Treatment - How can I help

Diabetic Foot

Other popular names

Who does it affect?

Anyone with Diabetes, which is not uncommon, affecting some 6% of the population.  Diabetic foot problems can be severe and inevitably require surgery.  People suffering from diabetes generally face 2 problems: nerve damage and poor circulation. These conditions can result in the formation of blisters that can develop into serious and problematic infection within days.  Chronic nerve damage (neuropathy) can cause dry and cracked skin, which often allows bacteria to enter and cause infection.  This nerve damage in a diabetic patient may lead to the loss of sensation in the feet. 

Diabetes also damages blood vessels, decreasing the blood flow to the feet. This poor circulation can weaken the bone and result in the disintegration of the bones and joints in the foot and ankle. As a consequence, people with diabetes are at a higher risk for breaking bones in the feet.  With the problems associated with nerve damage and limited feeling, a diabetic patient may fracture a bone int he foot and not even realise this.  Continuing to walk on the injured foot compounds the problems and more often than not, results in more severe fractures and joint dislocations. 

The consequences are far and wide ranging, from the requirement for antibiotics to amputation of a toe or foot. For people with diabetes, careful, daily inspection of the feet is essential to overall health and the prevention of damaging foot problems.

Symptoms

Although a patient with Charcot (Diabetic) arthropathy typically will not have much pain, they may have other symptoms, which may include:

Diagnostics

You are likely to require an x-ray, which will how fractures and dislocations of the joints.



The patient shown in the x-ray had noticed swelling of the foot for approximately 3 weeks without any known injury. The x-ray shows several fractures (arrowheads) and a dislocation of the first metatarsal (arrow). This type of traumatic injury is typically seen only after a high-impact event in patients without diabetes. 

It is possible that you may require an MRI or Ultrasound scan.  This will be requested if your Consultant wants to see more details of the soft tissue structures in the foot. 

In situations whereby your Consultant suspects an infection in the bone, you may be required to undergo a Bone scan (DEXA) /indium scan.  The details of this will be discussed at your Consultation.

Non-surgical treatment

Although in the majority of cases, Charcot will require surgery, if identified in early stages, there are a number of options open to your Consultant:

Casting

The early stages of Charcot are usually treated with a plaster cast or air boot to protect the foot and ankle. The use of a cast is very effective in reducing the swelling and protecting the bones.  Casting requires that the patient does not put weight on the foot until the bones begin to heal. Crutches, a knee-walker device, or a wheelchair are usually necessary and healing can sometimes take 3 months or more. The cast will usually be changed every week or two to make sure that it continues to "fit" the leg as the swelling goes down.

Custom shoes

After the initial swelling has decreased and the bones begin to fuse back together, a specialised custom walking boot or diabetic shoe may be recommended. The specialised shoe is designed to decrease the risk of ulcers (sores that do not heal). Some diabetics may not be able to wear regular, over-the-counter shoes because they do not fit the deformed foot correctly.

Surgical treatment

The goal of treatment for Charcot arthropathy is to heal the broken bones, as well as prevent further deformity and joint destruction.

Surgery may be recommended if the foot deformity puts the patient at a high risk for ulcers, or if protective shoewear is not effective. Unstable fractures and dislocations also require surgery to heal.

Fractures that occur in the softer bone of diabetics are typically more complex. Operations to fix them generally involve more hardware (plates and screws) than would normally be required in people without diabetes. The screws and plates may even be placed across normal joints to provide added stability.



The top x-ray shows that the patient has unstable Charcot of the back of the foot (hindfoot). The dislocation of the joints is seen where the two bones in the back of the foot do not line up (arrowhead). The bottom x-ray shows a complex realignment and fusion was performed to prevent the patient from developing a prominence and ulceration.  

This operation is extremely difficult to perform and carries a higher risk of wound complications, infections, and amputation, compared to routine foot and ankle fracture surgery.  After this type of operation, there is typically a period of no weight on the foot for at least 3 months. Placing weight on the foot early and failing to follow your Consultant's instructions will likely lead to complications, such as the return of the deformity or even worsening of the deformity.

Post-surgery rehabilitation

As there are numerous possible options for surgery, it is not possible to give exact guideslines on post-surgery rehabilitation.  More often than not, surgery will be performed as a day case and you are able to go home soon after the operation.  The anaesthetic will wear off after approximately 6 hours.  Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off.  The dressing is removed soon after your operation.  The wound is cleaned and redressed with a simple dressing.  The sutures are removed at about 10 days. 

General Care of the Diabetic Foot

Return to normal routine

Keep the wound dry until the stitches are out at 10 days.

Return to driving:

The foot needs to have full control of the pedals.  You are advised to avoid driving until you have full movement and control back in your foot.

Return to work:

Everyone has different work environments.  Returning to heavy manual labour should be prevented for approximately 4 - 6 weeks. Early return to heavy work may cause the tendons and nerve to scar into the released ligament.  You will be given advice on your own particular situation by your Consultant.

Risks

Overall over 95% are happy with the result. However complications can occur.  General risks (less than 1% each):

Reflex Sympathetic Dystrophy - RSD (<1% people suffer a reaction to surgery which can occur with any surgery from a minor procedure to a complex reconstruction).

Specific risks:

Failure to completely resolve the symptoms results in less than 1% of patient

 

« Back to treatments

Cookies
This site uses cookies to store information on your computer. Some of these cookies are essential to make our site work and have already been set. By using our site you accept the terms of our Privacy Policy.
×