. Patient education, protective footwear and routine foot care will help to prevent things such as ulceration.

When you go to the doctor and are diagnosed as a diabetic (diabetes mellitus or type II) you should expect him, or her to touch base on the following with you when it comes to your feet. Diabetes makes Charcot Foot worse.

• The acute Charcot Foot may mimic cellulitis and sometimes deep venous thrombosis. The foot has swelling and erythema (redness over the skin and heat like an insect bite)

• The existence of little or no pain can often mislead the patient and the physician.
None of us want to admit to having a problem Pain is like a thermometer. It indicates the seriousness of the problem. However, because of neuropathy, there is minimal to no pain. Thus, the Charcot fracture and this serious disease is often over looked.

• Findings on x-rays can be normal in the acute phase of the Charcot Foot
Every time I had an x-ray, they said I had arthritis, but not until I took my x-ray to a knowledgeable podiatrist was I diagnosed with Charcot.

However, if Charcot Foot is suspected, they will suggest: foot up, immobilized and non weight bearing

More on this next week

This weeks article was contributed by Founder Annita ShawBrought to you by Charcot Awareness Education Foundation