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Cite this article: Lozano Del Hoyo ML, Armalé Casado MJ (2017) Charcot Foot: A Sequence of Disasters. JSM Foot Ankle 2(3): 1030.

*Corresponding authorMaría Luisa Lozano Del Hoyo, Department of Gerontology, Health Center Las Fuentes Norte, Iranzo 69, 50002, Zaragoza, Spain; Tel: 34-686 900 447; Email:

Submitted: 16 November 2016

Accepted: 28 June 2017

Published: 30 June 2017

ISSN: 2475-9112

Copyright© 2017 Lozano Del Hoyo et al.

OPEN ACCESS

Keywords•Charcot foot•Nursing consultation•Diabetic foot

Short Communication

Charcot Foot: A Sequence of DisastersMaría Luisa Lozano Del Hoyo* and María José Armalé CasadoDepartment of Gerontology, Health Center Las Fuentes Norte, Spain

Abstract

The Charcot neuroarthropathy is a progressive degenerative disease which affects the foot joints, and diabetes is its main cause. This neuroarthropathy is one of the most serious complications in diabetes mellitus, because it induces important deformations in the toe and foot with big disability in the patient.

The scientific evidence shows that those patients must keep a strict control in their blood glucose levels. Other studies have reported that most of them had a previous history of problems in feet, along with a loss of feeling of protection. To avoid “disasters” that end with an amputation of the limb, patients must be teaches about foot care and favoring the training of skilled nursing professionals on diabetic foot.

It is primordial to always keep in mind that the sooner this asthropathy is diagnosed, the sooner most complications can be avoided in the medium and long term. The creation of diabetic foot units favors the early diagnosis and this means a bigger economic saving and a bigger quality of life for the patients and their families, it also means a place where patients can be sended in case they don´t evolve properly in nursing consultation. Giving the importance diabetic foot has among professionals and diabetic patients is a pending subject in a lot of cases. Listening to the patient and their family is a fundamental step of the process which is forgotten in lots of cases.

INTRODUCTIONThe diabetes mellitus and the peripheral neuropathy are the

main risk factors of the neuroarthropathy in the foot and the toe. The diabetic polyneuropathy is the most common cause of the neuropathic osteoarthropathy in the developed countries. This neuroarthropathy is one of the most serious complications in diabetes mellitus, because it induces important deformations in the toe and foot with big disability in the patient [1-3].

The Charcot neuroarthropathy is a progressive degenerative disease which affects the foot joints, and diabetes is its main cause. It is characterized by a progressive destruction of the bones that bear weight and the joints, which leads to a bigger instability, ulcerations and/ or recurrent amputations [4].

Jean Marie Charcot, in 1868 described the Charcot foot in patients with dorsal tables as a quick and unfavorable evolution, deterioration and joints instability. In 1936 Jordan affiliated the diabetes mellitus to neuropathic changes in the foot and the toe [5,6].

One of the theories that try to explain the changes that happen in the Charcot arthropathy is the neurovascular theory. This theory refers to the rise of the peripheral blood flow of the foot bones being this the responsible of the bone reabsorption, demineralization and osteopenia that are found in this pathology.

The Charcot arthropathy reduces the quality of life of patients and leads to a motor disability, loss of limbs, early retirement, and death.

To avoid the complications of this arthropathy is essential to keep a strict control of patients with high risk diabetes and to recognize the first signs of Charcot arthropathy. To people with diabetes you have to educate them in the right self-care and daily feet inspection and in the glycemia control [7-10].

MATERIALS AND METHODSDescription of a clinical case that was shown in a meeting of

skilled diabetic foot and that since that moment a tracing was made in our consultation. Woman, 69 years old, arterial hypertension, obesity (IMC 39,12), hypothyroidism, dyslipidemia, diabetes mellitus type 2 for 14 years, insulinized 2 years ago, diabetic retinopathy, Charcot arthropathy in the right foot, polyarthrosis and exhumation for 20 years.

Biochemical parameters: HbAcl: 7.7%, the rest is within normality.

RESULTS AND DISCUSSION

Disaster nº1

This patient had never subjected to no diabetic foot revision

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in 14 years, neither in primary care, nor in specialized, i.e., in no level of care.

The “Clinical Guides” recommend to check the feet of every patient with diabetes at least once a year and to stablish the risk of ulcers. Prevention, since Primary Care by identifying the “high risk” patients, represents the most effective way to reduce the ulcer formation and the number of amputations on those patients.

According to the recommendations of the International Working Group on Diabetic Foot [IWGDF 2015], the basic exploration should include a search of signs and symptons of sensory neuropathy, peripheral arterial disease and foot deformations.

Disaster nº2

When the evolution of her astropatia started nobody recommended her to go to a specialist in podiatry to put the appropriate discharges [11-15].

It is necesary to make a clinical assessment to the patient and to adjust their clinical necessities to technical possibilities, evaluating in each case different aspects (neuropathy, range of joint mobility, deformities, partial amputations).

Disaster nº3

Ulcer cure by a non-expert staff Figure 1. In November 2014 they blew her a blíster in the foot in the urgency service, closing in false and the ulcer and the aspect of the foot in general were worsening. The families attend to different public and private centres, but without expert staff in diabetic foot, looking for the cure. This has given them a total economic outlay of 30.946 euros and a year of their time. In our city there is no diabetic foot unit [16-18].

The patient is derived from a hospital to a primary care consultation that owns a nursing professional who is an expert in the field. Begins to heal with discharges of felt and the ulcer improves Figure 2.

Disaster nº4

The patient attends to a trauma consultation to value her Charcot arthropathy and on that, the Traumatologist recommends as a treatment putting the foot to soak with water. The wound got worst and ended with two cracks of 1´7 and 1´2 cm in length. Since 2 months ago we have resumed the cure in primary care, she has been referred to a specialized podiatry center to the realization of discharge templates in both feet and the use of suitable footwear and in this moment she is really close to a healing Figure 3.

CONCLUSIONThe scientific evidence shows that those patients must keep

a strict control in their blood glucose levels. Other studies have reported that most of them had a previous history of problems in feet, along with a loss of feeling of protection, hence the importance of diabetic foot units with multidisciplinary teams that favor the diagnosis, the prevention and the treatment in diabetic patients including in being teaches about the feet self care.

Figure 1 Ulcer cure by a non-expert staff.

Figure 2 Healing with discharges of felt and the ulcer improves.

Figure 3 Close to a healing.

It is primordial to always keep in mind that the sooner this asthropathy is diagnosed, the sooner most complications can be avoided in the medium and long term. The training of nursing professional’s experts in diabetic foot and the creation of diabetic foot units favors the early diagnosis and the treatment and this means a bigger economic saving and a bigger quality of life for the patients and their families, to get there, the patient and their relatives must be taught to work with their emotions [19-22]. Giving the importance diabetic foot has among professionals and diabetic patients is a pending subject in a lot of cases. We would like to expose the “Family thoughts”, main part of the process and in most cases forgotten:

Trying to achieve a contact person specialized in diabetic foot, above all a nurse for the cure and having they as a reference, for any anomalous sign. Template guidelines, foot support… to whom to turn.

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Lozano Del Hoyo ML, Armalé Casado MJ (2017) Charcot Foot: A Sequence of Disasters. JSM Foot Ankle 2(3): 1030.

Cite this article

Recommended follow-up time between visit and visit, how to coordinate specialists and to see who is able to take command of the problem, a coordinator is needed. Searching for diabetic foot unit somewhere. Is there any solution for the real problem? Or just extreme prevention and vigilance? Can only pallia not cure?

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