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Diabetes week – 10th June – 16th June 2024

Currently, it is estimated that around 3.9 million people in the UK live with diabetes and a further 1 million are likely to be living with undiagnosed diabetes. According to Diabetes.co.uk, this represents roughly 6% of the UK population and this figure is rising year on year.

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Andrew Lee

What is diabetes?

It is a disease that occurs when a person’s blood glucose, also called blood sugar, is too high.  There are two types of diabetes.

Type 1 diabetes is caused by the body’s immune system destroying the pancreatic cells, which produce insulin that is vital for controlling blood sugar levels.

The most common form of diabetes is type 2 and this mainly appears in adults. However, as lifestyle habits have changed, younger, overweight people have begun to develop the disease. Type 2 diabetes is caused when cells in muscle fat and the liver become resistant to insulin and don’t take in enough sugar. Type 2 diabetes is the most common undiagnosed form of the disease.

Diabetes can be managed with lifestyle changes, medicines and managing your blood glucose level. This can be done by the sufferer themselves or they can get help from a medical professional. However, some of the side effects of diabetes need more help and regular check-ups.

Foot problems are common with diabetes, why is this?

Diabetes can affect the feet.

High blood sugar can damage the nerves and blood vessels in the feet. Nerve damage, known as peripheral neuropathy, causes numbness, pain, pins and needles or even a loss of sensation.

One of the lesser-known, but serious complications of diabetes is Charcot foot, a condition that can lead to severe deformities and disability if not managed correctly. However, early detection and treatment can reduce the risk of further problems.

What is Charcot foot?

Charcot foot, also known as Charcot arthropathy, is a progressive and degenerative condition affecting the bones, joints and soft tissues of the foot and ankle. It primarily occurs in people with peripheral neuropathy. Some serious complications that can occur with Charcot foot are:

Bone fractures and dislocations. If someone with Charcot foot loses sensation in their foot, they may exacerbate existing damage by continuing to walk on a fractured or dislocated foot, which could lead to severe deformities.

Foot deformities. As the condition progresses, the arch of the foot can collapse causing a ‘rocker-bottom’ deformity (where the middle of the foot touches the floor and the toes and heel curve upwards). Not only does this change the shape of the foot, it can also affect the alignment and function of the entire lower limb.

Ulceration and infection. Deformities and abnormal pressure points in the foot increase the risk of skin breakdown and ulcers that may become infected, leading to further complications such as osteomyelitis (bone infection) or even amputation.

Impaired mobility. Structural changes in the foot can lead to significant mobility issues. Pain and deformity can make walking difficult and can severely impact quality of life and independence.

How is Charcot foot diagnosed?

An expert should be contacted when symptoms such as  pain, swelling, a warm feeling or a loss of feeling in ankles, feet or toes are noticed.  The expert will be able to diagnose whether Charcot foot is the issue. There will be a physical examination, imaging (foot x-rays and MRI scans) and most probably blood tests to check for signs of infection. Both feet should be checked to look for changes or differences and the expert will check how much feeling there is by touching ankles, feet and toes.

If Charcot foot is suspected, immediate management is required. If Charcot foot is not accurately diagnosed, there may be a serious risk of the associated complications.

Management of Charcot foot

Early diagnosis and management are crucial in preventing the severe complications associated with Charcot foot. There are several strategies for managing the condition:

Regular monitoring and early detection. People with diabetes should undergo regular foot examinations to detect early signs of Charcot foot. Swelling and warmth are key indicators that warrant immediate medical attention.

Immobilisation. Once Charcot foot is diagnosed, immobilisation is essential to prevent further damage. This often involves using a total contact cast (TCC) – a fiberglass shell that fits the leg and foot very closely, touching or in contact with the whole foot – or a removable boot to offload pressure from the affected foot and allow proper healing.

Custom orthotics and footwear. After the initial immobilisation, custom orthotics and specially designed footwear can help redistribute pressure and prevent recurrence. These can be tailored to accommodate deformities and provide support.

Surgical intervention. In severe cases where conservative management is insufficient, surgical intervention may be necessary. This can involve realigning bones, fusing joints or correcting deformities to restore function and stability to the foot.

Blood sugar control. Tight glycaemic control is vital in managing diabetes and preventing complications like Charcot foot. Maintaining optimal blood sugar levels helps reduce the risk of neuropathy and other vascular complications.

Patient education. Education about the importance of foot care, recognising early symptoms and adhering to treatment plans is essential. Inspecting the feet daily and avoiding walking barefoot are important for those affected. Medical advice should be sought promptly where changes are evident.

Charcot foot is a serious and potentially disabling complication of diabetes, but with vigilant monitoring, early intervention and appropriate management, its progression can be controlled. Consultants and health care providers should always be on high alert for this condition in patients with diabetes and should ensure that intervention is swift once Charcot foot is suspected.

Here at Graysons, we have helped clients who have suffered poor management of diabetic foot problems and missed opportunities to diagnose Charcot foot and have helped them to claim compensation for sometimes life-changing consequences.

If you feel your diabetes has been mismanaged, please contact one of our specialist advisers. We will assess your case free of charge and advise on the potential of success.

For further information about diabetes, please see the NHS website or consult your doctor.

Diabetes – NHS (www.nhs.uk)

Author: Andrew Lee, medical negligence solicitor.

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