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Re: [IP] Charcot's Foot HELP!!

Charcot's Neuropathic Arthropathy can be caused by any disease which has
neuropathy and is most common with Type II Diabetes..  For the purposes
of this discussion I will divide Charcot (pronounced shar-KO) into 2
stages.  The active stage and the residual stage.

In the active stage, the leg is swollen, red, and hot.  There will
often, though not always, be pain.  During this stage, the bones and
joints become very unstable.  The joints can dislocate and the bones can
change shape or even develop fractures.  The ideal treatment is to get
the patient into a situation where there is no weight being applied to
the foot (no deforming force).  Personally I usually put my patients in
a soft cast with a CAM walker/below-knee boot.  Walking with crutches
and the effected foot held in the air is NOT an option as this increases
pressures on the "good" foot and can initiate a Charcot attack in that
foot.  Other good options are walking casts and wheel chairs.  I
probably wouldn't put a patient in a wheel chair unless they couldn't
tolerate the other treatment options.  Other than removing deforming
forces from the foot, there are no treatments that have been proven to
slow or stop an attack, though putting ice on the foot is a popular
adjunct treatment.

Once the active Charcot has calmed down, you are left with the residual
deformity.  If the active Charcot was caught early enough and treated
properly, there might not be any actual deformity.  Charcot attacks can
recur at any time and patients must see their doctor immediately if they
feel they might be getting an attack.  If there is residual deformity,
then pressure relief treatments must be applied.  This is typically
custom molded shoes - or at least extra-depth shoes with a custom molded
insert.  If the deformity is not accommodated, the pressure will cause
an ulcer to form and infection and/or necrosis could make an amputation
necessary.  If there is no ulcer and circulation is fine, no amputation
should be necessary, though occasionally surgical reconstruction (which
often includes removing some bone) may help.

Heather, if your mom does not have an ulcer and her circulation is good,
call her insurance to find out what you need to do to get custom molded
shoes and/or insoles for her.

Feel free to write to me if you have any questions.

Jeremy Cowan, DPM
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