Charcot's foot

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I've got a patient with a Charcot's foot on the left and prosthetic limb on the right leg. The problem is that he is having an active charcot's foot with destruction of bone joints demonstrated on the xray film. Temperature mapping showed 3 degrees celsius significance difference as compared to the last mapping done 3 weeks ago.

I've reinforced on the importance of non-weightbearing activities. However, patient stills weight-bear when he goes to the toilet only. He lives in a nursing home and I am keen to put him on a total contact casting.

My dilemma is that I'm afraid to put him at a higher risk of falling with a cast on the foot.

Any suggestions will be much appreciated.

Cheers.

 

http://www.aircast.com/products/pro...AE2-49CC-4EF9-BFA2-46DA37C84782&rnd=232025172

Get Prosthetist to adjust contralateral side length for duration. Make a total contact insole for the walker.

 

How long will you usually put such patient on an aircast for? And how often will you get the patient to come in for review?
Thanks for the suggestion though.
Cheerios

 

Hello,In acute charcot most important thing you must do with your patient is nonweithbearing,so you can put a total contact cast or a walker removible aircast.In the acute process the bony destruction is important,you have to prevent fractures or important deformities.In one week or 10 days you have to do a X-ray control and the treatment with inmovility is for 8-10 weeks.Is important revision the patient 48 hours after put the boot,so you con see the aspect of the maleolus that is a place to avoid pression of not ulcer.Sorry for my english.I hope be helpfully.

 

These are always difficult. The replys here are right on. The only thing I might add is that you mentioned your patient is already an amputee. I assume Diabetic PVD. I would send out for Vascular assessment on his remaining limb if you haven't already and perhaps help him improve his vascular supply. I realize he may look hyperemic but of course this doesn't correlate to the overall LE blood supply.
Good luck
Dr. Steve

 

Thank you for all the wonderful replies!
I've actually consulted with an Orthopaedic Dr. Blood tests ordered and (CRP and ESR) demostrated elevations of results. He suggested that the patient may have osteomyelities.

Oh I've forgot to add on. He has previous left 1st and 2nd ray amputations done.

 

Hello again.You said the patient have a Charcot process?one of the diferential diagnoses of Charcot foot is osteomyelitis,but for an osteomielytis process the patient must have an ulcer.The Charcot is a diabetic neuroarthropaty,so in Xray there is a bony destruction like ocurr with bone infection,but in osteomyelitis the infection is seen in the lesion and the probe to bone test is positive,so you can touch the bone trough the lesion with an esteril tweezer.how long from the amputation?One of the possible origins of the charcot is a surgery or a trauma in the foot,so if the patient have suffered amputation is a probably desencadenante.
So many diagnostic tests(proofs) are not necessary.Only see the aspect of the foot,so you can make the diagnose,look the bed of amputation if there is ulcer or lesion try to introduce an esterile instrument for touch the bone,so you can make a diagnose.If osteomyelytis is intaured the indicated treatment, if good blood suplies,is surgery with removal infection bone and antibiotic therapy.Bye.

 

Hi,

Take his prosthesis off him, that'll sort out the mobility problem!!

The prosthetist should be able to adjust the height of the prosthesis to accomodate the addition of aircast or total contact cast.

The total contact cast may be the better solution as compliance can be an issue with the aircast.

Declan