Grapevine Man Loses Leg from Diabetic Charcot

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.

Healing Diabetic Foot Ulcers

In my practice, I treat a lot of diabetic patients, and I see a lot of diabetic wounds. In this case, the wounds are called diabetic foot ulcers.

When evaluating diabetic foot ulcers, some of the things we look for as foot specialists are signs of infection, size of the wound, lab tests, blood sugar levels, shoes, and circulation of the feet and legs. All of these are important. Also, getting a good history from the patient is very important. We need to know how long the wound has been present, what medications have been given, and if any other treatments have been rendered yet.

As a podiatist, my main goal is to save my patients' feet. So this is a very important topic for me. We need the patient to help us do our job to heal the diabetic foot ulcer. Whether that means staying off of the foot or wearing a special boot, the doctor knows best when it comes to healing the foot ulcer. The longer the ulcer remains open, the higher incidence of infection (whether it be in the soft tissues or in the bone). And once it goes into the bone, that is when amputation occurs.

Dr. Michele Summers Colon, DPM, MS
3503 Lexington Ave.
El Monte, CA 91731
626-442-1223
www.elmontefootdoctor.com

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Please feel free to email me if you have any questions or if you would like to schedule an appointment, or you can visit our website or call our office.
dr.michele.colon@gmail.com

Diabetic Foot Infections Can Kill You!

Do you or someone in your family have diabetes? Ignoring your feet can kill you! Take a listen, save a life!

Why Do Diabetics Lose Their Legs?

You have had problems with your foot for years. Your doctor now tells you that the foot needs to be amputated. How did this happen? Do you have to go through with the surgery? What will happen if you keep your foot?

Diabetes is a devastating disease. It can be managed, and many of the complications of diabetes are preventable. This takes much dedication of the patient and a team of doctors. Discovering you have diabetes and making life changes to prevent life threatening complication of the disease is very difficult. Thus, many people still run into problems associated to diabetes. Foot problems are among one the most common complications. 70% of all limb amputations are due to diabetes!

There are several reasons diabetics have foot problems but let’s talk about the three big causes. When the nerves are exposed to high levels of glucose or high blood sugars, they are slowly damaged. Thus, many diabetics suffer from peripheral neuropathy, a disease in which they slowly lose protective sensation in the feet. This can be very dangerous. I have had patients who had glass, needles, tacks and other objects stuck in their foot and they never remember how it happened. I have also had patients burn themselves in the bath tub. Their feet can no longer perceive temperature and they can easily burn or freeze their feet!

Diabetics also suffer from poor circulation. Blood carries many nutrients and oxygen that is essential to keep tissues healthy. Poor blood supply makes it extremely difficult for damaged tissues to heal. When a patient has a wound or ulcer on the foot, their poor blood supply makes it is so hard for the area to heal. Diabetics also have a compromised immune system. The body is weakened in its defense mechanism to fight off infections. Infections kill good tissues and leaves dead necrotic tissue behind. Infections can spread very fast from soft tissue to bone and joints and even into the blood supply. Infections can be life threatening.

When the threat of infection is too severe and can no longer be managed by antibiotics, the doctor may suggest an amputation. To remove all or as much dead tissue as possible helps prevent the infection spreading to other areas of the body. A doctor may also suggest amputation if the foot has become non-functional.

The thought of losing a part of your body is a very difficult concept to deal with. It is not uncommon for the doctor to suggest therapy to help the patient cope with process of surgery and rehabilitation. It is important to note that amputations are a part of medical plan to keep you as health as possible. It is important to discuss your fears and concerns with your doctor and to seek second opinions if you do not feel comfortable with your doctor’s advice. It is your leg and should be fully aware to the risk and consequences of keeping and amputating portions of your limb.

Save a Leg, Save a Life

One of the many complications associated with diabetes is the presence of diabetic foot ulcers. These ulcers are open wounds that are slow to heal, and affect roughly fifteen percent of all diabetic patients. Often the wound is explained by a loss of sensation in the foot, and the patient can not feel that there is an open sore on the bottom of their foot, and may not see it, either.

When the ulcers become infected, which is usually the case; the infection can quickly spread to the other tissues. This can lead to infections of the bone (osteomyelitis) or of the blood (sepsis). Complications due to diabetic foot ulcers will often lead to amputations or even death.

On average, a lower extremity amputation will cost close to $50,000 annually. This cost is mostly from hospital stays and aftercare related to the surgery. Of the patients that do have an amputation, less than 50% will be able to walk with a prosthesis following a below the knee amputation, and less than 25% will be able to walk with a prosthesis following an above the knee amputation. Without the ability to move around on their own, many patients become institutionalized, which can cost upwards of $100,000 per patient. With a 25% reduction in the amount of lower extremity amputations each year, over $4 billion would be saved annually.

Save a Leg, Save a Life is an organization that is devoted to educating doctors and the public on the ways to address these issues. The organization is an interprofessional team, made up of podiatrists, vascular surgeons, nurses, and many other types of doctors with an interest in wound care. The organization seeks to provide information about the advanced methods of treating wounds, including new materials and technologies used in the treatment of diabetic foot ulcers.

Health care providers and health insurance companies are becoming more and more dependent on evidence based medicine as a foundation for treatment. Through Save a Leg, Save a Life, that information is being dispersed through the medical community. Products that are designed to help regenerate healthy tissue and promote healing are replacing the old methods of washing the wound with saline solution. However, these old methods are all that many doctors know, and so they become the standard in wound care. Through programs like Save a Leg, Save a Life, as well as the American Academy of Wound Management and the College of Certified Wound Specialists, hopefully the more advanced methods will become the new standard.