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Rare Diabetes Foot Complication Becoming More Common

Posted: Friday, November 02, 2007

As diabetes rates soar, doctors with the American College of Foot and Ankle Surgeons say they're noticing more patients developing a rare and dangerous diabetic foot complication. Few patients or their diabetes care providers know of the complication, or its warnings signs. 

It may start with getting a bunion removed or just poor fitting shoes, certainly poor blood sugars can help bring it on, it is called Charcot foot and used to be a rare occurrence. It is estimated to affect less than one percent of people with diabetes. Now doctors with the American College of Foot and Ankle Surgeons (ACFAS) say Charcot foot’s prevalence appears to be growing as more Americans get diabetes.

Some worry that few patients – or their diabetes care providers – seem to know about this complication or its warning signs.
Charcot foot is a sudden softening of the foot’s bones caused by severe neuropathy, or nerve damage, a common diabetic foot complication. It can trigger an avalanche of problems, including joint loss, fractures, collapse of the arch, massive deformity, ulcers, amputation, and even death. As the disorder progresses, the bottom of the foot can become convex, bulging like the hull of a ship. Since most people with Charcot cannot feel pain in their lower extremities, they continue walking on the foot, causing further injury.
Charcot cannot be reversed, but its destructive effects can be stopped if the complication is detected early.
The symptoms of Charcot foot appear suddenly. They include warm and red skin, swelling and pain. A person with diabetes who has a red, hot, swollen foot or ankle requires emergency medical care because these can also be symptoms of deep vein thrombosis or an infection.
Doctors say Charcot’s ambiguous symptoms can lead to misdiagnosis. Since patients don’t feel pain, doctors may presume the swelling is due to infection and prescribe antibiotics. Meanwhile the patient continues walking on a foot that is collapsing.
“More people with diabetes, their families and their care providers need to know about Charcot foot,” says J. T. Marcoux. DPM, FACFAS, one of only a handful of Massachusetts foot and ankle surgeons who performs Charcot foot reconstructions. “When I diagnose a patient with this complication, I telephone their primary care doctor and educate them about it as well.”

But educating patients and their care providers is only half the battle. Keith Jacobson, DPM, FACFAS, who stated that there’s little they can do when patients are apathetic or in “diabetic denial.”

“I’ve had patients who are literally blind, on dialysis and neuropathic who refuse to admit they have diabetes,” says Jacobson. “I have seen horrific deformities with this condition.”
Foot and ankle surgeons expect to see more patients like that as diabetes rates soar.
Today, it can mean reconstructive surgery,  including spending three months in a “halo” external fixator where a series of pins and screws are placed into the bones and connected to clamps and rods outside the skin and then having to wear a custom shoe boot for a year.

The experience taught her four children to appreciate their mother a lot more, since all the cooking, cleaning, and laundry fell on their shoulders.

Source: Diabetes In Control: American College of Foot and Ankle Surgeons. More information on Charcot foot is available on the ACFAS consumer Web site,

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