Neuropathic Joints

Charcot is a condition in patients who have neuropathy or loss of sensation. Charcot can lead to fractures and dislocations in the foot and ankle. As the disease progresses the joints collapse and the foot can take an abnormal shape known as a rocker-bottom foot. Diabetes is the most common cause of Charcot because diabetes is associated with poor blood flow, causing weakening of bones, and neuropathy, which is the main cause of Charcot. Other causes and risk factors include repetitive microtrauma and patients with peripheral neuropathy secondary to:

– Chronic alcoholism

– Leprosy

– Syphilis

– Poliomyelitis

Symptoms

There are various stages of Charcot and symptoms will vary depending on the stage of the deformity.

Stage 1: Red, hot, swollen foot/ankle.

X-rays show soft tissue edema and bony fragments

Stage 2: Decreased local edema foot/ankle

X-rays reveal coalesence of bony fragments

Stage 3: No local edema

X-rays show consolidation and remodeling of the bone

Imaging

In addition to reviewing your overall health, symptoms and discussing your medical history, our physicians at Foot& Ankle Doctors, Inc may order various imaging tests for further detailed pictures of your foot or ankle.

X-rays:

In early stages of Charcot, x-rays may appear normal. As the disease progresses the bones may fracture or dislocate. As a result repeat x-rays may be taken several weeks later.

MRI:

Ordered to evaluate soft tissue and when a bone infection is suspected

Bone Scans:

Helpful to differentiate between Charcot and infection. Charcot and an infection are positive on a technetium bone scan, however infection will only produce a hot spot on an indium bone scan and Charcot will not.

Non-Surgical Treatment

– Immobilization is important in the early stages of Charcot to protect the bones

from stress and shear forces that can further damage the bones

– Total contact cast changed every 1-2 weeks for 2-4 months

– Charcot restraint orthotic walker (CROW) boot

Custom Shoes designed to decrease the risk of ulcers

– Rocker bottom shoes will help reduce the risk of ulceration

Surgical Treatment

Depending on the type and extent of the deformity surgery may be recommended

Dr. Dardashti

Shooting Foot Pain – Tarsal Tunnel Syndrome

Tarsal tunnel is similar to carpal tunnel where a nerve is compressed producing sharp shooting pain. Tarsal Tunnel refers to a canal on the inside of the ankles. This canal allows tendons, nerves, arteries and veins to course along the ankle and into the foot. A sheath covers this canal to hold the structures in place. When this canal becomes compressed it pinches the tibial nerve in the canal causing a shooting pain.

Tarsal tunnel can be caused by:

  • Flat feet or “fallen arches” can compress the tibial nerve

  • Trauma or previous ankle injury causing swelling placing pressure on the nerve

  • Abnormal structures such as ganglion cyst, varicose veins, inflamed tendon, bone spur

  • Systemic diseases: arthritis, diabetes

Symptoms include tingling, numbness or shooting pain in the feet. Our doctors at Foot& Ankle Doctors, Inc will tap along the course of the tibial nerve, if symptoms are reproduced while performing this test it is an indication for tarsal tunnel. It is important to exclude the possibility of a pinched nerve in the lower back that can produce similar symptoms.

Treatment for tarsal tunnel syndrome starts with conservative options to reduce inflammation, pressure and or limit motion to the tarsal tunnel:

  • Rest

  • Ice

  • Oral medication

  • Immobilization/bracing

  • Steroid injection

  • Physical therapy

  • Orthotics

In cases where conservative treatments fail, surgery may be required in which case a tarsal tunnel release will be performed.

Come see us at Foot& Ankle Doctors, Inc for more information

Dr. Dardashti

Feeling pins and needles in your feet?

If you experience burning, tingling, stabbing, pins-and-needles sensation in your feet, you’re not alone. This sensation is referred to as peripheral neuropathy and commonly affects diabetics. 60-70% of diabetics will develop peripheral neuropathy because they have uncontrolled blood sugars which damage nerves in the hands and feet leading to a tingling sensation and loss of feeling. Your feet may feel numb and you may loose the ability to feel temperature and pain making you more susceptible to injury, infection and burns. It is important to check your feet every day for signs of injury or infection. Many patients suffering from peripheral neuropathy are unable to sense a small pebble in their shoe and after walking on it all day long can develop a wound. It is important to wear properly fitted shoes and avoid walking barefoot. Make sure to check the temperature of the shower water before jumping in to avoid burning your feet.

There is no cure for peripheral neuropathy but there are medications that can help with the tingling sensation. Controlling blood sugar can help prevent the onset of peripheral neuropathy.

Peripheral neuropathy can also be caused by a vitamin B deficiency, certain medications, alcoholism, autoimmune diseases, infections, toxins and by many others. A herniated disk can also produce symptoms of a burning, tingling pain in the legs and feet. Come see Dr. Dardashti at Foot& Ankle Doctors, Inc for adequate diagnosis and treatment of your foot pain.

Dr. David Dardashti

The VIP’s of wound healing

According to APMA (American Podiatric Medical Association) approximately 15% of individuals with diabetes will develop an ulcer. Celebrities like Halle Berry and Tom Hanks are diabetic and it is important for them or any person with diabetes to check their feet daily and ensure they do not have any open lesions. Wound healing is slowed when you have diabetes so it is important to treat wounds promptly. There are three important factors Dr. Dardashti checks when a patient presents with a wound and they can be summarized as “VIP.”

V is for vascular, for a wound to heal you need an adequate blood supply to provide proper nutrients to the injured area in order for healing to take place

I stands for infection, an infected wound needs to be treated with antibiotics before the wound can heal itself

P stands for pressure; some wounds on the feet are in places that are constantly subjected to increased pressures when walking. This chronic pressure will cause the tissue to breakdown resulting in a wound, thus it is important to relieve pressure from a wound to allow it to properly heal.

Dr. David Dardashti