Charcot – The Painless Road To Amputation

Shark – O? No Charcot.

For nearly 30 million American with diabetes, a debilitating and often preventable foot condition exists that is often misdiagnosed and untreated. A lack of awareness of this condition can lead to the need for multiple surgeries and even amputation. All of this, however, can be avoided if caught early.

Charcot neuroarthropathy is a result of peripheral neuropathy, or the loss of feeling in the feet and legs. Diabetes is the number one cause of peripheral neuropathy in the world. An estimated one third of all diabetic patients develop peripheral neuropathy. The problem with diagnosing Charcot is that the early symptoms are usually minor, typically just swelling of the foot and leg which may or may not be uncomfortable or painful due to the presence of peripheral neuropathy. If care is not sought, or a doctor misdiagnoses the condition, deformity of the foot will develop.

 

While the way Charcot occurs has been debated for years, the end result is the bones of the foot shift out of position and fracture, leading to loss of the arch of the foot and foot deformity where bony bumps appear on the bottom of the foot that were not there before. Walking barefoot and in poor fitting shoes cause calluses to form over these bony bumps. If not treated early, these calluses can result in an open wound, or ulcer, on the foot. Having an ulcer on the foot increases the risk for infection of the skin and bone under the ulcer, which is the main reason for surgery and amputation.

Because peripheral neuropathy must be present for Charcot to occur, many people do not realize they have a “Charcot foot” until a change in foot shape, or sometimes an ulcer, is seen. Anyone at risk for peripheral neuropathy, particularly patients with diabetes, should see a podiatrist at least once a year, even if they are considered low risk, to catch this condition early if it arises. Treated early in a special cast or boot can drastically reduce the potential for foot deformity, ulcer, infection and amputation. If any difference in the feet are noticed, discomfort, unexplained swelling, redness, or changes to the shape of the foot, you should be seen by your podiatrist right away.

Annita Shaw, a retired school teacher and diabetic, knows this all too well. Annita visited an emergency room three times for foot pain over several years before seeing a podiatrist who ultimately diagnosed her with a Charcot foot. “Several physicians suggested my foot pain was due to arthritis or that my shoes were too tight. No one x-rayed my feet. Finally, I found a podiatrist who determined that Charcot was the cause of my ongoing foot problems,” says Annita. Annita created the Charcot Awareness Education Foundation, http://charcotawareness.org/, to advocate for greater awareness of Charcot foot, informing and educating at-risk patients and the general public. “If I can save even one person from the pain of surgery or amputation by raising awareness of Charcot foot, I’ll have done my job. People spend so much time and money worrying about again and maintaining beauty, when really they should spend time caring and worrying about their feet.”

Next topic in this series: Signs I may be having an early Charcot event