Normal Anatomy

26 bones connected by 33 joints and  over 100 muscles, tendons and ligaments
              … all of which sustain the force of 10 – 20,000 steps daily.”
– Dr. Wayne Evans

Changes Which Occur (Injury or Disease –  including Charcot)



DIABETES – Why does Diabetes present a challenge?

To the newcomer,  Diabetes may seem to be a simple problem of sub-optimal fuel (blood glucose) regulation  by your pancreas.  Unfortunately that is only the tip of the iceberg!

Diabetes is certainly about blood glucose but also a range of other regulation problems. For instance, it causes accelerated deterioration and obstruction of the arteries. This means it can affect the heart (eg Heart attack) as well as the need for surgical procedures to save the limbs (angioplasties and bypass operations). 

Diabetes causes nerves to malfunction as well denying you the sensation you rely on to warn you of danger. This is caused “neuropathy”.   Diabetes can contribute to most of the risk factor for ulceration noted in the side illustration.

As well, the little known “autonomic nervous system” functions poorly in many persons with diabetes.

 Q – What is the autonomic nervous system (ANS)?
A – The part of the nervous system responsible for control of the bodily functions not consciously directed, such as breathing, the heartbeat, and digestive processes, (think “automatic nervous system”).The ANS nerve dysfunction also affects the foot by causing the structural weakness at various times on an unpredictable schedule (read more below, “Charcot Arthropathy”).

CHARCOT ARTHROPATHY – A special problem, unique to diabetes

The Charcot Arthropathy is a problem whereby the structures of the foot become weakened and slowly collapse over months to years.

  • Guess how we can predict when a person with diabetes should be asking questions about this problem which occurs slowly without warning over a period of months?
  • Introduction to use of the digital thermometer.
  • The 2 most common problems causing unusual warmth of the foot are:
    • Infection
    • Active phase of Charcot Arthropathy

Self Management of Charcot Arthropathy – Active Phase

  • Daily measurement of several points on both feet should be a routine activity of those who have been diagnosed with Charcot Arthropathy.
  • When the foot is warm – the bones and structures are inflamed and can deform if pressure is applied. This phase can last several weeks.

Do Not Weight Bear On A Foot With
Charcot Arthropathy
When It Is In The Active Phase

Charcot Deformity is Progressive

HOWEVER: By careful management you can slow the process of deformity down and get more useful years out of those legs!


How is that possible?

Protect the foot when in the Active Phase

Specialized Protection exists for this condition:
The CROW  (Charcot Restraint Orthotic Walker)

You can compare the temperature of your right vs left foot. 

See below for a good graphic example of to visualize the data you collect.

REMEMBER:  Don’t Walk On An Active Charcot Foot!