Archive for March, 2015

What is Diabetic Charcot Foot?

As most of our readers know, I have Charcot Foot and also am a diabetic. After my Charcot Surgery in 2006, My husband and I with the encouragement of influential individuals did all the work to become a nonprofit 501 (c) 3. This happened in late 2008 and took us over a year to create this website which we have posted to every Thursday since. The main question to us has always been, “What is Charcot?”

When I met with my surgeon, Dr. Roukis, he questioned me about having a trauma sometime in my life. I told him of my being thrown from a horse at about the age of 10. He said that that was probably when Charcot started and when I was in my 60’s I was diagnosed with Diabetes causing the neuropathy and the seriousness or complication of Charcot began, hammer toes and the break down of the arch.

Since diabetes is now the number one disease that causes Charcot (though there are 25 other diseases that causes Charcot to become worse) the term Diabetic foot pops up. This is confusing to me. So, I have been doing a lot of searching and researching and have come to the conclusion that Diabetic Charcot foot deformity works best for us at the present time in the world of Diabetes. Any diabetic that has neuropathy for more than 10 years is at risk of developing Charcot.

In 1705 Charcot foot was written about by a British physician. In 1868 Jean Martin Charcot, a leading physician in Paris, practiced at La Salpetrierre (“The Grand Asylum of Human Misery”). Here he discovered Charcot in syphilis patients. It is now recognized as diabetic peripheral neuropathy. However, it was not found in the diabetic patient until 1936. Charcot was the first to publish descriptions of arthropathy and its involvement in the joints of the foot thus the name Charcot Foot.

So to answer the Question “What is Chacot?” I have come up with two things that seems to define the disease.

Charcot Foot causes bone in the foot to weaken. In those with neuropathy (nerve damage) such as the diabetic, bones easily fracture and with continual walking the foot gradually changes shape.

From above notice bulge on the arch.  Notice no arch showing on the side of foot.

From above notice bulge on the arch. Notice no arch showing on the side of foot.

Joints collapse, such as the arch, and an abnormal shape comes about.

Since Charcot is a very serious progressive condition leading to a severely deformed and disabling foot that is difficult to shoe and brace properly, this often leads to amputation. Because of the lack of feeling, the diabetic often has recurrent infections and ulcerations which adds to the severity of the condition.

A trauma, such as my fall from a horse, to as little as a can falling from the cupboard and hitting the foot can start Charcot. If the bone was fractured and the individual continues to walk on it, it only makes the injury worse. Balance can become an issue and falls occur. My experience.

Neuropathic patients with a tight Achilles tendon have been shown to have a tendency to develop Charcot Foot. My Achilles tendon had to be “lengthened” in my case as they were both very, very tight.

Message by the Founder Annita Shaw

Brought to you by Charcot Awareness Education Foundation

How Do You React?

How Do You React? 3/19/15

Personalities are interesting. In visiting with a number of people over the past few weeks we came up with two questions. What type of a patient are you and the other. What type of doctor do you want to work with?

How do you react when you go to the doctor? Defensive? Denial? Have to be there? Can’t communicate my problem? Needy?

I am diabetic and would like to think I’m in control of my situation. I really don’t like being told what to do. I have had a really wonderful medical team, but over the past few years they have changed, retired, moved or had health issues themselves. This means I have had to deal with different people. They often didn’t seem to know anything about me, yet they had my medical records. There didn’t seem to be any carry over. I guess I expected them to just continue with our usual routine.

Example: One doctor started to tell me that I needed to improve my A1c as it was too high at a 7.2. He wanted to see it in the 5’s or low 6’s. My eye surgeon has always complimented me on keeping it in the 7’s and doing so has sometimes been a challenge. He did try to give me some suggestions about lowering chloesteral . Mine has always been the same numbers within 10 points since I can remember. I’ve been told not to mess with it unless there suddenly is a change. I listened and tried to put some of his suggestions into play but the test showed no change. My A1c continually went up over the past three years and 6 months ago it hit 8.4. My weight had gone up nearly 20 pounds. I wasn’t happy, but I didn’t want to go to another doctor either. Strangely, he didn’t say anything.

Just a couple of weeks ago I had my 6 month check up. I had lost weight and my A1c was 7.1. He was surprised and said I did much better if he didn’t say anything to me. He finally gave me credit for understanding my situation and decided to work with me. This is what I prefer to do.

One problem I see is that the doctor often doesn’t take into consideration the feelings of his patients. He feels this is all about him and is the most important piece to the puzzle. Doctors and patients need to form a partnership in order to solve the problem. I see too many doctors who are brilliant, but can’t connect with the patient and truly care for them. Doctors seem to be afraid to get to know their patients and often give the patient the feeling they really don’t care what happens to them. They don’t want to spent too much of their emotional currency on the patient because they might end up showing that they care about what happens to them.

This attitude can also affect the medical staff that they work with. I actually loved going to the doctor who did my Charcot surgery and saved my foot from amputation as he used humor. Treated me like I had brains and kept me in every loop of the treatment. He was always willing to explain in greater detail something I didn’t understand didn’t seem to hurt his reputation. In fact, I am sure he has trained some very fine surgeons to follow in his foot steps.

Since Charcot Awareness is an educational foundation, I hope we can address some of these issuses in the near future.

Message by the Founder Annita Shaw

Brought to you by Charcot Awareness Education Foundation

Diabetic, Charcot (Diabetic) Foot and PAD

logo 72 SIGN CAEF
This past week I went to see my podiatrist. While I was waiting for him, I found a brochure put out by the WA St. Podiatric Medical Association. the responsible party for the contents Contents was the American Podiatric Medical Association of which the Wa St. group is a component.

Anyway after reading it, it became more clear that the diabetic really has a problem with their feet. This brochure was PAD and Diabetes. I have said Charcot Foot was usually caused by a trauma. The diabetic foot has good blood flow. PAD is “atherosclerosis” or hardening of the arteries which affect the blood flow to the legs.

This results in serious consequences. The worst result is also amputation.

PAD is peripheral arterial disease. They say PAD affects 8 to 12 million Americans. The American College of Foot and Ankle Surgeons say Charcot Affects 10 million diabetics of the 30 million diagnosed. In my math that says 20 million are at risk of amputations. Also there are others that Diabetics that have both Charcot and PAD.

Those at risk

• Smokers
• High Cholesterol,triglycerides
• Obesity
• Diabetes
• High blood pressure

Many individuals with PAD do not experience typical leg symptons so those at risk should undergo screening for PAD.

Message by the Founder Annita Shaw

Brought to you by Charcot Awareness Education Foundation

More Diabetics: Charcot Foot Becomes More Common (cont.)

All exercise done without any weight bearing on the right foot[/caption]More Diabetics: Charcot Foot Becomes More Common (cont.) 3/12/15

The American College of Foot and Ankle Surgeons tells us the symptoms of Charcot Foot appear suddenly. They include warm and red skin, swelling and pain. A person with diabetes who has a red, hot, swollen foot or ankle requires emergency medical care because these can also be symptoms of deep vein thrombosis or an infection.

Doctors say Charcot’s ambiguous symptoms can lead to misdiagnosis. Since patients don’t feel pain, doctors may presume the swelling is due to infection and prescribe antibiotics. Meanwhile the patient continues to walk on a foot that is collapsing.

“More people with diabetes, their families and their care providers need to know about Charcot Foot,” says J.T. Marcoux. DPM, FACFAS, one of only a handful of Massachusetts foot and ankle surgeons who performs Charcot Foot reconstructions “When I diagnose a patient with this complication, I telephone their primary care doctor and educate them about it as well.”

Kim says no one told her about Charcot. “It was not even in my vocabulary,” she says. “If someone had educated me, I think I would have been more aware that I had a major problem.”

This Orbital Fixator used to stabilize the foot while the patient is not putting weight on it.

This Orbital Fixator used to stabilize the foot while the patient is not putting weight on it.

But educating patients and their care providers is only half the battle. Keith Jacobson, DPM, FACFAS is the Houston foot and ankle surgeon who diagnosed and reconstructed Kim’s Charcot Foot. He and Marcoux say there’s little they can do when patients are apathetic or in “diabetic denial.”

“I’ve had patients who are literally blind, on dialysis and neuropathic who refuse to admit they have diabetes,” says Jacobson. “I have seen horrific deformities with this condition.”

Marcoux tells of a middle-aged woman he diagnosed with Charcot. Typically the first order of business is to immobilize the foot by putting the patient in a boot or cast, and to keep the patient off the foot by using crutches or a wheelchair.

Marcoux says his patient was “in massive denial” about her Charcot diagnosis. “I tried to get her off her foot, but she wouldn’t do it” He says, “Six months later she came in with a bone infection and a gaping hole in her foot.”

Foot and ankle surgeons expect to see more patients like that as diabetes rates soar.

Today, Kim is back to walking on both feet. Three months after her Charcot diagnosis, she underwent reconstructive surgery. Her recovery included spending three months in a “halo” external fixator where a series of pins and screws are placed into the bones and connected to clamps and rods outside the skin. She then wore a custom shoe boot for nearly a year.

The experience taught her four children to appreciate their mother a lot more. Since all the cooking, cleaning and laundry fell on their shoulders.

“They’re all like hawks now,” she says. “If I’m sitting here with bare feet, they’ll look to make sure they’re not red, hot and swollen.”

My experience was similar to Kim’s. I was given a window of time to do my surgery and plan for it. My recovery time

This deep where Annita did exercise without placing any load on her foot. Notice the chair life used to get her into and out of the pool

This deep where Annita did exercise without placing any load on her foot. Notice the chair life used to get her into and out of the pool

was longer, totally non weight bearing for nearly six months after which I spent quite a bit of time in the wheelchair. I was always afraid I would fall using crutches and my doctor, I believe, felt the same. I did much of my rehab in the diving portion of our local pool, deep water walking, making it easy to walk later.

I would like to say the purpose of this foundation is to educate about Charcot Foot and help those that are diagnosed with it avoid amputation.

Message by the Founder Annita Shaw

Brought to you by Charcot Awareness Education Foundation