Ulceration of Charcots osteoarthropathy of the midfoot

A 54-year-old man with type 2 diabetes mellitus of 12 years' duration and a mid-foot Charcot's osteoarthro pathy, developed an ulcer over the bony prominence on the plantar surface of his rockerbottom deformity which remained unhealed for 7 years. He was referred to the diabetic foot clinic and was treated with a total-contact cast and Dermagraft. The foot healed in 7 months and has remained healed (Fig. 4.32a,b).

Fig. 4.30 (a) Indolent ulcer under a rockerbottom deformity associated with Charcot's osteoarthropathy of the mid-foot which had been present over 6 years, (b) The same ulcer healed in 30 months after being initially treated with Dermagraft.

Fig. 4.31 (a) Indolent ulceration over the lateral malleolus in an unstable ankle with Charcot's osteoarthropathy of the hindfoot. (b) The ulcer has healed following internal fixation to stabilize the ankle. The healed surgical wound can be seen.

Key points

• Patients who develop callus over a rockerbottom deformity need regular podiatry to debride callus

• Ulcers associated with deformity of Charcot's osteoarthropathy should be treated with a total-contact cast

• Advanced wound products may be helpful in conjunction with a cast

• Surgical removal of the bony prominence is a simple procedure which can achieve healing.

Fig. 4.32 (a) An ulcer over a bony prominence on a rockerbottom foot with Charcot's osteoarthropathy of the mid-foot, (b) The foot healed after 6 months with Dermagraft and off-loading.

Fig. 4.32 (a) An ulcer over a bony prominence on a rockerbottom foot with Charcot's osteoarthropathy of the mid-foot, (b) The foot healed after 6 months with Dermagraft and off-loading.

Fig. 4.33 This patient arrived at the foot clinic with a drawing pin still in her foot. The puncture wound can be clearly seen.

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Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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