I do. It is a very common condition amongst PWDs, particularly those with longer duration diabetes, and unfortunately it is relatively unknown amongst many HCPs especially in early stage development. Initially the PWD may present with a foot that is slightly swollen, reddish in color, warm to touch, mild to moderate discomfort, with intact skin.

It is not uncommon for an unaware HCP to assume it is a sprain or strain injury, or even a gout flare-up and will do a work-up and treat that, then send the patient home with generic instructions. In general most HCPs are more familiar when they see a Charcot foot that is misshapen and has progressed with ulcerations and swollen up like a football.

Serious diabetes foot problems often stem from from an innocent and undetected injury in one or both feet going untreated as it progresses into bone, joint and tissue causing internal structural damage defined as Charcot arthropathy. It develops insidiously. There are many factors – including diminished nerve sensation in the feet from peripheral neuropathy, vitamin D deficiency causing brittle bone syndrome, wearing improperly fitting shoes that do not support the weight of the body during certain activities, such as protecting the feet from repetitive pounding action, plus just daily life wear and tear on the feet as people age. Another factor is that PWDs with peripheral neuropathy and diminished nerve function may not feel any pain or discomfort when they innocently twist an ankle or jam their foot on a trip & fall and stub a toe or toes.

Subtle changes can be initiated by and happen progressively from repetitive activities in otherwise healthy PWDs who are physically fit and active on their feet – like runners, dancers, restaurant workers & servers, mailman, truck drivers, store clerks, warehouse workers, nurses, athletes, gym teachers, or folks who engage in hobbies like tennis, hiking, dance activities, trampoline jumping to name a few examples.

I am a RN and T1 PWD since 1962. In 2005, when I was finally informed (after 4 months of being misdiagnosed by several MDs) that the painful swelling in my R foot that wasn’t healing was something called “Charcot” arthropathy I had never heard of it. I started doing research on Charcot foot and found that very little had been written about it in nursing journals or literature, or even in diabetes care publications available to both professionals and the general public. I wrote a paper about it for nurses and other health care professionals to “WAKE UP and SMELL the COFFEE” about Charcot Foot in People with Diabetes. Eventually I wrote about it for AADE publications, gave professional presentations about it at AADE Annual Meetings, and co-authored a published booklet about Chronic Complications and Comorbidities in People with Diabetes, along with two other RN, CDE colleagues who also have life-long T1D and have suffered with some of the unique and not always well-known challenges of living with TID.

My goal was, and is, to educate people about early signs and symptoms of Charcot Foot in diabetes to recognize it, treat and stabilize at EARLY onset to prevent progressive damage from collapsed internal bone, joint, and ligament tissue structures of the foot and subsequent external tissue breakdown – which is often where the serious damage that requires amputation happens. From inside out – not the other way around.

Sure you need to keep your feet clean, moisturized to prevent dry skin that can crack and cause fissures, and watch out for blisters from ill-fitting shoes or puncture wounds from stepping on broken glass or a rusty nail or thumbtack. But that’s not all there is.

Be mindful of subtle structural changes in your feet and seek prompt therapeutic medical attention from a qualified professional – preferably a podiatrist who knows what to do with diabetes foot issues. Sad to say it is still not unusual for many primary care providers, or even some orthopedic and endocrinologists to not recognize an early stage Charcot foot process – which is when it needs to addressed and treated properly NOW. Of course prevention is the best intervention, which is why we all are told to practice diligent self-care to our feet.

My motivation was, and still is, that no other PWD has to go through the clinical inertia and barking up the wrong diagnostic tree that I went through.

Thank you for taking the time to read through this. I did try to post a slide from one of my presentations with a visual example, but was unsuccessful. For those of you who wish to know more I encourage you to google images of Charcot Foot to educate yourself. Once I learned what it was called, that’s how I began to educate myself about it.

We are all in this boat together!