diabetic foot care – Anderson Podiatry Center

Why you need to know about Charcot foot if you’re a diabetic!

Posted on April 6, 2022 by admin

Diabetes is a common problem that is affecting more people worldwide and Charcot foot is associated with the diabetic foot. It may be one of the most overlooked problems for not only the patients but healthcare providers in the diabetic population. Charcot foot can result in foot deformities which can be debilitating from a functional standpoint but also put you more at risk of amputation. It has been estimated that two percent of diabetics have a Charcot foot. The percentage is low but the risk of not knowing about it can put you at risk as early diagnosis and intervention are important. So, what is a Charcot foot, and what causes it?

Description

A Charcot foot can result in the breakdown of the foot. There may be multiple fractures that occur primarily in the midfoot region. The result can be a foot that becomes very flat. So flat that it may be referred to as a rocker-bottom foot. This means there is no arch but instead where the arch used to be there can be boney prominences associated with the deformity. This causes excessive pressure on the soft tissues and skin and eventual risk of callouses which can then ulcerate and lead to infection. So how did this come about? What can increase your risk? It can be from poor control of your diabetes, a broken bone, or an injury to the foot and ankle To understand how you get a Charcot foot and why this puts you at risk we need to discuss diabetes and its effect on the nervous system and the arterial system.

Nervous system

It is common for people with diabetes to have neuropathy. Approximately 50-70 percent of diabetics have this condition. This will cause burning tingling and numbness in the foot. The numbness is what puts the diabetic foot at risk because of what we refer to as a protective sensation. If you have numbness, you may not feel what normally would have been a painful callous for instance. The callous then breaks the skin down and this leads to an infection. What is happening in the Charcot foot is the damage to the nerve’s effects blood flow to the foot. The damage to the nerves may occur in the autonomic nervous system which regulates blood flow. When the nerves are damaged the small nerve branches that regulate blood flow by constricting blood flow no longer work and the arteries dilate. This causes an increased amount of blood in the foot. This then results in the diminishment of calcium in the bone and the bones of the foot become weaker and fractures occur. The bones and joints that support the foot collapse causing various deformities which are referred to as a Charcot foot. Circulatory system

Circulatory system

The arterial blood flow that takes blood from the heart down to the foot is affected in the diabetic state. When it occurs, it’s referred to as arteriosclerosis and tends to involve the smaller arteries in the lower legs and into the foot.

What are the symptoms of a Charcot foot?

The primary symptoms can be a hot red swollen foot. A Charcot foot is commonly misdiagnosed as being infected or a gouty attack. Both of these can also cause redness and warmth in the foot. Because of neuropathy being present the patient may experience little to no pain and that’s what makes this dangerous.

How is Diabetic Charcot Foot diagnosed?

Often a diagnosis is arrived at by exclusion of other problems such as infection or gout. X-rays are also important as fractures may be seen and evidence of flattening of the arch. The foot that is affected may begin to have a flatter appearance compared to the opposite foot.

What are the treatments options for someone with Diabetic Charcot Foot?

When diagnosed early it’s important to have the patient immobilized and be non-weight bearing to reduce the breakdown of the foot. Because the foot may have small fractures and the stability has been compromised casting the foot and remaining non-weight bearing is the standard treatment. This will lessen the amount of deformity that occurs and protect the fractures from getting worse. With proper treatment, the number of foot deformities that occur can be greatly reduced. The amount of time for casting may vary but can be a minimum of two months or more in many cases.

Special shoes and orthotics. Conservative treatment may include orthotics or custom shoes to reduce pressure on soft tissues from the boney pressure points

Surgery – If the Charcot foot is not diagnosed and no treatment is done or it is treated but not early enough then surgery may be necessary to reconstruct the foot. These surgeries are among the most challenging foot procedures and require immobilization and non-weight bearing.

What you need to know – If you are diabetic and your foot feels warm or looks red, think Charcot foot as it may not be an infection! Both can appear the same.

So even though the chances of you getting a Charcot foot are very rare, it’s important that you remember the points covered in this blog. If you or someone you know is diabetic please seek medical attention if you suspect these symptoms as it can help to lessen the chance of amputation.

The three things you need to know about diabetic foot amputation

Posted on March 17, 2022July 12, 2025 by admin

What you can learn and do to prevent diabetic foot amputation

Whenever you hear the word diabetes, you may have heard of someone you know of who has lost a foot or limb because of their diabetic state. In this blog, I will break down what you need to know into three basic categories. You will also learn about what you can do on a regular basis if you are diabetic to reduce the risk. The good news is even though the risk is still present, the overall risk of amputations has gone down in recent years because of medical advancements especially in wound care.

The three conditions that can cause an amputation in a diabetic person are:

Foot deformities
Arterial disease
Neuropathy

Foot deformities are a major cause for concern

Any foot deformity that can lead to pressure on the skin, when shoe gear is worn, can put you at risk. Problems such as a bunion (also known as a deformity by the big toe joint) can create a prominence that can rub against a shoe. Another example would be a hammertoe, which could cause excessive rubbing against a shoe. When this happens, the skin may break down or a callus/corn may form which eventually leads to an opening in the skin.

If you also have diabetic neuropathy, you could lose your ability to sense or feel; this allows the problem to become more severe before you’re aware of it. So, what can be done?

Wear shoes that fit well and don’t cause irritations on the skin
Check your feet daily
Be evaluated by a podiatrist for conservative, or, some situations surgical options

Arterial disease is riskier than you think

Peripheral artery disease or PAD can also make it riskier for an amputation. Diabetics tend to be more at risk of having peripheral artery disease and it tends to present lower in the leg and into the foot and ankle area rather than higher up the leg. It can become challenging for doctors to conduct procedures that can improve circulation in these smaller blood vessels when they become blocked. Obviously, without adequate blood flow to the foot, the potential for healing may be limited.

What can you do to help yourself in this situation

Avoid smoking as this will increase the risk many fold.
Have your circulation evaluated as it is important to be educated about the potential risk you may have.
Regular exercise can help maintain good circulation.
Avoid sugars and carbohydrates: Good diabetic control is the need of the hour, as this helps with the risk. Avoid anything that comes in a package (such as processed foods). These foods often are high in sugar and carbohydrates. Finally avoid all soft drinks or juice as many contain fructose.

Neuropathy is in fact, reversible

Diabetic neuropathy occurs in 50-70 percent of diabetics. For many, neuropathy is the most important consideration to take when risks such as diabetic ulcers and limb loss are attached. The symptoms that you will experience with neuropathy are: burning, tingling and numbness in the feet. It is the numbness and inability to feel that becomes quite problematic to daily life. The good news is that for many, the lack of sensation can be restored.

If you have heard that diabetic neuropathy is irreversible, it is simply not true!

Our award-winning research refutes this statement. More studies are also supporting the concept of nerve decompression surgery. In the diabetic state, a sugar molecule called Sorbitol is absorbed into your nerves and attracts water to the nerves, making them swell. This increase in size creates compression in areas where nerves pass through nerve tunnels. This then damages the nerves and creates neuropathy symptoms. Reducing compression can restore more normal nerve function.

To be more informed on this topic, you can refer to two research papers on our website, that show objectively that nerve function can be improved, and that this can ultimately lead to decreased amputation risk. Here are some more measures that you can take:

Make sure you have good control of your diabetes.
Be evaluated by a peripheral nerve surgeon – Potentially you could have your neuropathy reversed by surgical means.
Visual inspection- Make it a habit to visually inspect your feet daily for problematic issues. Things you should be looking for include:
- Blisters
- Cracks
- Sores
- Redness
- Thick calluses
- Ingrown Nails
- Plantar warts
- Warm spots

Along with controlling your blood sugars, remember the three potential problem areas – foot deformities, arterial disease and neuropathy. If you would like to know more about what we can do to help with your foot and ankle concerns, or your neuropathy please reach out to us.

Listen to Mary’s testimonial where she talks about her recovery from surgery that involved reversing diabetic neuropathy.

View testimonial

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Diabetic Foot Care: Important Steps to Follow.

Posted on July 7, 2021 by admin

Do you have questions about diabetic foot care? Read this to know more!

Diabetes can be profoundly serious for your feet. In this blog, I will explain what you need to know about diabetic foot care. But before we get started on a list of things to keep in mind, it’s important to remember three basic principles about your feet. Understanding the following will give you better clarity regarding your diabetic feet and what’s important to consider.

Three ways diabetes affects your feet.

The nervous system – If you have diabetes there is a 50-70 percent chance you will have neuropathy. Diabetes can cause nerve damage especially in the feet and lower extremity. This will result in the symptoms of burning tingling and numbness in the feet. Because of numbness problems such corns and calluses may not be felt. At first the idea of numbness in the feet may not seem that bad because it might prevent you from feeling pain but that’s where the problem lies. This prevents the warning signs of pain that can be associated with an ingrown nail, a cut or blister. Quite common and serious issues occur with callouses on the bottom of the foot. With no pain the callous may eventually break down the skin causing an ulcer. Once the skin has broken open from the ulcer an infection is likely, and this can eventually get into bone. Once this occurs an amputation is more likely,so without the nervous system giving a warning in the form of pain problems such as corns, calluses, blisters and ingrown nails become more serious.
Circulatory system – It’s also known with diabetes that you have a higher propensity to have decreased blood flow to the lower extremity, especially the feet. When this happens, if there is any kind of cut or problem with the foot it may be harder to heal properly. It should also be emphasized that smoking combined with diabetes should be avoided. There is a many fold increase of circulatory complications with people who smoke. If a toe is injured with a cut and develops an ulceration, a dark area of the skin in this area could be an indication of gangrene and should be evaluated immediately.
Foot Deformities – Any type of foot problems such as a bunion or a hammer toe can create any irritation where the bony prominence will rub against shoe gear. This too can cause a problem because this can lead to a breakdown in the skin in the form of a callous or a corn that can eventually cause a foot ulcer. Properly fitted shoes are especially important. If the deformity is severe and difficult to accommodate in shoe gear, surgical correction may be considered by the podiatrist after appropriate workup, to ensure adequate blood flow is present for healing. Better to correct earlier then later in some situations as the circulation could become compromised enough later in the life to where surgery would be too risky.

General guidelines to follow

By following these tips, you can do a lot to take better care of your diabetic feet.

Be sure that you bathe your feet daily. Be careful to dry your feet especially between the toes after you are done.
It’s a good idea to inspect your feet every day. You may need to use a mirror to look throughout the foot on the top and on the bottom. Also in between the toes for any types of cracks or cuts that may be there.
Make sure to avoid walking barefoot. This is obviously a problem if you step on a foreign body or a cut.
Make sure that you test water with your hand before putting your foot in warm water such as a hot tub or a bath.
Use appropriate shoe gear and socks.
Make sure that you attributed nails and not dig in on the sides. Try to cut them somewhat straight across as if you don’t this could cause an ingrown nail.
Make sure that you control your diabetes well by controlling your blood sugar levels.
Make sure that you see your podiatrist on a regular basis. Some will recommend coming in every two to four months just for a general foot inspection.
With diabetes your feet may become drier, and this can cause cracking of the skin. So be sure to keep your skin moisturized.
Make sure that you have your foot checked by a professional, especially if you are getting a corn or a callus that could be problematic and painful.
Never treat corn and calluses yourself. Over the counter products that are sold frequently have acids in them that eat away at the corn or callus. This is too risky to use in the diabetic foot.
Wear socks to bed if your feet are cold at night.

Diet Tips

To stop or delay nerve damage avoid carbohydrates and sugars. Make sure to have a diet that includes vegetables, fruits and protein. Also, a diet that includes fat is important as nerves need fat for proper function. Make sure it’s healthy fat such as grass-fed butter. A daily habit I have is to add grass fed butter to my coffee along with cinnamon. This avoids unhealthy additions to the coffee such as sugar or artificial creamers. The fat also satisfies your hunger so that you’re less likely to want to eat. A great book to use as a reference is Sugar Crush written by a colleague of mine Dr. Richard Jacoby.

Following these general guidelines should help you protect your feet from a dangerous situation that could occur when you have diabetes. Educating yourself is key when you want to prevent any serious problems.

Treating Neuropathy: 5 Stages

Posted on March 29, 2017July 1, 2025 by admin

Stage 1

In this stage, the patient is experiencing symptoms of neuropathy, but they are still very mild.

Stage 2-4

Many patients will experience the most pain here, along with the burning and tingling and it can become very hard to sleep. This is also where people typically begin taking neuropathy medication.

Stage 5

At this point, the neuropathy has usually progressed to where the patient’s feet are numb and very weak. They aren’t in pain, but often have trouble standing or walking and don’t have the strength that they used to have. If the patient is diabetic, the risk of amputation goes up here, because the nerves are often dead.

The good news is that patients have an opportunity to decrease the risk of getting to stage 5 and also of amputation. During the middle stages, the nerves are still very much alive and that’s where nerve decompression surgery plays a very important role in the patient’s treatment. Many ask, can you reverse neuropathy? We can go in and open up these nerve tunnels that are being compressed and many times, we can reverse the symptoms of neuropathy in feet, neuropathy in legs, and restless legs, which drastically improves the patient’s quality of life.

To learn more, click here.

In this video, Dr. Anderson discusses the five neuropathy stages, the symptoms that can occur at each stage, and treatment options that are available throughout the journey.