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foot pain

Posted by margie s on 9/26/01 at 14:03 (061635)

My mother is a 74-year-old diabetic who has had first her right foot, then her left foot get swollen and extremely painful . She cannot walk on it or even stand on it. She has been to two doctors and has taken antibiotics and she is still in a wheelchair because it is too swollen and painful to stand on or walk on. Does anyone have any idea what it could be? She goes for a vascular test of some kind next week.

Re: foot pain

Ed Davis, DPM on 9/26/01 at 16:41 (061653)

There are quite a few things it can be. Some common things include diabetic peripheral neuropathy, nerve compression due to edema. Are her feet swollen all the time? Any discoloration? Any breaks in the skin?
Ed

Re: foot pain

Dr. David S. Wander on 9/26/01 at 17:14 (061661)

I would agree with Dr. Davis, and would also suggest having x-rays to rule out a 'Charcot' foot. This can develop in diabetic patients or patients with peripheral neuropathy. It is basically a break down of some of the bones of the foot, resulting in discomfort, deformity, swelling, etc. It is usually self limiting and must be addressed via immobilization to prevent additional complications. This may not be the answer or diagnosis, but it certainly must be considered and brought to the attention of her doctor.

Re: foot pain CHARCOT FOOT ATTN: ** DR. WANDER **

Lisa C on 9/27/01 at 03:11 (061707)

My sister has Charcot foot.Could you elaborate on 'self limiting?' She has been in a cam walker for over 2 yrs. Failed orthopedic shoes. Do you ever perform surgery for this condition? Surgery where a portion of the bone is 'shaved?' Her foot was undiagnosed for a long time. It is now very deformed and she has no balance because of numbness. Thank you for ANY info on this condition, and for yor time!

Re: foot pain

Margie s on 9/28/01 at 07:32 (061782)

My mother had x-rays taken and they showed no broken bones, but did show 'some tissue damage'. She has lots of feeling in her feet, so I don't think it's Charcot Foot from what I've read about it. The pain centers just beneath her outside ankle bone. She has been in a wheelchair now for three weeks and cannot stand or walk on her feet. The initial pain was so bad she cried for days, but that pain has subsided, unless she tries to stand or walk.

Re: foot pain CHARCOT FOOT ATTN: ** DR. WANDER **

Dr. David S. Wander on 9/28/01 at 12:29 (061803)

You stated that your sister was in a Cam Walker for approximately 2 years. Unfortunately, although a Cam Walker is certainly useful, a non healing Charcot foot requires strict non-weightbearing. This can be done via a Cam Walker, traditional cast, wheelchair, etc. The surgery that is usually performed is a fusion of the involved bones/joints. If there is a bony prominence that is isolated and causing pressure on the skin and a potential ulceration, 'shaving' down the bone/removing the bony prominence is acceptable. However, if there is destruction of the bones and joints, a fusion is the treatment of choice. If your sister has been weightbearing with the CamWalker, than STRICT non weightbearing should be attempted prior to surgical intervention.

Re: foot pain CHARCOT FOOT ATTN: ** DR. WANDER **

Lisa C on 9/29/01 at 01:45 (061841)

Thank you for your reply. My sister has worked 6 days a week through all of this. She owns her own business and it is a 2 person operation. Bedrest/wheelchairs were not an option. I think she felt the cam walker WAS a non weight bearing subsitute. She has never used crutches so I guess she was weight bearing even in the cam boot. Is there any point to being non weight bearing prior to surgery if she is past the breakdown phase and all the bones have 'solidified' in their deformed position? If the bones are 'solid' but in a deformed shape, which bones are fused? How will fusion help her? Does it help with balance? If she does have a bony prominence but does not get ulcers is there any reason/benefit to shave down the bone? Sorry for the zillion questions. I appreciate your time & interest greatly! If you can answer any questions that would be great. Thanks in advance!

Re: foot pain CHARCOT FOOT ATTN: ** DR. WANDER **

Dr. David S. Wander on 9/29/01 at 09:34 (061854)

Although your sister has been weightbearing in the Cam Walker because of her business, she will have to be strict non weightbearing following a surgical fusion. The bones fused are usually the major joints of the rearfoot and midfoot. This is dependent on the site of the deformity and the amount of destruction. Removal of a bony prominence is often prudent if the physician believes it can be a potential problem in the future. Regardless, strict non weightbearing will eventually be mandatory, whether she is attempting to heal the Charcot deformity or whether she undergoes surgical fusion (arthrodesis). Prior to any possible surgical intervention, it is imperative that she understand the non weightbearing requirements post operatively, and that she discusses this with the surgeon.

Re: foot pain CHARCOT FOOT ATTN: ** DR. WANDER **

Lisa C on 9/30/01 at 01:30 (061902)

Thank you for your prompt reply! I wish she had your instructions 2 years ago!!!

Re: foot pain

Ed Davis, DPM on 9/26/01 at 16:41 (061653)

There are quite a few things it can be. Some common things include diabetic peripheral neuropathy, nerve compression due to edema. Are her feet swollen all the time? Any discoloration? Any breaks in the skin?
Ed

Re: foot pain

Dr. David S. Wander on 9/26/01 at 17:14 (061661)

I would agree with Dr. Davis, and would also suggest having x-rays to rule out a 'Charcot' foot. This can develop in diabetic patients or patients with peripheral neuropathy. It is basically a break down of some of the bones of the foot, resulting in discomfort, deformity, swelling, etc. It is usually self limiting and must be addressed via immobilization to prevent additional complications. This may not be the answer or diagnosis, but it certainly must be considered and brought to the attention of her doctor.

Re: foot pain CHARCOT FOOT ATTN: ** DR. WANDER **

Lisa C on 9/27/01 at 03:11 (061707)

My sister has Charcot foot.Could you elaborate on 'self limiting?' She has been in a cam walker for over 2 yrs. Failed orthopedic shoes. Do you ever perform surgery for this condition? Surgery where a portion of the bone is 'shaved?' Her foot was undiagnosed for a long time. It is now very deformed and she has no balance because of numbness. Thank you for ANY info on this condition, and for yor time!

Re: foot pain

Margie s on 9/28/01 at 07:32 (061782)

My mother had x-rays taken and they showed no broken bones, but did show 'some tissue damage'. She has lots of feeling in her feet, so I don't think it's Charcot Foot from what I've read about it. The pain centers just beneath her outside ankle bone. She has been in a wheelchair now for three weeks and cannot stand or walk on her feet. The initial pain was so bad she cried for days, but that pain has subsided, unless she tries to stand or walk.

Re: foot pain CHARCOT FOOT ATTN: ** DR. WANDER **

Dr. David S. Wander on 9/28/01 at 12:29 (061803)

You stated that your sister was in a Cam Walker for approximately 2 years. Unfortunately, although a Cam Walker is certainly useful, a non healing Charcot foot requires strict non-weightbearing. This can be done via a Cam Walker, traditional cast, wheelchair, etc. The surgery that is usually performed is a fusion of the involved bones/joints. If there is a bony prominence that is isolated and causing pressure on the skin and a potential ulceration, 'shaving' down the bone/removing the bony prominence is acceptable. However, if there is destruction of the bones and joints, a fusion is the treatment of choice. If your sister has been weightbearing with the CamWalker, than STRICT non weightbearing should be attempted prior to surgical intervention.

Re: foot pain CHARCOT FOOT ATTN: ** DR. WANDER **

Lisa C on 9/29/01 at 01:45 (061841)

Thank you for your reply. My sister has worked 6 days a week through all of this. She owns her own business and it is a 2 person operation. Bedrest/wheelchairs were not an option. I think she felt the cam walker WAS a non weight bearing subsitute. She has never used crutches so I guess she was weight bearing even in the cam boot. Is there any point to being non weight bearing prior to surgery if she is past the breakdown phase and all the bones have 'solidified' in their deformed position? If the bones are 'solid' but in a deformed shape, which bones are fused? How will fusion help her? Does it help with balance? If she does have a bony prominence but does not get ulcers is there any reason/benefit to shave down the bone? Sorry for the zillion questions. I appreciate your time & interest greatly! If you can answer any questions that would be great. Thanks in advance!

Re: foot pain CHARCOT FOOT ATTN: ** DR. WANDER **

Dr. David S. Wander on 9/29/01 at 09:34 (061854)

Although your sister has been weightbearing in the Cam Walker because of her business, she will have to be strict non weightbearing following a surgical fusion. The bones fused are usually the major joints of the rearfoot and midfoot. This is dependent on the site of the deformity and the amount of destruction. Removal of a bony prominence is often prudent if the physician believes it can be a potential problem in the future. Regardless, strict non weightbearing will eventually be mandatory, whether she is attempting to heal the Charcot deformity or whether she undergoes surgical fusion (arthrodesis). Prior to any possible surgical intervention, it is imperative that she understand the non weightbearing requirements post operatively, and that she discusses this with the surgeon.

Re: foot pain CHARCOT FOOT ATTN: ** DR. WANDER **

Lisa C on 9/30/01 at 01:30 (061902)

Thank you for your prompt reply! I wish she had your instructions 2 years ago!!!