Are you diabetic with neuropathy? If you are, then you know all about charcot. Never heard of it? Well, listen up. This disorder is one of the leading causing of limb loss for a diabetic patient. And it is the reason a patient of ours recently lost their leg.
Charcot (pronounced shark-o) is the break down of bones at the joint level causing deformity of the foot or ankle. It occurs when the nerves around the joint are not longer functioning properly, thus preventing the feedback mechanism of pain. Pain is what tells you that your shoes are too tight, you are walking too much, your shoes are uncomfortable, your arches are falling, etc. Without this mechanism, you continue to walk and not know you are breaking down your joints.
This breakdown continues with each step eventually resulting in fractures or broken bones, dislocated joints and a deformed look to the foot. The joints most affected are in the arch or center part of the foot. This break down can cause severe dislocation that results in a large bump on the bottom of the foot that we refer to as "rocker bottom". This prominence can then be a pressure point on the inside of the foot leading to ulcers that then lead to infection. And if you've read previous posts, infection is the number one reason you will lose your leg as a diabetic.
How do know if you have Charcot? Warning signs include:
- a very swollen foot and leg that started suddenly without an opening in the skin or any signs of infection
- the foot is starting to change shape, which occurs rather quickly
- a clicking sound when you walk barefoot (this is you walking on a dislocated joint)
- pain when you normally don't have much feeling in your feet
If you think you may have Charcot:
- ice and elevate your foot
- don't walk barefoot
- apply an ace bandage or wear a compression sock to reduce swelling
- call our office for immediate evaluation. Charcot can often be confused with infection and vice versa. A complete exam with xrays is necessary. Often you will be required to stay off the foot and wear a tall boot until the acute phase has passed. After that, we will devise a plan to attempt further breakdown of the foot and possible amputation.
The best thing you can do to save your legs is see a podiatrist. Call us today.
Tuesday, April 9, 2013
Monday, March 11, 2013
There is so much research right now using stem cells and we are finding so many wonderful applications where they can be beneficial in the foot and ankle. But none better so far than in healing chronic wounds.
Now the stem cells I’m referring to are not used to grow an ear on a rat or clone a sheep. These cells are obtained from human placenta immediately after child birth. Learn more about that process here.
How are they helping in wound care? Healing a chronic wound can be challenging at best. Make it a diabetic ulcer on the bottom of the foot and it can be almost impossible in a less than 6-8 months. These ulcers are difficult to heal for several aspects. Pressure from walking causes chronic trauma thus reducing the ability to heal. The body’s own mechanism of filling a wound is often inefficient due to chronic disease. Uncontrolled blood sugars add to this. Bacteria can sit on the wound and may not be causing an infection but will prevent healing. This list goes on and on.
And up until now we have tried numerous products to improve ulcer healing. Some would be quickly beneficial. But in the long term, it always took what seemed like an eternity to heal a diabetic ulcer. Thanks to scientific research, I am now using live stem cells to close a diabetic ulcer often within 1-3 weeks.
My approach to wound care is aggressive. I know that if you have an open wound you are susceptible to infection. This infection can be limb or life threatening. So I want to close this ulcer as quickly as possible. Here’s how I do it:
1st: culture the ulcer to see what bacteria is growing. Antibiotics either pill form or topically may be started immediately to reduce this growth.
2nd: debride the ulcer. This means remove all soft tissue that is no longer healthy from the ulcer and get a good bleeding base. This brings the body’s own healing cells to kick start the process. If your circulation is impaired, I may not be as aggressive with this step. Alternatively, I may use a topical cream to slowly debride the ulcer for me.
3rd: offload the ulcer. I want you in a special boot or shoe and possibly non-weight bearing so that I can take off as much pressure to the ulcer as possible.
4th: daily care. You will be putting some kind of wound product on your ulcer daily followed by a dressing of gauze. And keep your foot out of shower or bath water. When you shower, there are several dirty areas between your scalp and your toes. All of this dirt can end up in your ulcer!
I follow this regimen for 4-6 weeks. If this does not work, the next step is stem cell therapy combined with a theraskin graft.
This is done in a surgery center setting so that deep debridement of your wound can be performed removing all nonviable tissue. The stem cells are injected around the edges of the wound and throughout the ulcer base. This does 2 things:
1. stimulates growth of skin cells
2. reduces the bacteria on the ulcer base
Next, I apply a theraskin graft. This is cadaveric skin that has been donated just like a heart or liver for transplant patients. But this graft has been treated to remove all living cells so there is no transfer of disease possibility. This graft acts as an immediate skin covering.
Expect your ulcer to be significantly smaller if not healed within 1-3 weeks depending on size. During this time, you will need to keep it wrapped with a gauze dressing and wear your boot or shoe at all times. Minimal pressure to the foot is required otherwise you could injure the graft and stem cells, thus causing the entire thing to fail.
Sounds great, doesn’t it. Well it is as long as these things are in check:
1. You are keeping your blood sugar in control. High sugar means failed graft.
2. You are compliant with your post op regimen. Non-compliance means failed graft.
3. Take prescribed antibiotics as instructed until you are healed. Too many bacteria means failed graft.
4. Don’t get it wet. A wet graft is a failed graft.
If you are dealing with a chronic wound that just won't heal and feel like you have tried everything, call us today.