How does foot destruction develop?
In long-term diabetes and other causes of severe neuropathy, two mechanisms are disrupted. Firstly, pain and deep sensitivity are lost: the person does not feel overload and minor fractures and continues to walk, causing new damage to the bones. Secondly, damage to the autonomic nerves leads to vasodilation and increased blood flow to the bones, which activates cells that resorb bone tissue. The bone becomes loose and breaks under normal stress. The debris moves, the joints lose support, and the foot becomes deformed. In the active phase, it is swollen and hot, and as the process subsides, the bones grow together in the wrong position.
- Loss of protective pain sensitivity
- Increased blood flow and bone resorption
- Microfractures during normal walking
- Displacement of bones and destruction of arches
- Active phase - swelling and fever
- Chronic phase - persistent deformation
Who's at risk
Most often, the disease develops in people who have lived with diabetes for more than ten years and have severe neuropathy: numbness, burning, or, conversely, complete loss of sensation in the feet. The trigger point is often an injury, even a minor one, foot surgery, infection, or prolonged walking in uncomfortable shoes. Less commonly, similar changes occur in other diseases that damage the nerves. It is important to understand: with good blood flow and intact pulsation in the foot, the risk does not disappear - it is neuropathy, and not circulatory disorders, that plays the leading role.
- Long-term diabetes mellitus
- Severe peripheral neuropathy
- Previous foot injury or surgery
- Previous foot infection and ulcer
- Foot deformities and incorrect shoes
- Overweight
Symptoms
The earliest sign is a difference in temperature between the feet: the affected one is noticeably warmer, which is easy to check with the back of your hand. The foot swells, the skin turns red, the volume increases, but there is either no pain at all, or it is surprisingly weak for such a picture. Over time, the shape changes: the longitudinal arch flattens and even bends down, the sole becomes convex, and bony protrusions appear. These protrusions form calluses and then ulcers, which become easily infected. It is ulcers and infection, and not the deformity itself, that most often lead to serious consequences.
- One foot is warmer than the other
- Swelling and redness without significant pain
- Increase in foot volume, shoes become tight
- Flattened arch, convex sole
- Bone protrusions and calluses on the sole
- Non-healing ulcers
Diagnostics
The diagnosis in the active phase is made primarily clinically: in a person with diabetes and neuropathy, a sudden hot, swollen foot is considered Charcot's foot until proven otherwise. X-rays at an early stage may be normal, so if in doubt, an MRI is performed, which detects bone marrow edema and microfractures long before visible changes. Computed tomography helps assess displacement when planning surgery. Be sure to check the blood flow in the arteries of the leg and glycated hemoglobin. The main task is to distinguish the condition from a bone infection, in which the tactics are fundamentally different.
- Comparison of temperature and volume of feet
- X-ray of foot bones in dynamics
- MRI of the foot for early diagnosis
- Computed tomography before surgery
- Arterial blood flow assessment
- Glycated hemoglobin and diabetes control
- Rule out osteomyelitis
Treatment and prevention
The main and indispensable method in the active phase is complete unloading of the foot. Usually a special immobilizing bandage is applied or a removable orthosis is used, and they have to be worn for months until the temperature normalizes and the process subsides. It is impossible to walk on a sore leg without unloading: every step aggravates the destruction. At the same time, good blood glucose control is achieved and associated problems are treated. After completion of the active phase, individual orthopedic shoes and insoles are selected. In case of severe deformation with the threat of ulcers, reconstructive operations are performed. Prevention - daily foot examination and regular visits to a specialist.
- Complete foot unloading for months
- Immobilization bandage or orthosis
- Control of glucose and glycated hemoglobin levels
- Custom orthopedic shoes and insoles
- Reconstructive surgeries for severe deformities
- Daily foot self-examination
- Regular preventive visits to a specialist