Diabetes Related Foot Deformity Is on the Rise
DIABETES CARE

Diabetes Related Foot Deformity Is on the Rise

By Richard Asa @RickAsa
 | 
July 20, 2015

An alarming increase in obese diabetics is causing a deformity that can lead to amputation.

If you have diabetes, you know that it can wreak havoc throughout your body, causing complications that seem unrelated to the disease itself.

One on the increase is called Charcot foot, a debilitating deformity typically related to obesity, particularly in those considered extremely overweight. It starts with the nerve damage causes (diabetic neuropathy). That impairs the ability to feel foot pain, in turn essentially causing the bones in the foot to disintegrate.

 

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About 62 percent of U.S. adults with type 2 diabetes are obese, and 21 percent are morbidly obese, meaning you are 100 pounds or more over ideal body weight or have a body mass index (BMI) of 40 or more. Those figures were published in a study by Holly Kramer, MD, and colleagues in the Journal of Diabetes and its Complications.

You can be categorized as morbidly obese with a BMI of 35 if you are also experiencing obesity-related health conditions such as high blood pressure or diabetes.

There is help in an orthopedic procedure developed by a surgeon who has performed more than 560 Charcot foot operations on patients with an average weight of 360 pounds. More than 90 percent of his patients walk normally again.

The minimally invasive approach makes use of a brace that was originally developed in the 19th century to lengthen legs in concert with surgery.

Michael Pinzur, MD, an orthopedic surgeon at the Chicago-based Loyola University Health System, developed the technique. He refers to the foot problems obese diabetics face as a “perfect storm.” The physical hurricane includes symptomatic osteoporosis, the release of certain chemicals that further destroy bone, and the neuropathy that disguises all the disintegration.

Traditional surgical techniques involve holding damaged bones in place with internal plates and screws, while the leg is in a cast. But, says Pinzur, the surgically treated foot would later “just fall apart. If it didn’t fall apart, it would become infected.”

“It was like sticking a screw into balsa wood,” he adds. Plus, it’s difficult if not impossible for obese patients to walk on one leg with the other leg in a cast. Patients typically are in wheelchairs for up to nine months. Even after the cast comes off, they have to wear a bulky and unwieldy leg brace.

If you have diabetes and are obese, a sprained foot or a stress fracture can serve as a catalyst toward Charcot foot because you continue to walk, not feeling the injury. But all the while, bones fracture, joints collapse, and your foot becomes deformed.

Eventually, you walk on the side of your foot, which then also leads to pressure sores and infection.

 

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In a study, Pinzur and colleagues found that the quality of life in patients with Charcot foot was equal to a person with an amputation below the knee. Even with traditional treatment, their quality of life failed to improve.

Pinzur has been the world’s foremost advocate for an approach that involves a small incision in the deformed foot. With an external frame, today made of stainless steel and aircraft-grade aluminum, the realigned foot bones are held in place with stainless steel pins that bridge the frame and the foot.

Following surgery, the device remains on you for 10 to 12 weeks. You are often able to walk, or at least bear some weight. When the fixation device is removed, you wear a walking cast for four to six weeks. Eventually, you progress to a removable boot and then, finally, diabetic shoes.

It all started for Pinzur in 2003 when he faced the quandary of treating a morbidly obese patient with Charcot foot who was also developmentally disabled. Traditional surgery and a leg cast were not possible because the patient wouldn’t be able to deal with a leg cast and it’s limitations.

So Pinzur improvised, and the alternative technique was born. “Within a short period of time, I could correct deformities, and it became much simpler than anything I had done before,” he says. “There are virtually no complications and the rates of healing are very high. It’s becoming more and more accepted.”

Still, there is the preventive end of the equation, one that Pinzur attributes, in part, to the epidemic of obesity in America. “Are we diagnosing diabetes better or are people just getting (more obese)?” he asks. “The incidence of diabetes has almost doubled in 26 years.

“I think a lot of it’s because we’re fatter.”

 

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Updated:

July 20, 2015

Reviewed By:

Janet O’Dell, RN

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