crippling condition often misdiagnosed

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Crippling Condition Associated with Diabetes Often Misdiagnosed and

Misunderstood

1-Sep-2011

Winkler says he limped around on his painful left foot for six

months, suffering unnecessarily from a misdiagnosis by a physician who

didn't know about the symptoms and treatments for Charcot foot, a form of

localized osteoporosis linked to diabetes that causes the bones to soften

and break, often resulting in amputation.

When his primary care physician finally agreed to Mr. Winkler's request for

an x-ray, they discovered the metatarsal bones in Mr. Winkler's left foot

were all broken-a common symptom of this serious and potentially

limb-threatening lower-extremity complication.

A new article in the September issue of the journal, Diabetes Care,

describes Charcot foot and its treatment with a goal of educating medical

professionals about this painful inflammation of the foot. The article is

the product of an international task force of experts convened by the

American Diabetes Association and the American Podiatric Medical Association

in January to summarize available evidence on the pathophysiology, natural

history, presentations and treatment recommendations for Charcot foot

syndrome.

" Even though it was first described in 1883, the diagnosis and successful

treatment of Charcot foot continue to be a challenge because this syndrome

is not widely known or understood by the broader medical profession, " said

Lee C. , D.P.M., co-director of the Amputation Prevention Center at

Valley Presbyterian Hospital in Van Nuys, CA, and lead author of the

Diabetes Care article. " Charcot foot is now considered to be an inflammatory

syndrome most often seen in patients with diabetes which can be successfully

treated in its early stages. "

The article describes Charcot foot as a condition affecting the bones,

joints and soft tissues of the foot and ankle, which is characterized by

inflammation in the earliest phase and is associated with diabetes and

neuropathy. The report finds offloading, or removing weight from the foot,

is the most important initial treatment recommendation. Surgery can be

helpful in early stages involving acute fractures of the foot or ankle or in

later stages when offloading is ineffective, according to the article.

In Mr. Winkler's case, he was first diagnosed with Charcot foot in 2004 and

had already undergone one surgery that relieved the problem for several

years. By 2010, though, he was facing the potential amputation of the foot

because of complications associated with Charcot foot syndrome.

His podiatrist referred him to Dr. at Valley Presbyterian Hospital's

Amputation Prevention Center, an integrated limb salvage center that is one

of only a handful in the nation. Since its December 2009 opening, the

Amputation Prevention Center's specialized multidisciplinary team of highly

skilled professionals has treated patients from all over the country and

around the world with leading-edge technology, achieving a limb salvage rate

of 96 percent.

Andros, M.D., the Center's Medical Director, performed vascular

surgery to restore circulation to Mr. Winkler's left foot so that it would

heal. Then, Dr. performed surgery to rebuild the bones in Mr.

Winkler's foot. Dr. also implanted a bone stimulator that acts like a

pacemaker for bones which encourages Mr. Winkler's body to rebuild and fuse

the broken bones in his left foot. As a result, Mr. Winkler is expected to

be able to recover the use of his left foot.

" I'm very pleased because I had gone to another doctor and he wanted to

amputate my foot, " Mr. Winkler said. " When I found Dr. and Valley

Presbyterian Hospital's Amputation Prevention Center, it's like I found a

blessing and an angel in disguise. I have tears running down my face as I

describe to you how I will be able to get up out of my chair and walk

because of the care I received at Valley Presbyterian Hospital. All the

people there are superb. They treat me like a king. "

Source: Valley Presbyterian Hospital

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