Charcot foot is a neuropathic foot disease that is sometimes seen in patients with diabetes. The prevention of further joint destruction and foot deformity is the primary initial aim in treatment of charcot’s foot. Dr. Babak Kosari of Valley Presbyterian Hospital tells us about this disease and how critical it is to have it treated promptly and correctly. It’s a condition that affects diabetics. Now it’s an end stage type of a condition where once you start developing a charcot foot, your disease process has gone on for a long time your neuropathy or lack of sensation in the lower extremity which is one of the.
Conditions that happens with over 40 of diabetics. The bones in the foot, they start to demineralize. In other words the calcium, the minerals, the get less and less the bone becomes weak and it starts to crack just by standing or walking. Now if you have a minor trauma that exacerbates it. Eventually what happens, the arch of the foot starts to collapse and the foot changes the shape and then you develop this what’s called technically Bag of Bones and these are tiny fractures that happens in the bones of the foot of the diabetic patient.
It’s a very very serious condition when it happens for a diabetic. In the initial phase, it goes untreated, unnoticed again primarily because the patient doesn’t feel pain. The disease process is very complicated, there are many theories about it. One of them is that the nerve endings that supply sensation to the arteries, they don’t function well. So the signal goes to open up the vessels the rush of blood comes into the foot and the rush of blood demineralizes the bone, weakens the bone. The treatment involves a team process we have a foot surgeon, we have the vascular surgeon, we have the endocrinologist,.
Treatment Options for Charcot Foot Babak Kosari, MD
Primary physician, all these have to come together and develop a plan. The point is to prevent all this, once it happens the game changes. Then you get into first trying to stabilize this process because these bones are breaking. The patient is walking, they’re working, they’re doing things they’re weight bearing and they’re not realizing that this foot is actually collapsing slowly, slowly, slowly and if you take photographs from day one to day thirty, the drastic change in the foot. This is not a reversible type of a condition.
What we do is in severe cases, we do reconstruction of the foot. It’s a very complicated surgery, it involves metal frames that go from the foot to the leg. It’s a long recovery and it has many facets to postop care and education you know education for a long term. The first preventative treatment for these types of patients is education. You want your patient to know about what to look for, they have to have a comprehensive plan of care which routinely involves being checked by a foot specialist for types of foot changes that.
Normally we don’t think about. For example a small callus, you know we have calluses on our hands and our feet but that callus for a diabetic patient underneath is a very significant finding underneath, what’s happening in the bones is very crucial. Xrays, different imaging studies, just watching the patient walk, how they’re walking, the biomechanics of the foot, the types of shoes that they wear, the type of activity, their lifestyle, all these come into effect and my biggest weapon against all this is educating my patient as to what to look for. It’s a preventable condition but it has to be caught early and.
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