Archive for April, 2015

Kitsap Great Give 2015

CAEF is participating in the 2015 Kitsap Great Give on Tuesday, May 5, 2015. Please take this opportunity to donate to nonprofits. This is a one-day charitable event, so be sure to check back next Tuesday!

Please visit the Charcot Awareness Education Foundation page at the Kitsap Great Give.

CAEF to Take Part In Kitsap Great Give May 5, 2015

Help prevent amputation for those with peripheral neuropathy which causes Charcot Foot. Donate to Charcot awareness Education Foundation through Kitsap Great Give May 5, 2015. Go to www.kitsapgreatgive.org to make your donation.

All Sponsor pool group

All Sponsor pool group

Great Give information

Great Give information

Inside item 2

No matter where you are you can donate to Charcot Awareness Education Foundation. May 5, 2015 only from 12:01 am to 11:59 pm at www.kitsapgreatgive.org.

Education is the Key to Understanding.

Message by the Founder Annita Shaw

Brought to you by Charcot Awareness Education Foundation

Diagnosis of Charcot Foot and How

Though Charcot was discovered by Jean-Martin Charcot in France in 1868, It was not discovered in the diabetic patient until 1936 in the USA. One reason given was that the diabetic didn’t live long enough until that point in time.

I was talking with a nurse that is a diabetic educator last week and learned that she was educated on the east coast to diagnose Charcot Foot deformity in the early 1960’s. She worked in the south before coming to the west coast. She placed strong emphasis on neuropathy as the reason for much of the Charcot diagnosis.

She stressed that a diabetic have the feet checked. The exam would not only be finding out the extent of neuropathy in the feet, but for the doctor to x-ray and check the foot for bone placement, checking for any abnormal structure. This should be done yearly as the foot can change gradually. Mine did, but for some reason I didn’t think this was a problem.

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.

Had a doctor told me to keep track of any changes in the foot and let him know it might not have gone so long. Maybe it wouldn’t have been diagnosed as arthritis for nearly 10 years before I was told I had Charcot Foot.

Research will some times tell you, you have to have neuropathy a long time, at least 10 years before Charcot will show up. This is maybe one of the reasons the diabetic needs to have the feet checked every year. Also, many who are diagnosed with Diabetes may have had it for 10 years or more before they were diagnosed.

It puzzles me as to why it seemed to become less important if those in the medical profession were taught about Charcot in the 1960’s. Maybe other things took presidence. Maybe someone more important or who had money to put behind another disease suddenly became more important.

Hardware in right foot.  A successful surgical repair.

Hardware in right foot. A successful surgical repair.

Jean-Martin Charcot is reported to have said: “To learn how to treat a disease, one must learn how to recognize it.” And “In the last analysis, we only see what we have been taught to see.”

Message by the Founder Annita Shaw

Brought to you by Charcot Awareness Education Foundation

Pain And The Diagnosis fF Charcot Foot

I mentioned last week that pain was an indicator of a problem that both the patient and doctor relied on. However, in the case of diabetic neuropathy the feeling is minimized and possibly nonexistent so not a reliable predictor. Thus Charcot could be ignored.

When a person is diagnosed with diabetes, has swelling in their lower extremities, especially the foot they should be considered to have Charcot. Diabetes is presently the major disease that has Charcot foot deformity. The number of those with Diabetes is growing rapidly in the USA. Even if you aren’t diagnosed with Charcot the first time, it is wise to check each year as it can develop.

Going back to the experience I had with Charcot apparently started long before I was diagnosed as a diabetic. My surgeon determined it probably started after I was thrown from a horse at the age of 10.

Taking a ride on "Pat" who was not a horse that bucked people off.

Taking a ride on “Pat” who was not a horse that bucked people off.

I landed on my feet and probably fractured some of the bones in my feet. I was not taken to a doctor as I was able to walk. We lived on a farm quite a distance from a doctor and I am sure there was no insurance. Since I walked on my feet the bones never really had a chance to heal and in 1995 I was diagnosed with type II diabetes. Diabetes had already caused the Charcot to become worse.

During the school years, playing on a dirt basketball court at recess led to turned ankles and more falls.

The Henry School where we played on the gravel

The Henry School where we played on the gravel

This became a norm and by the time I was in High School I could walk anywhere step on a rock, an uneven sidewalk and fall. One time in particular, my friends and I were coming back from lunch and I fell crossing the gravel street. Once in the classroom my teacher asked me to leave the room and wash the blood off my knee and leg. College seemed to be fine, maybe because I got most of my exercise in the swimming pool. However, while teaching elementary I fell playing games with the little ones outside. This concerned them. After marriage, we were at the Vietnam Memorial in WA, DC when my leg just gave way and I fell. I learned to walk near railings and to watch where I was walking. I also learned how to fall without ever breaking a bone or being hurt badly. Pain? Honestly, it hurt, but never made a big deal about it. I know it hurt, but I couldn’t tell you to what extent.

After my reconstructive Charcot surgery, I was totally non-weight bearing, orders from Dr. Roukis. That meant I had to wake my husband if I had to go to the bathroom even though the potty chair was only about a foot from the bed. Max was sleeping soundly and I really didn’t want to wake him. After all I had done this many times before, so I surely could do it now by myself. So I began the process, Whoops! Down I went. No matter how hard I tried I couldn’t get up and finally woke Max for help. Try getting yourself up on a small stool without putting any weight on the foot and trying to get enough purchase on the bed to pull yourself up and into a wheelchair. Not easy and I have no idea how long it took us, but a while. I had an appointment with Dr. Roukis in a couple days and had to tell him what happened. Believe me he was NOT pleased. Did it happen again? No way.

I was non-weight bearing for nearly six months and basically in the wheel chair for

Judging the County Fair Art Show - student work

Judging the County Fair Art Show – student work

six more months with only a few steps at a time. Once the foot was nicely healed I had surgery on my left foot for Charcot. This was minor compared to the Right foot and recovery was about six weeks and I was back to walking. Early diagnosis is key.

I really believe everyone who has diabetes, or Charcot symptoms need to have it checked so you don’t end up with the complications. Waiting too long can lead to amputation which is another problem entirely.

Message by the Founder Annita Shaw

Brought to you by Charcot Awareness Education Foundation

Misdiagnosis of The Diabetic Charcot Foot

Diabetes is number one where Charcot Foot appears. In fact in my readings of research many are referring to it as Diabetic Charcot Foot. Experts believe there are about 10 million diabetics with this progressive and devastating disease that leads to amputation for many.

Charcot Foot commonly goes unrecognized until severe complications occur. Early recognition and diagnosis with a program of preventive care can minimize the morbidity associated with this potentially devastating complication of diabetic neuropathy.

Researchers suggest a lifelong program of patient education, protective footwear, and regular foot care for patients with Charcot Foot. The problem I find is lack of diagnosis not just misdiagnosis. Even the podiatrist that diagnosed me with Charcot saw me regularly for two years yet didn’t diagnose me until I brought him a set of x-rays that I had done at my request because my feet hurt and things just weren’t right.

My concern is that if you are a diabetic the medical staff only looks at blood work, your A1c, your weight and how much exercise you get. They never touch on Charcot. When I complained to my doctor about my feet he sent me to a podiatrist. What did he do? He said my shoes were too tight and put me in a running shoe and told me I needed to walk about 2 to 3 miles a day. I tried it. My feet hurt worse. I went to a chiropractor who adjusted my foot and ankle which helped. Unfortunately, I had to have the adjustment more often as time went on and this concerned him.

I wonder what education they have since they were suggesting a program of patient education. If the doctor isn’t trained to look for, or know Charcot, where does one go from here. Jean-Martin Charcot said, “ To learn how to treat a disease, one must learn how to recognize it.” He also said, “In the last analysis, we only see what we have been taught to see.” Where is the educational break down? Where should the education about Charcot Foot begin since there are 25 diseases that affect Charcot. Diabetes just happens to be at the top of the list.

Research says Charcot is often misdiagnosed as Cellulitis and/or deep venous Thrombosis (DVT). Trauma, or an identifiable injury could create factors for Charcot Foot also.

Misdiagnosis: They think it is Cellulitis because you are diabetic, have cracked heels and your foot is red , warm to the touch and swollen. Cellulitis is a bacterial infection. Diabetics often have ulcers that are hard to heal. Thus Charcot is missed.

Misdiagnosis: They consider deep venous Thrombosis, (DVT) because you are diabetic, over weight, inactive, which means you sit for long periods of time. You have decreased blood flow. Your legs may be blue from the lack of oxygen and swollen. They worry about a blood clot. Pain and tenderness are usually absent because of sensory neuropathy. Both doctors and patients rely on pain as a predictor which in this case doesn’t exist.

All of this takes time and recently at one of my appointments I came in for one thing and I wanted to talk to him about another. He politely told me he had only 15 minutes to spend with me and I would have to make another appointment if I wanted to discuss this one. So, how does a patient become properly diagnosed? Could this be another reason why a patient doesn’t get properly diagnosed? Could clinic economics play a part?

Message by the Founder Annita Shaw

Brought to you by Charcot Awareness Education Foundation