What you should know about foot pain in diabetics with neuropathy

I see feet. All day, everyday, I see feet of all sizes, of all characters and diseases, of all ages, live feet, dead feet, I see feet even when I'm off duty. I recognize people's feet better than I know faces at times. I see infections, trauma, pain and can diagnose in a lickety split because I see so many of the same problems over and over and over again. It is my specialty and my passion to diagnose and treat foot and ankle problems. And there is one thing that I want to share with you especially if your patient population consists many diabetics. 

An example of a patient history

"Mr/Ms Lovely developed pain in one foot that has been increasingly painful, red, and swollen. They cannot recall having fallen or tripped, maybe a little ankle sprain but nothing eventful is reported. They admit to being diabetic for a long time and are not so good at controlling their blood sugars. They may also have numbness in the feet and have been diagnosed with peripheral neuropathy. There may be an abrasion on the skin but it is not deep and there are no puncture wounds or ulcers in the foot or between the toes. The whole foot is swollen and has not resolved with anti-inflammatory medication or even antibiotics. You are stumped. What is happening?"

Let's get X-rays.

 

The top picture is of a patient without the described condition but is here for comparison. The bottom picture is the patient described. Here you can see irregularity of the bone structure, missing joint spaces, and an obliteration of bony architecture at the midfoot. The navicular is fractured and dislocated, an example of Charcot foot. 

The top picture is of a patient without the described condition but is here for comparison. The bottom picture is the patient described. Here you can see irregularity of the bone structure, missing joint spaces, and an obliteration of bony architecture at the midfoot. The navicular is fractured and dislocated, an example of Charcot foot. 

Quickie Formula for Charcot Foot = Diabetic + Peripheral Neuropathy + new onset of pain (because of broken bones), redness & swelling to one foot without a break in the skin --> refer to your friendly podiatrist, discontinue antibiotics, and keep the patient non-weightbearing to prevent further breakdown

I have same day appointments for at risk diabetics so come on in, let me help.