Diabetic foot problems

There are a number of problems which diabetic patients can experience. The main aim is prevention with good sugar control and regular foot care and assessment.

It is important to have good team work to prevent and manage these problems. Your primary care doctor, a diabetologist (diabetes specialist) and podiatrist (foot care specialist) are the first line in prevention. When non-healing ulcers become a problem, a vascular surgeon may be required.

The role of an orthopaedic surgeon is if the foot collapses. The commonest cause of this is a Charcot foot.

 

 Charcot foot

Background

Charcot foot is a destructive process that can occur in people with nerve damage to the sensation of the foot. The foot becomes swollen and red with no history of injury. There is often only minimal pain. The initial Xrays are normal and the patient is often treated for an infection (it is not an infection but has similar appearances). We do not fully understand the cause of Charcot disease.

 

What causes it?

The commonest cause is diabetes which can damage the sensory nerves to the foot. The condition is more common in patients who have had diabetes for some time and with poor sugar control. THis condition is commonly mistaken for an infection.

 

What happens with no treatment?

The condition goes through 3 phases each of which last many months (total time 1-2 years):

1. The first stage is when the foot is swollen and warm but the bones and joints look normal.
2. The second stage is when the bones and joints become soft, crumble and the foot can collapse.
3. The final stage is when the swelling settles and the bones become firmer.

If no treatment is given in stage 1 and 2, ulcers can develop in the collapsed foot. The damaged joints can also become unstable (floppy) making shoe wear and walking very difficult. This condition can result in amputation in severe cases.

 

Treatment options

The main principle of treatment is to protect the foot whilst it is progressing through the 3 stages. Plasters or boots can be used and have to be worn ALL the time (even if there is no pain). These spread the load of walking over the foot evenly and help to maintain the foot arches. Regular review with podiatry is important as is good sugar control.

No other treatment has been shown to significantly help.

Long term use of a brace or adapted shoe is recommended.

Occasionally orthopaedic surgery is necessary to remove prominent bony lumps or to reconstruct the foot. Early recognition and treatment make the need for surgery much less likely.

 

Typical appearance of a Charcot foot in the early stages