Swollen Foot..advice needed

[Pauly21]

hi
Haven't been here for a while.
I'm Type 1 Diabetic with slight Neuropathy.(hb1 = 10.4)

About 4 weeks ago i was having more and more problems with aching legs and pain in my lower limbs, to the point where it was getting difficult to walk. Then i noticed that my right foot was quite swollen while the left was perfectly ok. Also the toe next to my big toe looked like it may be broken, it had a 'kink' in it which had not been there previous to me noticing the swelling. I visited the doctor who said it didn't look like gout but may be an infection so put me on a course of antibiotics just in case. This didn't make it any better so i went back to the doctor and was then sent for x-rays. The results came back that there were no breaks or fractures in the foot. I am currently off work with this problem as i can't really stand on the foot for more that 10 minutes without some pain, it also makes the foot swell up again. In my job i am stadning/moving about for 7 hours a day and am worried if i go back to work then i could be doing some serious damage to my foot.
I'm thinking along the lines of perhaps a damaged/snapped tendon?
Has anyone ever had something like this as a diabetic?
any help/advice would be appriciated
Paul

 

[catherinecherub]

Hi Paul,

This must be very worrying for you.

The only things I can think of are,
1. Charcot foot. This causes bone deformities and slack ligaments. Did anyone mention this?
http://sydney.edu.au/medicine/diabetes/ ... rcot1.html

2. Cellulitis.

3. The fact that you already have peripheral neuropathy may be causing the swelling.

You need to go back to your G.P. and make a fuss as your quality of life is being affected and you cannot be expected to suffer this indefinately.

As an aside, your blood sugar levels are quite high and I wonder if you need any help from other Type1's with regard to food and insulin practices?

 

[robert72]

Hi Paul

Best to go back to your GP and get him to refer you to a podiatrist soonish, or else go to A&E.

Agree with Catherine that you should aim to reduce your HbA1c as that must be aggravating the cellulitis and neuropathy.

Hope your foot clears up soon.

Robert

 

[Pauly21]

Thanks for those suggestions (robert & catherine). There are so many things that i have read over the last few weeks it's difficult to really say one way or the other, but this isn't going away. I am going to a 'walk-in' Podiarty Clinic next week to seek some more advice, so hopefully they will be able to pinpoint what it may be.

As for my HbA1c yes it's high. It was 13.5% last August. Since then i've been really focused on trying to get it lower. My Diabetic Nurse and Specialst haven't really got anything to help except maybe an insulin pump they said. I did have a blood Glucose monitor fitted last year for 2 weeks but apparently it didn't work correctly and the hospital are awaiting 'new' working monitors before i can have another go (lack of funding apparently, i had to wait nearly 2 years for the 1st one). The main problem i have with trying to lower my Blood Sugar is that any slight ajdustment in Insulin usually ends up with me having an hypo. I've recently been told that i may be a 'Brittle' diabetic.? and that's the reason i'm not having much luck lowering the HbA1c.
I've written my own excel spreadsheet with formula to work out an average HbA1c by the normal blood sugar testing (which i do on average 3-4 times a day at the moment) and that is currently showing 9.6% ,so hopefully that's on the right track.
cheers
Paul

 

[robert72]

Paul - Great that it's moving in the right direction. :thumbup:

Has your specialist/nurse offered to send you on the DAFNE course to learn carb counting? I consider myself to be a brittle diabetic but have spent the last 6 months really getting on top of it and I think I'm winning - although it's hard work and my fingers are sore

Robert

 

[Pauly21]

They did mention it last year but thought that it probably wouldn't work for my circumstances.
The background being that i work in car manufacturing and the type of work and level of exertion varies from hour to hour and isn't the same the following day, so having 'fixed' insulin injections during the day has different effects on my blood sugar. I have a lot better control when i'm in the house/holidays and as a matter of fact now i'm off work with this foot problem.

I will look into DAFNE myself to see if it would help though, thanks.

 

[WhitbyJet]

Pauly21 - please go to podiatry sooner rather than later, if this is Charcots foot then you need this confirming or rule out you will need an MRI scan, very often an ordinary x-ray doesnt show up that its Charcots. I know one gentleman who had a few x-rays on his foot, it remained swollen, he was advised to strengthen the leg and do lots of walking on it, unfortunately thats the worst he could do, Doctors dont always recognise the symptoms, its not all that often they come across it.

I cant advise you on reducing your bg levels, I hope that some of the Type1 members can help you there, many are low carbing and adjust their insulin accordingly.

I wish you all the best and hope you get a diagnosis asap.

 

[Pauly21]

Just in case anybody has something similar in the future.
I've been to the Podiatry clinic and having been examined for nearly an hour by 2 specialists they more or less ruled out 'Charcot' and came up with 3 possibilities
1. Gout (currently awaiting blood test results to rule this out/in)
2. Soft Tissue Damage (this is going to be almost impossible to diagnose)
3. Severve Infection

The infection is the one i'm being treated for first. Been given stronger anti-biotics for a week.
When they examined the foot they could feel the heat coming from it without touching the foot.
Also, i have developed a severve itching in both legs with some redish patches on the left leg where the foot problem is. So it's looking like an infection. The only thing that is still outstanding is why the second Toe looks like it has a deformation in it (claw like) which only happened when it flared up 4 weeks ago.

 

[noblehead]

Sounds painful Pauly .......hope the antibiotics clears it up!

 

[hanadr]

Has anyone suggested an MRI scan?
Hana

 

[Pauly21]

Yes it was suggested but only when the infection or gout have been eliminated. They also said that it may not show up on the MRI anyway.

 

[stevvie1]

Not diabetic but have neuropathy and charcot in left foot.

I went through the same symptoms you are experiencing and had similar treatment before an MRI scan confirmed charcot. Basically if you've a noticeably hotter foot, with swelling and neuropathy, an unconfirming x-ray you should insist on an MRI scan as soon as possible. Don't walk on it because this will make it far longer to heal. Ignore the advice about walking on it that people may give you and don't jump into physio because at first this won't be helpful.

Finally you will find more help from this website and others like it, which in many respects have more helpful comments and advice than many of the professionals can contribute. Charcot is very rare in the scheme of things so not many professionals pursue it as a major interest. Best wishes with your diagnosis.

 

[Pauly21]

I've just had the results of the blood tests back and they show no infection or gout. My GP is now going down the road of possible Charcot Foot.

Any advice concerning this stage would be helpful as i have a problem.
I'm due to go on Holiday aborad in 2 weeks times and since i would assume that it's gonna take a month or maybe more before i see a specialist of have an MRI scan, what sort of treatment is given in the interim between suspected Charcot and confirmed?

Would it still be possible to travel (taking it as easy as i could)?

 

[Pauly21]

Been back to my GP again today. The swelling has gone down a bit and the heat has reduced. Still a possible infection so i'm finishing the course of antibiotics i was given before being referred for an MRI.

By the way, can anyone recommend a painkiller that i could take for this problem. ?

 

[BaliRob]

Ibuprofen - if not on Warfarin

 

[Pauly21]

I completed the course of anti-biotics and the swelling had reduced quite considerably. That was 3 days ago. This morning the swelling has returned.

Something has struck me though. I have changed my medication to treat neuropathy, from amatriptyline to Gabapentin (Neurontin) about 2 months ago. It may be coincidence but around about that time i had this aching in the lowers legs which gradualy became worse and then this swelling in the right foot. I initially went on a dose of 100mg 3 times a day, then changed to 300mg 3 times a day about a fortnight before i started having this swelling.

Searching the internet for maybe a link i saw that there were quite a few people who were having swelling in the feet/foot/legs etc due to taking 'Gabapentin'.

Has anyone here ever taken Gabapentin and had similar side effects.?

 

[Pauly21]

Just an update on this for future reference for anybody that has similar symptoms.

After a few more courses of Anti-Biotics. I was advised to go back to work part-time as the 'infection' had gone down.
After 2 days i had severe brusing underneath my foot and the 'infection' had come back and swollen my foot again.
I visited my local podiatry clinic as they had said when it flared up again to see them immediatly.
As a co-incidence they had their first patient with Charcot's Foot the night before. They said that this now could be the same and put me in an 'Air-Cast Boot' and i was told to keep the weight off it as much as i could. I had a further x-ray which this time showed 3 fractures.
After a few weeks i was called to Fracture clinic. I had another x-ray which showed that the fractures had healed and was told to remove the air-cast boot as 'it would do me no good'. I didn't follow this advice as i thought it was wrong.

I wasn't happy with what was going on so i told my GP, I was then refered by my GP to see a Diabetic Podiatry Specialst. At this point i got the treatment that i think is right.
They put me in a total contact cast. They measured the temperature difference in the feet. The affected foot is 4 degrees higher than normal. It looks like the bones are 'soft' in the foot and prone to movement at the moment.
I am now having it checked and the cast changed every 3 weeks until the temperature goes down and the bones have a chance to harden.

I suppose they diagnosis didn't take as long as some i've read about, but the lack of knowledge about Charcot's by some medical staff is not as good as it should be.

I'm not optomistic about the future as this could be life-changing for me if it goes on longer that 6 months, and i now understand others with this condition when they say that they feel depressed and anxious. It's also very difficlut to keep weight off the foot when you've still got to do many daily things (toilet, food etc...) so trying to keep walking to a minimum with and without the aid of crutches.

 

[LauraMac]

Hi.

I think you CAN get over this but it is no fun at all. I have been in an air cast boot for 8 months now - awaiting suitable orthotic shoes on the NHS for the last three - but that is another story! I was told by the orthopaedic team that my local hospital contracts out its orthotics service as so huge delays are routine and they have no leverage; they did not even pretend it was an okay situation.

So, I was diagnosed with Charcot in my R mid-foot in late February. But the consultant now agrees that I had it for months before that e.g. I was in great pain on a hillwalking holiday in the Lake District last October. At diagnosis, my foot was very hot, inflamed, swollen and painful. Now the Charcot is dubbed inactive and the foot is cool and non-red, although it has healed in a deformed shape. I can still wear normal shoes though e.g. to drive in.

Don't try to drive in the air cast boot! It can get caught on things.

I only take my boot off in bed and to drive and for a shower etc. I try to make sure there is someone in the house when i shower, in case of a slip. I also pad certain bits of the boot with animal wool padding, bough in small boxes from the Chemist. I am lucky as I have not had any ulceration problems.

I don't have much pain now. Dihydrocodiene helped the fracture pain for the first few weeks, high doses of Evening Primrose Oil and a Vit B Complex supplement seem to help the neuropathy e.g. I no longer get night-time tingling and burning, although I did for some months before the Charcot was diagnosed.

So, 8 months on, life is livable. It will be better when I have special shoes. Even then, I have been told to keep the boot for emergencies, in case of a flare-up. I think ongoing care is pretty much non-existent - I have been discharged by both the ortho team and my diabetic foot clinic now - they just don't have the resources for long-term care.

Good luck! Don't despair. But realise that YOU will have to keep making a fuss and make things happen.

Laura Mac, West Yorkshire, mum to two young children.

 

[Pauly21]

Thanks for that Laura Mac.
I now see that this is going to be a very long recovery process.
Just been back to have my total contact cast changed for the third time and a little bit of good news that the temperature in the charcot foot has come down 1 degree. There is now only 3 degrees difference, so hopefully this will continue.
My diabetic foot clinic team managed to 'call in a favour' with the local consultant that i was seen on the last appointment. (The normal waiting list to see that consultant was 25 weeks! ).
She examined the foot and was optomistic that the foot would remain foot-shaped and no further damage has occured since i caught it early. The treatment would continue as is and when the temperature was normal to follow the 'orthotic shoes' route to get me back to work as soon as possible.
Not being able to drive at all is a major inconvience when trying to attend appointments and has cost quite a lot of money so far in Taxi fares.
Still very apprehensive about the future as it is so uncertain if i'll be able to return to a 'normal' a life as possbile.
Will look into the Evening Primrose Oil and a Vit B Complex supplements to see if they will help with me aswell.

 

[Pauly21]

Just a quick question for anyone that's had/has charot foot/Neuropathy.
During the healing process, has anyone had increased pain in the foot? such as increased shooting pains, dull aches etc.
I'm not on any painkillers for the charcot.
I'm assuming this may be down to the foot healing, the excess temperature decreasing so i can now actually feel some of the pain that's associated with the condition?