Our discussion regarding nerve dysfunction has culminated into this week’s topic. We’ve learned that loss of pain sensation and loss of autonomic (or automatic) function of nerves can be caused by diabetes. What happens if you lose both?
When nerves lose their autonomic ability to control blood flow to the bones in the foot, the excess blood makes the bones soft and unable to support weight. The minerals that keep bone strong are washed out and therefore, the bones become very weak. They cannot withstand the pressure that comes with walking around the house to do daily tasks. These patients tend to be overweight which only adds to the stress on the bone. The bones become deformed and the foot becomes unfunctional. This deformity is termed Charcot Foot.
As if that wasn’t bad enough, the people susceptible to Charcot foot are the same people who have lost their protective pain sensation. Even though their bones are being crushed and deformed with walking, they don’t feel a thing. For this reason, it may be weeks before the individual notices the bony bumps on their foot, and goes to see their podiatrist.
Charcot foot develops in stages. Initially, the foot will look swollen, red, and hot, but yet painless. This can be confusing because these symptoms are seen in other conditions like gout, osteomyelitis, and cellulitis, so it is important to seek attention immediately to make the correct diagnosis. If Charcot foot is diagnosed, it is imperative that you follow your podiatrist’s order to be non-weight bearing in a cast for a couple months. This spares the soft bones from being deformed. After the redness and swelling diminish, your bones begin to recover, and eventually they heal. If the patient has been dedicated to keeping weight off the foot, the deformity will be minimized, the patient can be fitted for a boot or shoes that will accommodate any bony protuberances, and reconstructive surgery can be avoided. If the patient has not been as compliant, the foot may no longer be functional and it will be at greater risk for friction ulcers forming where bone protrudes. Surgery will be needed to reverse the deformity, and foot functionality afterward is difficult to predict.
So what is the moral of the story? Nerve function is essential to healthy feet. You can minimize nerve damage by tightly controlling blood sugar. Keep an eye on those precious feet you have. Rub them and talk to them daily. If they look bad, but it doesn’t hurt, you know what to do. Your podiatrist will be waiting.