Dr Mark Nelson
Foot & Ankle Specialist
Neuropathy is Key Predictor for Amputation Risk in Diabetic Patients
ORLANDO, Feb. 20, 2003 -- New research reported today by diabetic foot care experts shows that aggressive screening for evidence of nerve damage and sensory loss (neuropathy) will identify diabetes patients at the highest risk for severe, disease-induced foot problems, such as infection-prone skin ulcers and a debilitating deformity called Charcot foot. Left untreated, these complications put advanced-stage diabetes patients on a path to a lower-limb amputation.
Several research presentations at the American College of Foot and Ankle Surgeons (ACFAS) annual meeting here featured podiatric foot and ankle surgeons who specialize in diabetic foot care. They reported that the presence of neuropathy is the most critical predictor of which diabetic patients eventually will develop severe foot problems.
“Simple neurologic testing combined with a thorough patient history are the most useful tools to identify diabetes patients with neuropathy and the highest risk for crippling foot disorders,” said Lawrence Fallat, DPM, FACFAS, director, podiatric surgical residency, Oakwood Healthcare System (Mich.). “Accordingly, doctors must screen more aggressively to identify patients at high risk for Charcot foot and foot ulcers to help them spot early warning signs and seek immediate care.”
“Many foot and ankle complications associated with diabetes can be prevented or minimized with regular check-ups and daily patient inspections for sores, cuts and tiny puncture wounds,” said ACFAS President Robert G. Frykberg, DPM, MPH, FACFAS. “With early detection, doctors can institute measures to prevent foot deformity and eventual amputation.”
Fallat’s study showed that a simple, non-invasive test performed by a podiatric foot and ankle surgeon or primary-care physician is effective in detecting neuropathy. A readily available instrument with a fine monofilament tip is used to pressure the bottom of the foot to gauge nerve sensation. “Severity of numbness is the critical factor,” said Fallat, “and we found that gradually increasing pressure gives a much better assessment of the extent of peripheral nerve damage and risk for Charcot deformity and foot ulcers.”
Fallat recommended that all diabetes patients with severe peripheral neuropathy should be informed about their elevated risk for Charcot foot and be monitored regularly for neurologic deficits. “Hopefully, practitioners can more readily identify high-risk patients to prevent Charcot deformities and resultant foot ulcers and lower extremity amputations,” he said.
Charcot foot occurs in approximately 30 percent of diabetic patients with peripheral neuropathy, and it often is misdiagnosed in early stages as gout, septic arthritis or osteomyelitis. The first symptoms occur when the foot becomes hot, painful, swollen and red. Balance is affected, bones become soft and prone to fractures, and many patients are unable to wear shoes. Treatment at this stage is intended to slow progression of the deformity by minimizing the weight bearing load on the foot through cast immobilization walkers, rigid leg braces and custom orthotic insoles.
At more advanced stages, Charcot patients lose most of the sensation in the foot and are unable to feel pain. Muscles fail to support the ankle joint properly, the foot becomes unstable, and a reverse ach or “rocker foot” develops. Walking worsens the condition, as inflammation from pressure leads to further instability, ulcers and dislocation. Eventually, the foot may collapse. In these cases, surgery is the best option to correct the reverse arch and make it less prone to ulceration.
For further information about diabetic foot conditions and to locate a podiatric foot and ankle surgeon in your area, contact ACFAS toll-free at 1-888-THE FEET or at www.acfas.org.
This press release article was provided by the American College of Foot and Ankle Surgeons (ACFAS).
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