podmart at tiscali
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Dec 6, 2007, 11:19 AM
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Fw: [ORT-L] charcot foot ????
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Hi Jeff,
I'm forwarding your mail to the UK podiatry Jiscmail group who may have some ideas, you may also like to post the query on the Podiatry Arena forum: http://www.podiatry-arena.com/ which is an international discussion form and also a UK version which is : http://davidmhol.proboards29.com/index.cgi? (you will need to register in each case, which is free)
Regards,
Martin
Martin Harvey BSc(Hons) DPodM
Podiatrist
Tamworth UK
martin@podmed.info
----- Original Message -----
From: Jeff Richmond
To: ort-l@www2.aaos.org
Sent: Thursday, December 06, 2007 5:49 PM
Subject: [ORT-L] charcot foot ????
I know this is not the ideal forum for this, but I'd appreciate any help.....
52 year old obese female in "perfect health" (ie hasn't been to a doctor in 15 years for anything) slipped in the bathroom a few weeks back, and came to an ER 9 days later because of bleeding from her foot. No pain. Finger sticks in excess of 400. Transferred to my institution.
She had an approximately quarter size wound over her midfoot with her medial cuneiform extruded. I washed her out, reduced, perc pinned the cuneiform back in place and placed a limited ex-fix and a VAC to temporize. The wound has become very soupy in the few days since I first washed her out, and the skin has necrosed to about a half-dolalr size. The cuneiform is soft and clearly has to go..... Then what?
Is it worth a plastic procedure to try to cover this defect over beads while the foot is so acutely inflamed, with an attempt at a midfoot fusion down the road or amputation now, and at what level?
Any guidance would be appreciated. Unfortunately, she has fallen into the hands of a trauma surgeon as I can't get a foot surgeon interested.
Thanks
Jeff Richmond
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