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January 29, 2007


Question from Deridder, Louisiana, USA:

I have Charcot and need reconstruction on my foot. My foot doctor says that he can do surgery on my deformed foot, but he is not helping me get to the point where I can have the surgery. What can I do to get him to help me? I want to get my foot fixed so I can get back to work. I am only 45 years old and want a normal life.


Charcot joints occur because of the development of neuropathy in the feet. It causes you to develop microfractures that end up deforming the foot and can be a debilitating problem. To do surgery for a Charcot joint is a major medical endeavor and procedure. I would suggest these points for discussion for both you, your foot doctor, and your doctor supervising your diabetes care:

How well controlled are your blood sugars? It is not a good idea to have an elective surgery in the face of poor control. You are asking for the wound to heal badly and with increased risk of infection and even amputation. Ask your physician taking care of your diabetes how good your control is and how much better it should be if it is not in control. This is an issue that you can do something about and will help the doctors to move and do something if you are working at things.

Ask your foot doctor about how a surgery would be designed to reconstruct your foot. Will the process require more than one surgery? What are the chances of success and failure? No need to know your risk versus benefit.

Are there other options that have not been discussed? Will a walking cast allow you resume your work without having the whole reconstruction performed?

I would ask them why they have been dragging their feet. Is it the inherent risk of the procedure? Is your control good enough? Do you have additional medical issues that they are concerned about? The surgeries are not easy to do. Maybe they have not done it right away because it is more serious than other cases.

Are you being realistic about your rehabilitation potential? Make sure you talk about likely scenarios. Ask about what happens after the surgery, in terms of physical therapy. Talk about how much of your outcome is dependant on rehabilitation work. You could have a good immediate surgery report but have a poor rehabilitation outcome and not get the benefit you want.

In the end, if you do not have the ability to ask these and other questions, you might want to seek another opinion about your condition. I believe patients have the right to ask such questions.