Monday, April 6, 2009

Finally a diagnosis

After work today I couldn't wait to get to the hospital. The specialist was due in around noon to update and provide a plan for my Dads foot. I made it to the hospital in plenty of time, thank goodness. My Dad is still in good spirits and being silly, so that helped to reverse my earlier feelings of the day. By dinner time the doc and two residents came in. Diagnosis- Diabetic Charcot Foot with 3 separate fractures and deterioration of the ankle joint. They FINALLY applied a splint and will cast the foot and ankle after a follow up appointment. So, now I'm off to google land to read all I can about this progressive condition. Looks like we may have a very rough road ahead as I expected. Just because it isn't infected doesn't mean this is going to be an easy fix. Dads first appointment with the wound clinic is on Monday.

My sisters and I will have to come up with a plan to help care for my Dad and keep him OFF his feet. Being that he does his Dialysis exchange every 4-5 hours I'm not quite sure how we will be able to help him overnight. I honestly don't feel that there is a good prognosis being his failing health, resistance to cooperating and smoking habit. Smoking, in which, he was urged to quit again immediately today, to aid in the circulation and healing process. I'm not being pessimistic, just realistic. I don't think the doctors were very informative as far as prognosis, in fact, they were too simple and I feel like they left my parents without any explanation as to how serious this is and why. I get the feeling both my parents are just happy it isn't infected and think that as long as he stays off the foot until it is casted that everything will just be great. Good to finally have a diagnosis, but that diagnosis means nothing unless you understand it. Time for me to get to googling and educating both my parents on how serious this really is. Read ahead for the Charcot details.....

What is Charcot Foot?
Charcot foot is a sudden softening of the bones in the foot that can occur in people who have significant nerve damage (neuropathy). The bones are weakened enough to fracture, and with continued walking the foot eventually changes shape. As the disorder progresses, the arch collapses and the foot takes on a convex shape, giving it a rocker-bottom appearance, making it very difficult to walk.

Charcot foot is a very serious condition that can lead to severe deformity, disability and even amputation. Because of its seriousness, it is important that patients with diabetes—a disease often associated with neuropathy—take preventive measures and seek immediate care if signs or symptoms appear.

The symptoms of Charcot foot can appear after a sudden trauma or even a minor repetitive trauma (such as a long walk). A sudden trauma includes such mishaps as dropping something on the foot, or a sprain or fracture of the foot. The symptoms of Charcot foot are similar to those of infection. Although Charcot foot and infection are different conditions, both are serious problems requiring medical treatment.

Charcot foot symptoms may include:

Warmth to the touch (the foot feels warmer than the other)
Redness in the foot
Swelling in the area
Pain or soreness

What Causes Charcot Foot?
Charcot foot develops as a result of neuropathy, which decreases sensation and the ability to feel temperature, pain or trauma. When neuropathy is severe, there is a total lack of feeling in the feet. Because of neuropathy, the pain of an injury goes unnoticed and the patient continues to walk—making the injury worse.

People with neuropathy (especially those who have had it for a long time) are at risk for developing Charcot foot. In addition, neuropathic patients with a tight Achilles tendon have been shown to have a tendency to develop Charcot foot.

Early diagnosis of Charcot foot is extremely important for successful treatment. To arrive at a diagnosis, the surgeon will examine the foot and ankle and ask about events that may have occurred prior to the symptoms.

X-rays are also essential for diagnosis. In some cases, other imaging studies and lab tests may be ordered. Once treatment begins, x-rays are taken periodically to aid in evaluating the status of the condition.

Following the surgeon’s treatment plan for Charcot foot is extremely important. Failure to do so can lead to the loss of a toe, foot, leg or life.

Treatment for Charcot foot consists of:

Immobilization. Because the foot and ankle are so fragile during the early stage of Charcot, they must be protected so the soft bones can repair themselves. Complete non-weightbearing is necessary to keep the foot from further collapsing. The patient will not be able to walk on the affected foot until the surgeon determines it is safe to do so. During this period, the patient may be fitted with a cast, removable boot or brace, and may be required to use crutches or a wheelchair. It may take the bones several months to heal, although it can take considerably longer in some patients.

Custom shoes and bracing. Shoes with special inserts may be needed after the bones have healed, to enable the patient to return to daily activities—as well as help prevent recurrence of Charcot foot, development of ulcers and possibly amputation. Bracing is required in cases with significant deformity.
Activity modification. A modification in activity level may be needed to avoid repetitive trauma to both feet. A patient with Charcot in one foot is more likely to develop it in the other foot, so measures must be taken to protect both feet.
Surgery. In some cases, surgery may be required. The foot and ankle surgeon will determine the surgical procedure best suited for the patient based on the severity of the deformity and the patient’s physical condition.

Preventive Care
The patient can play a vital role in preventing Charcot foot and its complications by following these measures:

Diabetes patients should keep blood sugar levels under control. This has been shown to reduce the progression of nerve damage in the feet. Get regular check-ups from a foot and ankle surgeon. Check both feet every day—and see a surgeon immediately if there are signs of Charcot foot. Be careful to avoid injury, such as bumping the foot or overdoing an exercise program. Follow the surgeon's instructions for long-term treatment to prevent recurrences, ulcers and amputation.

1 comment:

Scott K. Johnson said...

Glad to hear you and your family have a starting point at least. Though it does sound rough. I'll be thinking and praying for your dad and all of the family pulling to support and care for him.