Tag Archives: Ulcers

A Question From India: Can Charcot Foot Be Cured?

6 Aug charcot foot diabetes

The PA Foot and Ankle Associates blog gets questions from all over the world about foot and ankle health. Today we received this one from Manohar in Bangalore City, India.

“Hello sir. This is Manohar from India, Bangalore City. My father is suffering with charcot joint disease and also a diabetic neuropathy. In the last month his leg is completely swelling. An orthopedic surgeon has suggested amputation. My question is how can it be cured?”

Thanks for your question, Manohar. The doctors at PA Foot and Ankle Associates, and particularly Dr. Thomas Rocchio, are one of the United States’ foremost experts on Charcot foot disorder.

Charcot foot disorder is a side effect of diabetes and is accompanied by diabetic peripheral neuropathy. Diabetes damages blood vessels, causing a decrease in blood flow to the feet. Poor circulation weakens bones, resulting in a disintegration of bones and joints in the foot and ankle. This puts the bones at high risk of fracture. Unfortunately, a diabetic who has nerve damage from DPN has a loss of sensation in their feet, and will be unaware of the bones fracturing. They continue to walk on the foot, causing the joints to eventually collapse and the foot to change shape, most notably to a rocker-bottom appearance. Sharp edges of bone may put pressure on the skin, creating the risk of chronic skin sores. It’s this end result – a combination of bone disintegration and trauma – which is known as Charcot foot disorder. It’s one of the most serious complications of diabetes.

charcot foot diagramcharcot foot disorder

Charcot is a very dangerous disease, as it is in many cases accompanied by bone infection. In highly advanced cases, sometimes amputation is the only realistic treatment. However, it is far from the only treatment.

“There are reconstruction options for many Charcot patients, but there needs to be circulation in the foot for it to heal.”, according to Dr. Rocchio. “Infection can affect the result as well. The remaining reconstructed bone must be free from infection and there must be enough healthy soft tissue to close the incisions. Usually an aggressive external fixation is needed to stabilize the reconstruction. Unfortunately, no complete answer can be given without an exam of the patient.”

Dr. Adam Teichman adds, “There are treatments to stabilize, correct, and prevent Charcot and the breakdown of the foot. For instance, if  ulcers can be healed, infection can be cured, which allows a number of options to save the foot. Amputation is not a therapy, it’s a last resort.”

Read more about Charcot foot disorder

Early diagnosis of Charcot is key to saving the foot, which is why every diabetic should have their feet checked regularly by a podiatrist. Manohar, we’d be happy to examine your father and give you a complete diagnosis and treatment plan if you and he can travel to the States.

What Your Feet Tell You About Your Health

28 May

foot health

Seems to us that every general physician should ask you to take your socks off. Even if you’ve gone to see your doctor complaining of a chest cold, an inspection of your feet might inform them of the early symptoms of many conditions.

Our feet are farthest from our hearts and spine, so in many cases they’re the first area to indicate problems with the nerves or circulatory disorders. The brain and internal organs receive blood before our toes and feet do, so our appendages are the first to suffer.

Nine health problems which first show up in your feet

1.Always cold feet could be a sign of hypothyroidism, a condition in which your thyroid gland is underperforming. Most common as we approach middle age, hypothyroidism can also cause hair loss, fatigue, weight gain, and depression. A simple blood test ordered by your doctor can confirm this condition, and daily oral medication can get your thyroid gland functioning properly.

2. Suddenly hairless toes and feet could be a sign of a circulatory disorder, as your feet may not be receiving enough blood flow to sustain hair growth. Your doctor should check for a pulse in your feet, and if she has any doubts, should order a thorough cardiovascular screen.

3. Foot cramps that won’t quit may indicate a nutritional deficiency or dehydration. Sure, everybody’s feet cramp up now and then, but what matters is how often and how severe. If you exercise a lot, make sure you drink plenty of water to hydrate your muscles. You also should eat a balanced diet with plenty of potassium, magnesium, and calcium, as a lack of these nutrients can also cause cramping (good sources are nuts, leafy greens, and dairy). To relieve cramps in your feet, stretch your toes up, not down. If the cramping in your feet just won’t let up, see your podiatrist so that he or she can test for circulation issues or nerve damage.

4. Yellowing toenails is a sign of aging, but may also indicate a fungal infection. Yellowing can also occur when you wear nail polish for months without a break. If your toenails are flaky or brittle, you probably have a fungal infection and should see a podiatrist for treatment.

5. Flaky, itchy, or peeling skin between your toes is a sure sign of athlete’s foot. Even if you’re not an athlete, it’s easy to pick up a case of athlete’s foot if your feet are crammed in shoes all day or you walk barefoot in common areas like a sauna or swimming pool. Use an over the counter creme to relieve the symptoms, but if your flaking, itching, or peeling continues, you may have psoriasis or eczema. Your podiatrist can determine which is which and suggest a course of treatment.

6. Your big toe suddenly becomes swollen and painful. This is an almost sure sign that you have gout, a condition that inflames the joint. But it might also indicate inflammatory arthritis or infection. If it’s due to trauma, like someone landing on your foot after a jump shot, well, you’ll probably figure that one out.

7. A sore on your foot that won’t heal is a common side effect of diabetes, skin cancer, or circulatory disorders. In the case of diabetes, blood glucose levels that have raged out of control for long periods lead to nerve damage and small blood vessel damage, which in many cases appears first in your feet.  If the sore gets infected, it can lead to an amputation. But a sore on your foot – even between your toes – can also indicate certain kinds of skin cancer, so be sure to have it checked out by your podiatrist as soon as you discover it.

8. A slowly enlarging “growth” aside your big toe is probably a bunion. Faulty, inherited foot structure leads to this common foot deformity, which can be exacerbated by poor choices in footwear like high heels and flip flops. Unfortunately, bunions rarely stop growing, so that small, slightly sore bump today may be quite large and painful years from now. The only sure way to correct a bunion is with surgery. Splints, toe separators, and the like are temporary measures which will relieve symptoms, but won’t stop the deformity from becoming worse.

9. Pain in your heel may indicate plantar fasciitis, an inflammation of the tissue which connects your heel to your arch. If you have a sharp pain in your heel when you get out of bed in the morning, which slowly subsides as you move around, you probably have PF. There are many causes of plantar fasciitis, but primarily poor footwear, obesity, or working out too aggressively are to blame. To relieve minor symptoms of plantar fasciitis, ease up on your exercise program, lose weight, or wear shoes which support your feet properly. If symptoms persist, see your podiatrist for treatment.

Diabetes: How minor foot ulcers lead to amputation

5 Oct

Throughout the PA Foot And Ankle Associates blog we stress how important it is for diabetic patients to take proper care of their feet, especially those who’ve been diagnosed with diabetic neuropathy. We stress this because we see far too many patients in the OR requiring the amputation of a toe, a foot, or part of their lower leg in addition to a foot. This is truly a procedure we wish we performed less frequently. While amputation indeed saves the remaining limb and sometimes even the patient’s life, early care of diabetic foot ulcers and preventive treatment are the keys to keeping your legs, feet and toes intact.

Each year more than 60,000 people in the U.S. require a lower-extremity amputation due to complications from diabetes. That’s a tragic figure, considering that early intervention from a podiatrist can in most cases prevent ulcers and consequent infections from becoming serious enough to warrant amputation. The most frequent  reason for these amputations is poor treatment of infected diabetic foot wounds. Unfortunately,  about 50 percent of patients who have a foot, toe, or leg amputated die within five years – a worse mortality rate than for most cancers. Roughly half of these amputations can be prevented through proper care of foot infections.

foot with gagrene

A foot which has gangrene must be amputated

How foot ulcers lead to amputation

Because people with diabetes often have poor circulation and little or no feeling in their feet, a minor cut that goes unnoticed or a sore caused by a shoe becomes infected. If left untreated, the infection can spread, killing soft tissue and bone. Dead and infected tissue must be surgically removed, which, if the infection is extensive, can mean amputation of the toe, foot, or even part of the leg.

Nearly 80% of all nontraumatic amputations occur in people with diabetes, and 85 % of those begin with a foot ulcer.

“Lower extremity amputation takes a terrible toll on the diabetic patient,” says Benjamin A. Lipsky, MD, professor of medicine at the University of Washington and VA Puget Sound, Seattle. “People who have had a foot amputated often can no longer walk, their occupational and social opportunities shrink, and they often become depressed and are at significant risk for a second amputation. Clearly, preventing amputations is vital, and in most cases, possible.”

Read how one diabetic patient struggled to avoid amputation

You might be surprised to learn that doctors consider even minor redness, callus, blisters, sores, or any break in the skin on the foot to be a diabetic foot ulcer. It may seem over zealous, but impairments associated with diabetes, such as a weakened immune system, nerve damage, and poor circulation, diminish the patient’s ability to fight even a minor infection. Wounds easily treated and healed in non-diabetic patients often become chronic, non-healing wounds in diabetics. As a result, when a wound becomes infected, it enters a perpetual inflammatory state and can’t move through the healing process. These infections can become systemic, infecting the entire foot, including the soft tissue and the bones. Podiatrists have many tools and specialized training at their command to properly treat foot ulcers to heal them as fast as possible.

What you can do to avoid diabetic foot ulcers

The most important thing any diabetic patient can do is to effectively manage their blood glucose levels from the onset of their disease. If you’ve recently been diagnosed with diabetes, take your blood glucose levels seriously by eating correctly and monitoring levels as prescribed by your doctor. You should also be visiting a podiatrist on a regular schedule so he or she can create a baseline against which to measure any effects of diabetes on your feet or ankles.

Read about diet guidelines for diabetics

A word about preventive surgery: If you have diabetic neuropathy and you develop a bunion, hammertoe, charcot foot, or corns, you may want to consider surgery as soon as the abnormality is discovered. Because these conditions create areas of great pressure in your foot, if you have a loss of sensation, or if your blood circulation is poor, this pressure can lead to a non-healing wound. Eliminating the abnormality in the foot may deter a future ulcer which leads to an amputation. These surgeries are rather routine for podiatric surgeons and are usually performed on an outpatient basis.

Do You Have Peripheral Neuropathy?

9 Feb

diabetic patient with peripheral neuropathy

Do you ever wake-up at night because your feet are on fire? Have you been experiencing different sensations in your feet? Are you tired of your overly dry feet?

If you said yes, chances are you may be experiencing symptoms of peripheral neuropathy. Some of the most common symptoms are burning, tingling, numbness, pain or weakness in the legs and/or the feet.

These sensations can be explained as damage to the nerves, most commonly the nerves to the skin. The most common cause of peripheral neuropathy is diabetes with others being alcoholism, chemotherapy, various drugs, AIDS or even lack of nutrition.

Diabetic neuropathy is due to consistently higher levels of sugar in the blood.  The sugar accumulates in the nerve and ultimately disrupts the signals that are traveling through the nerves from the feet to the brain. These disrupted signals are primarily the cause of the various sensations such as burning in the feet. If left untreated overall sensation in the feet and legs could be lost.

The best treatment of diabetic neuropathy is to control the sugar levels in the blood. However if your sugars are under control and you still experience symptoms there are other treatments available such as oral medications or creams that may provide some relief. If these treatments do not work other options will be discussed.

If you think you may be suffering with diabetic neuropathy come and see us. We will do a full diabetic foot exam, testing all the sensations in the feet, the circulation and overall foot health. Come on in and start relieving the pain today.

Diabetic patients and nerve damage

9 May diabetic foot ulcers illustration

diabetic foot ulcers illustration

An estimated seven in ten diabetics have nerve damage that impairs feeling in their feet.

Loss of sensation inhibits the body’s normal pain response and as a result, walking can apply repetitive pressure to a wound, making it larger and deeper. This may lead to foot ulcers that won’t heal, serious infection or in the most extreme cases, amputation.

Fortunately, of all diabetes related complications, a foot ulcer may be the most preventable. Simply visit your podiatrist at least once a year to check for symptoms of ulcers on your feet.

The Diabetic Foot And Ankle Center at East Penn Foot And Ankle Associates offers state of the art treatment for all diabetes-related complications of the feet. On your first visit your podiatrist will create a diabetic preventative foot care plan for you and advise you as to your best course of treatment.

Dr. Adam J. Teichman



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