Posted by editor on Wednesday, July 27th, 2011
I am delighted to introduce myself as the newest member of the Center for Podiatric Care and Sports Medicine. I hope to add to the excellent work done by Dr. Geldwert and Dr. Lai. I’d like to take some time to talk about a subject that has a very personal significance for me; Diabetic foot pathology, specifically Charcot Deformity.
I have been a Type 1 insulin dependent diabetic since age 10. I share the same daily concerns and struggles as all diabetics. I consider myself very fortunate to be involved in a profession where I can make a real impact on the lives of those sharing my disease. Diabetes can affect many body systems. One area of the body affected most commonly is the foot. Diabetics often face problems that arise from poor circulation and nerve function. A major issue I’d like to focus on is Neuropathy and the problems it can cause and Charcot Neuroathropathy, often referred to simply as Charcot Foot.
Neuropathy is a condition affecting the nerves, which leads to a gradual loss of protective sensation. While many people develop numbness, the condition may also cause strange feelings known as paresthesias, which can also be very painful. Over time, the body loses the proper feedback from normal foot function and biomechanics. Eventually joints can undergo a degenerative problem known as Charcot neuroarthropathy. This condition dramatically changes the structure of the bone and joints of the foot. The foot breaks down and severe foot deformity follows. Most commonly the process affects the midfoot, and leads to a “rocker-bottom” deformity. However, the process can occur in any joint, and lead to other types of bony deformities. Often, this abnormal bone position leads to increased forces on the skin and soft tissue, which eventually break down and ulcerate.
These ulcerations account for a large majority of diabetic hospital admissions, as they often get infected. These infections can often reach the bone (a condition known as osteomyelitis).
Untreated or improper treatment can lead to serious life or limb threatening infections.
If you suffer from these conditions, a foot care specialist must be an integral part of your health care. Treatment plans run from the simple to complex depending on the details of your condition. Proper wound care is vital, including regular monitoring and debridement of any non viable tissue. There are also several devices which can offload the high pressure areas causing ulcerations.
There are also several surgical options which I have training in including soft tissue and skin procedures to cover the wound, as well as skin substitute grafts. Also, depending on the deformity and one’s overall health, surgical reconstruction may be an option. This is designed to either remove the bony prominence, or correct the bony deformity. This can be accomplished with internal hardware fixation, external hardware fixation, or a combination of both.
Charcot Deformity can be a troubling, frustrating problem. If you suffer from this condition, or other diabetic foot issues, I can help. Call the office, 212-996-1900 or 914-328-3400 for an appointment.