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Severity of Diabetic Neuropathy Predicts Charcot Foot Risk

The severity of numbness is directly related to the risk of Charcot foot deformity. In diabetic patients with peripheral neuropathy, the severity of numbness is directly related to the risk of Charcot foot deformity, according to study findings presented last week at a podiatry meeting in Orlando, Florida.

Charcot foot can be a serious problem in diabetic patients. If left untreated, the deformity can lead to problems, such as ulceration, that may require amputation, said Dr. Lawrence M. Fallat, from Oakwood Healthcare System in Taylor, Illinois.

"It has intrigued me as to why only certain patients with diabetes develop Charcot foot," Dr. Fallat said. "We were interested in identifying any possible predictors of Charcot foot in diabetic patients."

The study involved 18 diabetics with Charcot foot and 25 without this deformity, Dr. Fallat noted. The findings were presented at the annual meeting of the American College of Foot and Ankle Surgeons.

"We found that the strongest predictor of Charcot foot was the degree of neuropathy," Dr. Fallat said.

The degree of glucose control and current medications did not influence the risk of Charcot foot, the researchers note. Similarly, foot structure and activity was not predictive of Charcot foot.

"Normally, we test sensation in our patients with a 5.07 monofilament fiber–the equivalent of 10 g of pressure," Dr. Fallat said. "However, we found that we could often use a stronger fiber, equating to 300 g of pressure, and the patients with Charcot foot still felt nothing. A lack of sensation to such high pressures is a strong predictor of Charcot foot," he noted.

Dr. Fallat recommended testing diabetic patients with stronger filaments if they have no sensation to lighter ones. Such testing could lead to interventions designed to prevent the full-blown deformity, he added.