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Friday 01 April 2022

Diabetic foot deformities

Diabetic foot deformities


Foot deformities are a frequent consequence of the diabetic foot. These deformities can be relatively benign (toe claws, hallux valgus, etc.) or present severe forms such as a Charcot foot. This particular pathology is accompanied by bone fragility and increases the risk of injury. The symptoms of diabetic foot can be more or less severe. In the event of a fracture, the bone debris causes wounds, which can lead to severe infections. Management of foot deformities is therefore essential to limit the risk of ulcers and even amputation.


The diabetic foot: what are we talking about?

Diabetes is a chronic disease with many complications. The diabetic foot is one of the frequent consequences of this pathology. It results from the dysfunction of the blood and nervous systems.


The patient suffering from a diabetic foot presents several disorders, grouped under the name "diabetic neuropathy":

  • Motor disorders (muscular weakening, progressive deformities of the toes, imbalance of the supports on the ground);
  • Sensory disorders, called sensory neuropathy (loss of sensitivity in the lower limbs);
  • Vegetative disorders (dry skin, edema).

Together, these neuropathic disorders increase the risk of wound development. Above all, the loss of sensitivity makes it difficult to detect a wound. In a diabetic patient, infection of a wound is a frequent complication. Eventually, amputation of a toe or even the foot is sometimes unavoidable to stop the spread of gangrene. This podiatric risk increases with the development of neuropathic disorders. A classification from grade 0 to grade 3 allows to adapt the level of vigilance.


The diabetic foot causes foot deformities

The diabetic foot causes a total or partial loss of sensitivity in the lower limbs. The complications of the beginning of diabetic foot gradually lead to a change in the way the patient stands on the ground. In addition, blood circulation and nervous system disorders often lead to muscle weakness. The diabetic feet, weakened, end up being deformed: collapse of the arch of the foot, etc.





Charcot foot, a severe deformity of the diabetic foot

What is Charcot's foot?

Charcot foot, or neuroarthropathy, is a rare form of diabetic foot. The typical patient profile is an overweight male. In addition, two-thirds of diabetic patients with Charcot foot have type 2 diabetes. However, Charcot foot can be associated with other diseases (poliomyelitis, alcoholism, etc.).


Charcot's foot is an inflammatory and neuropathic condition that involves bone destruction of the foot and ankle joints. Its diagnosis is complex (symptoms identical to other pathologies, absence of examination allowing a formal diagnosis, etc.). Charcot's diabetic foot appears suddenly and presents inflammatory symptoms: increased systolic pressure, hot, painful and edematous foot.


If left untreated, the diabetic foot becomes deformed. The acute phase is accompanied by a collapse of the foot architecture. Eventually, bone fragility and inflammation lead to dislocation of the diabetic foot and ankle bones.


How to treat Charcot foot?

The main treatment for Charcot foot is immobilization of the diabetic foot with a cast or a walking boot. To control and prevent the formation of lesions, the cast must be renewed regularly. The immobilization of the foot is accompanied by an orthopedic follow-up and usually lasts between six months and one year. Thereafter, wearing orthopedic shoes with plantar pressure limitation is strongly recommended (standard shoes or shoes made to measure by a pedicurist-podologist).


The treatment of Charcot foot also involves preventive measures to limit the risk of severe deformities:

  • Improved stability and maintenance of the alignment of the back of the foot in its natural axis;
  • Regular podiatric examination to monitor the condition of the diabetic foot. The development of wounds must be particularly monitored to ensure prompt management and reduce the risk of ulceration. Inflammatory signs in the foot or ankle associated with neuropathy should alert healthcare professionals to the presence of Charcot foot;

Finally, in the case of acute Charcot foot disease, surgery is used to limit the risk of ulceration. Corrective treatment is based on the placement of internal and external fixators. To reconstruct the architecture of the foot, the surgeon may have to reduce the tendons. Reconstructive procedures are also performed with respect to bone dislocation.


Charcot foot and risk of wound development

The severe bone deformities associated with Charcot foot are the cause of bone splinters. Bone splinters are small fragments of bone that break away from a bone after a fracture. They cause lesions that are difficult to detect. Therefore, the risk of a diabetic foot wound becoming infected is particularly high. In the case of a splinter, surgical treatment is often indicated to avoid the risk of ulceration or even amputation of the foot.


Author : Pierre Durrmann - Pedorthist and diabetic foot specialist