Charcot's foot in diabetes mellitus: photo and treatment

Diabetes is known to many as a complex disease with which one has to live. But in some cases the very fact of this problem is complicated by additional destructive processes. One of the striking examples is Charcot's foot. This diagnosis is serious enough and dangerous.

Features of the disease

Charcot's foot in medicine is also defined as diabetic osteoarthropathy. This is a serious complication of diabetes mellitus, which is characterized by various bone changes:

• Hyperhistosis. Cortical layer of bone grows.
• Osteoporosis. We are talking about the weakening and thinning of bones.
• Osteolysis. Bone tissue is completely absorbed.

As you can see, Charcot's foot with diabetes is fraught with serious negative consequences. In the usual way of life such a disease can lead to frequent fractures of the bones, as well as their improper fusion. The latter fact sometimes causes the deformation of the foot.

It is worth waiting for such a development of events for those diagnosed with a decompensated form of diabetes mellitus. And this is relevant both for insulin-dependent patients and for those who do not get into this group. After a certain period of time, these patients often have neuropathic complications, which cause fractures in the foot area, and frequent ones.

The problem described above can be accompanied by ulcerative skin lesions, which makes the complicated situation already difficult. The bottom line is that when there are ulcers on the foot with neuropathy, they cause a noticeable blood flow, washing out the calcium from the bones. Naturally, after such a process, the bones lose their strength and can break at moderate loads.

It is worth noting the fact that Charcot's foot appears mainly in patients who have been struggling with the disease for more than 10 years.

Forms of the disease

There are several background diseases that cause the appearance of diabetic foot. Given this fact, we can distinguish several forms of the disease itself:

• Neuroischemic. Its development occurs against the background of diabetic angiopathy, which is expressed through the deterioration of blood flow in the area of the lower extremities. In this state, the foot does not change its shape and its sensitivity remains. This causes swelling, the skin surface becomes cold, and the pulse is weak.
• Charcot's foot is a neuropathic form. In this case, the disease develops against a background of diabetic polyneuropathy and leads to the defeat of the nerve endings in the region of the feet. Symptoms of this condition are reduced to a significant decrease in the sensitivity of the foot, with no pain. Due to the fact that the innervation is disturbed, the patient incorrectly distributes the load on the joints of the foot, which causes the risk of deformation of the feet.
• Mixed. In this case, simultaneously the signs of both forms described above appear.

Charcot's foot in diabetes mellitus: stages of development

If we take into account the assessment of the disease by Dr. Wagner, we can distinguish 5 stages that the patient passes with a diagnosis of "diabetic foot". Here is their brief description:

• The first stage. Ulcer of superficial type, in which only the upper layers of the skin are affected. As a treatment technique is used to remove corns. If necessary, antibiotics are used.
• The second. This is a deep ulcer that does not damage the bone. In this case, the impact of infection can be determined by the following signs: high fever, pus and redness around the affected part of the foot. The actual treatment with antibiotics and surgical intervention to remove dead tissue.
• The third. At this stage, a deep ulcer is formed and bone damage occurs (osteomyelitis develops). Destructive processes affect also soft tissues in the foot area. This condition is often accompanied by suppuration. Treatment is appointed the same as in the case of the second stage. In particularly severe disease, amputation is possible, but such cases are rare - the condition of patients can often be improved by medication.

• Fourth. Charcot's foot at this level is characterized by gangrene, which affects a certain area, for example a finger. With this diagnosis, amputation of the dead parts is carried out and in especially severe cases - the legs are below the knee.
• Fifth stage. At this stage, the maximum lesions: develops a vast gangrene of the foot, which can lead to a fatal outcome. The only effective measure is amputation, and immediate.

Understanding what Charcot's foot is like, it is worth mentioning the zero stage, which precedes all described above. In fact, we are talking about people at risk. In this state, there are no ulcers, but the deformity of the foot becomes noticeable, corns or corns appear, and hyperkeratosis also appears.

Diagnostics

Charcot's foot in diabetes mellitus, a photo of which confirms the seriousness of this disease, needs timely treatment, otherwise serious complications may develop.

Therefore, diagnosis at the first sign of the disease should be done with the participation of qualified specialists. At the first suspicions on diabetic osteoarthropathy it is necessary to pay visit to the doctor-endocrinologist. If possible, it is better to go to a specialized medical center.

In order to make an accurate diagnosis, you need to carefully study the clinical picture and radiologic signs that will point to a specific stage. The complexity of the process of determining the disease is reduced to the fact that the symptoms can resemble the manifestation of phlegmon of foot, thrombophlebitis, lymphostasis and other diseases.

The most difficult is the differential diagnosis in the case when Charcot's foot (diabetic) is at an acute stage. In this case, untimely treatment can cost the patient a loss of limb.

How is differential diagnosis made in the acute phase?

When the patient is in this condition, doctors try to get an answer to two key questions:

• If there are appropriate radiographic signs of bone destruction, what kind of nature do they have - infectious (osteomyelitis) or non-infectious (OAID)?
• Is it possible to determine inflammatory changes as a result of destruction of bone structures or are they signs of another disease (rheumatic joints, acute thrombophlebitis, phlegmon of foot, gouty arthritis, etc.)?

In order to get an answer to the second question, additional equipment will be needed, since without it it will be difficult to say that the patient has exactly Charcot's foot. X-rays in this survey is most relevant.

In addition to radiography, you will have to use magnetic resonance imaging. It will not be superfluous and scintigraphy of the skeleton of the foot. All these diagnostic measures will help to identify inflammatory changes, increased blood flow in the area of affected areas and micro-fractures.

If necessary, an evaluation of biochemical markers of bone tissue disintegration may be performed. Tissue markers can also be taken into account, as they reflect the activity of the bone isoenzyme.

As for the first question, it is most relevant with obvious signs of trophic foot ulcers. This information may be relevant during the postoperative period following amputation, or surgical intervention related to the foot. To determine the nature of bone destruction, take a blood test for osteomyelitis.

Charcot's foot: treatment

First of all, it is necessary to understand that the treatment process will give the greatest result if the patient in a timely manner turns to a doctor. But, for this to happen, people with a diagnosis such as diabetes should be able to independently assess the condition of their feet.

A competent examination can and should be learned, consultations of qualified doctors will help in this. As a result, the patient should cultivate the habit of constantly examining his legs, in particular feet. As soon as any changes in the structure are recorded, even minor ones, one should plan a visit to the doctor.

It is also important to consider the following fact accompanied by Charcot-Marie disease: pain in the foot in this condition is reduced due to atrophy of the nerve endings, and the patient may feel that the damage received is insignificant, while the damage is in fact serious.

If ulcers appear on the foot, then it is necessary to investigate them with the establishment of depth. As for the therapeutic effect, then with certain ulcers it is possible to restore with the help of orthopedic insoles, because they significantly reduce the pressure when walking. If this measure is not sufficient, then immobilization is used, which prevents a strong effect on the skin.

Surgical treatment is prescribed when the ulcer spreads to the level of the dermis. If the fact of infection was documented, the doctor prescribes the use of antibiotics.

Sometimes plantar ulcers can spread even to the bony protuberances. In this case, there is a need for surgical removal of the latter. As an example, you can bring a metatarsal bone, which can be removed with an ulcer localized at the front of the foot.

More information about conservative and surgical treatment

Combating the diabetic foot can be done promptly and through classical techniques.

Conservative treatment is focused on activities that can be divided into two types:

• Basic treatment. At this level, attention is paid to diabetes compensation, blood pressure control and normalization of blood sugar levels. Patients are taught the necessary knowledge and skills. If necessary, the doctor may demand to give up smoking, since it has a negative effect on the blood vessels.

• Additional medical measures. If Sharko's foot is diagnosed in diabetes mellitus, treatment may include antimicrobial therapy using antibiotics. To stop the pain, pain relievers such as Ibuprofen, Analgin, and others are used. The patient also undergoes a series of therapeutic measures aimed at restoring nervous conduction and improving blood flow in the region of the feet. It does not dispense with local effects with the help of antiseptic drugs.

With regard to surgery, it is used when there is a need to remove abscesses and ulcers. Operative treatment can be an actual measure for improving blood flow. If the patient entered a health facility at the last stages of the disease, the likelihood of amputation of the feet and lower limbs increases.

Restoring the skeleton of the foot

When the diabetic foot of Charcot appears, the treatment is primarily focused on the removal of abscesses and ulcers, but surgical intervention can also be used as a restorative measure. It is about correcting the deformation of the foot.

In fact, the resection of bone structures and arthrodesis is neutralized, which causes an increase in pressure on the plantar surface, which leads to the formation of an unhealed ulcer. In order to apply similar techniques, it is necessary first to achieve that the verse is an inflammatory process, and completely, and there was no osteolysis. If these conditions are not met, then there is a risk that surgical intervention will lead to the appearance of new foci of destruction.

Also before the operation it is desirable to strengthen the bones with the help of appropriate medications.

The surgical restoration of the foot described above is necessary if it is strongly deformed, making the use of special orthopedic shoes ineffective.

Preventive measures

Obvious is the importance of information on methods to prevent such a problem as Charcot's foot. Photos of patients Gives an opportunity to understand how serious this destructive process is. And even if he made himself felt and a course of treatment was conducted, this does not mean that ulcers will not appear again.

So, to prevent and prevent the re-emergence of Charcot's foot can be, following the proven principles in the prevention. First of all, it is necessary to independently conduct an examination of the feet and at the first signs of skin lesion or deformity immediately go for examination to the endocrinologist.

Also, you have to give up scissors for cutting nails and use a nail file. Narrow shoes should also remain in the past, as it is easy to rub their feet and get the corns afterwards. In addition, it is important to protect feet from exposure to high and low temperatures.

If a wound was found, treat it with a 3% hydrogen peroxide solution, "Chlorhexidine" and "Miramistin" followed by a sterile bandage. In this situation, those medicinal products that have a tanning effect are contraindicated. These include iodine, zelenka and manganese. It is important to take care that the skin does not stay dry. This will help moisturizing creams ("Calliusan", "Balsamed", etc.).

Results

Diabetic foot is a disease that can lead to serious complications if it is started. Therefore, when diagnosing diabetes mellitus, it is necessary to undergo appropriate training and carefully monitor the condition of your legs.