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AAOS (2011)
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Charcot Foot: severe deformity due to
ankle joint breakdown
AAOS (2011)
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Some statistics about DM
8.3% of US population has DM (25.8 million, diagnosed and
undiagnosed)
Most will be in their 50s and 60s and have had DM for 10-20 years
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Charcot Foot Progression
DM results in decreased circulation, which in turn weakens bones
and makes fracture more likely
AAOS (2011)
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Signs and Symptoms
Profound unilateral swelling
Locally increased skin temperature
Erythema
BUT no pain, or less pain than expected
No skin openings
X-rays may appear normal
Synovial joint biopsy is definitive; bone fragments
will be in joint
Witmer (2004)
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Bone fragments lead to ulcer
(Left) This patient with Charcot of the ankle has developed a deformity that
places abnormal pressure on the outside of the ankle. (Right) This pressure
has led to the development of a chronic sore (ulcer) that can be extremely
difficult to treat (AAOS 2011).
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How is Charcot Foot treated?
Prevention is the best treatment!
AAOS (2011)
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Complex Surgical Treatment
(Top) In this x-ray taken from the side, the patient has unstable Charcot of the back
of the foot. The dislocation of the joints is seen where the two bones in the back of
the foot do not line up (arrowhead). (Bottom) A complex realignment and fusion
was performed to prevent the patient from developing a prominence and
ulceration (AAOS 2011).
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What does this mean for us?
Clinician observation of key symptoms to report to
PT/ physician
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How to Assess Intervention?
Difficult to clearly assess interventions just
mentioned b/c patient outcomes affected by health
and health behaviors (not just by intervention)
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References and Additional Resources
References
American Academy of Family Physicians (AAFP) (1998). The Charcot Foot in Diabetes: Six Key Points.
http://www.aafp.org/afp/1998/0601/p2705.html, accessed 2/19/2013.
American Academy of Orthopedic Surgeons (AAOS) (2011). OrthoInfo: Diabetic (Charcot) Foot.
http://orthoinfo.aaos.org/topic.cfm?topic=A00655, , accessed 2/19/2013.
Centers for Disease Control and Prevention (CDC) (2011). National diabetes fact sheet: national
estimates and general information on diabetes and prediabetes in the United States.
http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf, accessed 2/26/2013.
Dutton, M. (2012). Orthopedics for the Physical Therapist Assistant, Sudbury, MA: Jones and Bartlett
Learning.
Witmer, J. (2004). Understanding Charcot Foot. Advance for Physical Therapy and Rehab Medicine. Vol.
15, issue 5, p.44.
Wrisley, D., Marchetti, G., Kuharsky, D. and Whitney, S. (2004). Reliability, Internal Consistency, and
Validity of Data Obtained with the Functional Gait Assessment. Physical Therapy. Vol. 84, no. 10,
pp906-918).
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Conclusion
Any questions?
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