Data presented to the American College of Foot and Ankle Surgeons (ACFAS) link diabetic peripheral neuropathy with heightened risk of lower extremity amputation. Aggressive screening for peripheral neuropathy, the researchers report, can identify patients most at risk, before they present with serious ulcers, non-healing wounds, and the deformity called Charcot foot.
"Severity of numbness is the critical factor," the researchers report. "Use of the simple, noninvasive, monofilament test can detect diminished nerve sensation."
Researchers recommend screening all diabetes patients for peripheral neuropathy, and educating all with neuropathy about their elevated risk for complications, especially Charcot foot. "Thus, practitioners can more readily identify high-risk patients, and intervene to prevent these complications," say researchers.
What is Charcot foot? Occurring in approximately 30 percent of diabetic patients with peripheral neuropathy, Charcot foot can be misdiagnosed as gout, septic arthritis, or osteomyelitis. The foot becomes painful and hot, swollen and red. Bones soften, and become more prone to fractures. Balance can be affected. Many patients become unable to wear shoes.
In advanced stages, Charcot patients lose most sensation in the feet. They cannot feel pain. Muscles fail to support the foot properly, the arches fall, and a reverse arch, a "rocker foot" can develop. Walking worsens the condition, as inflammation from pressure leads to instability, ulcers, and dislocations. The foot can collapse. Surgery can be the best option to rebuild the arch.
Of course, if deep ulcers develop, if infection cannot be conquered, amputation of the foot may become necessary. That such extreme measures might have to be considered is a ringing endorsement for prevention, for regular foot inspections, neuropathy screenings, and prompt intervention before serious foot conditions develop.
For more information, talk to your doctor, or contact ACFAS; telephone: 1-888-843-3338; Web site: www.acfas.org.