WHAT IS CHARCOT FOOT?
Charcot foot is a rare complication of Diabetes and relates to Diabetic neuropathy at its most extreme. It places the patient in a very dangerous situation, whereby it is much easier to get infections leading to surgeries and potential amputations.
Once Diabetes (or Prediabetes) has been present for 10 years, it affects many different systems in your body and in this case, we are going to talk about how the nerves are affected. Diabetic neuropathy will typically affect the feet and hands in what is called a “stocking and glove” presentation, that is symmetrical. It will usually present as numbness and tingling, which can eventually lead to burning pain. Ironically, the foot may feel like it is burning, but actually, you may not be able to feel pain in the foot at all. Over time neurologic tests will indicate diminished nerve sensation, including loss of protective sensation. Nobody likes pain, but it is a very important indicator to the person that there is something wrong.
In the person with advanced Diabetic neuropathy, there is no pain sensation going to the brain to alert you that there is something wrong. That is why it is very important to inspect your feet every day when you have Diabetes and to wear proper fitting supportive shoes, both in and out of the house. Extra depth supportive walking shoes (preferably high-top) with laces or Velcro are preferred for out of the house and orthopedic open toe sandals with a strap behind the heel are preferred inside the house. This is a proactive way to get ahead of the progression that leads to the foot deterioration seen in advanced Charcot foot.
WHAT TESTS ARE HELPFUL TO DIAGNOSE CHARCOT FOOT?
Some of the symptoms of Charcot foot include redness, discoloration, sudden swelling, and a feeling of warmth or heat. It can mimic other entities such as a fracture or an infection. At the first sign of any of these changes, it would be prudent to visit your Podiatrist for evaluation. Diagnostics such as X-rays and MRIs are in order, including blood tests to rule out an infection.
If the problem is addressed in its early stages, it is much easier to treat before the deforming forces take hold. Such treatments can include supportive high-top shoes, prescription foot orthotics, or custom ankle braces. Further down the line, advanced treatments include walking casts or complete off weight-bearing with knee roller, crutches, or wheelchair.
WHAT CAN HAPPEN WITH CHARCOT FOOT?
Left untreated, the Charcot foot can break the foot down in the middle of the foot, causing a “rocker bottom” appearance, similar to a rocking chair. The central area in the arch is particularly vulnerable to ulcerations and infections when this happens. At this point in its progression, weight-bearing is usually not indicated. Surgeries come into play at this point with the avoidance of amputation as the main goal.
It will usually take 10 years of a patient being either Prediabetic or Diabetic to get advanced symptoms of neuropathy in their feet. Obviously, the goal is to reduce the hemoglobin A1c not just below 6.5 but below 5.7 if possible. Do not think that just relying on medication and eating whatever you want in your diet is going to cut it. Making mindful changes in your diet early on when getting a diagnosis of Prediabetes or Diabetes is the first step towards treatment.
WHAT ARE SOME NUTRITIONAL STRATEGIES TO HELP?
Let’s start with the main culprit, which is white flour. This is commonly found in bread, pasta, pastries, and is the staple of most people’s diet. To reduce white flour yet still eat these foods, you would need to switch to sprouted bread as your bread of choice, since it does not raise blood sugar. This is easy to do when you’re in the house, but not when you go out to a restaurant. In that case, you want to go with the best conventional breads that will not raise blood sugar as drastically as white and whole wheat bread. The best three are sourdough, rye bread, and pumpernickel.
When it comes to pasta, switching from a wheat-based pasta to a lentil or chickpea-based pasta is preferred. You could even consider switching to spaghetti squash. All of these examples will enable you to still eat pasta without raising your blood sugar.
When it comes to pastries, even gluten-free desserts will raise blood sugar so the best advice is to limit eating them just on holidays. A good substitute for dessert is dark chocolate, which will not raise blood sugar as much as milk chocolate. I prefer to have my dark chocolate with nuts mixed in for better taste since dark chocolate can be bitter. Eating real low-glycemic fruit rather than fruit juice is preferred due to its higher fiber content. Some examples include apples, pears, blueberries and strawberries. Organic is recommended due to the lower chance of pesticides which cause Cancer.
WHAT ARE SOME OF DR. RICHARD RIMLER’S SOLUTIONS?
As a Holistic Podiatric Physician, I make it a point to talk to my patients about these dietary changes that should always be the first step in addressing their Diabetes. Added to that is a regular exercise program, which starts with my prescription for Interval Training, five days a week (for example Monday through Friday). The reason that I prefer Interval Training is that it only takes 10 minutes of time and the benefits are enormous. As it relates to Diabetes, one important benefit is the 12 hour fat “after-burn” that occurs post workout. This means that if you keep your white flour reduced in your diet, you should be able to prevent weight gain, and in fact lose weight. By doing this, you will help your body reverse changes that come with Diabetes and possibly be able to go off prescription medications. Of course, if you are doing your Interval Training, eating a low white flour diet, and are not able to lose weight, it does need to be investigated by a Functional Medicine Physician to determine if there are any physiological problems, preventing you from losing the weight, such as related to the thyroid, adrenal, and sex hormones.
For someone with the beginnings of Diabetic neuropathy on their way to a Charcot foot, it would be best to do a non-weight-bearing form of Interval Training, such as using an exercise bike or swimming. This will put less stress on the feet.
Just as important for weight loss is the need to do resistance weight training 2 to 3 times per week. This will help your body turn some of the fat into muscle and also help lose weight and redistribute weight properly. It is important to schedule both Interval Training and weight training into your weekly routine. For this reason, I recommend doing the Interval Training first thing in the morning to increase compliance. I like to do my weight training over the weekend with one day off in between so the muscles can rest and recover.
There are many supplements that can be taken to keep blood sugar lower. Some of these include Berberine (which mimics the prescription drug Metformin without the side effects), Apple Cider Vinegar, and Cinnamon. All of these can be implemented in lieu of or alongside prescription drugs. The end goal is to wean yourself off the prescription drugs if possible. The best way to do that is through the daily food that you are eating, regular exercise, preventing weight gain and promoting weight loss.
Shoe gear will play a very important role in the progression of Charcot foot. Outside the house, it is important to wear sturdy, walking shoes, or sneakers with a lace. One step better would be going with a high top shoe, such as a high top sneaker or hiking shoe or getting a supportive over-the-counter ankle brace in a low top shoe. A pair of Orthotics are imperative to reduce motion and promote foot stability. For advanced cases, a custom Ankle Foot Orthosis (AFO) is needed to promote additional stability.
When it comes to the treatment of a patient with Charcot foot, you will need to have a multidisciplinary approach for treatment. That includes your Podiatrist, Primary Care Physician, Infectious Disease doctor, Vascular doctor and Endocrinologist. The potential complications of Charcot foot include major foot surgery and potential amputation so this is a condition you must take very seriously!
I encourage you to book an office visit or teleconsultation so I can put you on a safe path to wellness. Any treatments mentioned should only be used after a one to one personal evaluation, do not start any kind of treatment without first consulting your doctor.
