Osteomyelitis

Since it has been awhile since I have posted on this blog, I wanted to post on a topic that I have seen a lot of patients develop recently.  I decided to talk a little bit about osteomyelitis, or bacterial infection of bone.

Working at the wound care center, I have found that a great deal of patients with chronic ulcerations can develop infection in the bone under the ulcer.  I have also found that a doctor needs to suspect this whenever there is a chronic wound that is not healing.  To say it in simple terms, infected bone can "die" and needs to leave the body and this can often be why a wound will not heal.  If infected bone can not find a way to "exit" the body, this infection can lead to a localized infection or abscess.

Sometimes a simple x-ray is enough to suspect osteomyelitis but often more advanced studies such as a bone scan or MRI are necessary to form a diagnosis.  The only definitive test, however, is a biopsy of the bone.  In my experience, though, MRI / bone scan is pretty reliable and a bone biopsy is often deferred due to its invasive nature.

Treatment for osteomyelitis includes more than 6 weeks of IV antibiotics and / or resection of the infected bone (amputation).  Obviously, amputation is always a last resort.  Medicine has made great advances to treat osteomyelitis.  Hyperbaric oxygen therapy is one such treatment.  The clinician must also assess other issues such as a patient's circulation to heal the infected bone and the patient's nutrition.

If you have a chronic wound that will not heal, do not delay treatment.  See you podiatrist if it is a foot or ankle wound or wound care specialist for any chronic wounds.

Charcot Neuroarthropathy

A recent article just came out that shows there is an increase in the occurrence of "charcot foot."  This condition usually affects diabetic patients who have decreased sensation or "neuropathy."  The process is not completely understood, but essentially the foot starts breaking in the midfoot.  What are supposed to be hard bones can become like mush.  The condition is self limiting and eventually the bone destruction stops.  The bones then will heal.  The problem is not the process causing damage it is when the patient walks on this foot that is breaking.  It can deform the foot and the bones can heal leaving a "rocker bottom" foot that is difficult to walk on.  This can cause sores, or "ulcers."  These ulcers can become infected and patients can have to have an eventual amputation from the problems this condition can cause.

The key to treating "charcot foot" is prevention.  A diabetic patient that usually doesn't have foot pain should be seen as soon as possible as this could be the early start of the condition.  The condition is often misdiagnosed as an infection or gout as the foot can become red and swollen mimicking these conditions.

If caught early, strict immobilization is imperative.  If caught after the deformity has already lead to disfigurement of the foot, wounds often develop and special braces and offloading shoes are needed.  This often becomes a wound care center issue.

I am not writing this to scare people but instead educate them.  This condition is rare but is becoming more common as I am seeing in my practice.  The take home message is to go see your podiatrist as soon as possible if you have any foot pain, especially if you are a diabetic.

Tom Hanks Makes an Announcement

Earlier this week, on late night TV, Tom Hanks announced that he has been diagnosed with diabetes.  He talked about lifestyle changes he needed to make and also a little about how the disease effects the body.  I have had a few patients over the years that presented with foot problems that lead me to suspect that he or she could be a diabetic.  The patient usually knew something wasn't quite right but was completely unaware that this disease was present.

One of the earliest signs of diabetes in terms of the foot would be numbness or tingling.  Diabetes is a disease of high blood sugar and this high blood sugar can cause several problems with the body.  Diabetic neuropathy is caused when nerve fibers are damaged by the high blood sugar.  This can be uncomfortable as a bothersome numbness in the feet but also can lead to pain.  Besides the discomfort, this loss of feeling can but a patient at risk for injury.  For example, a stone in the shoe can cause a sore.  A person without diabetic neuropathy would remove his or her shoe and remove the stone, but a diabetic patient may not even know that there is a stone in his or her shoe.  Left in the shoe the stone can lead to a sore or ulceration.

If you think you have diabetes you should see a physician for testing.  Symptoms are not just tingling in the feet but also weight loss, increased thirst, and increased urination.