I have a Charcot foot from diabetes, which means it's terribly deformed. The midfoot is dropped down so far, I'm walking on bone. Without surgery to fuse the damaged area, there's a risk of developing sores where the bones come in contact with the floor. With surgery, I could get an infection, the weak bone could fracture, it might not heal, etc. Am I just trading one problem for another by having a fusion?
As you have discovered, managing blood sugar levels isn't the only problem facing patients with diabetes. Over time, nerve damage and other complications such as collapse of the arch in the foot can occur. This condition is called Charcot midfoot arthropathy. Charcot is the name of the physician who first discussed this problem.
Ulceration, fracture, dislocation, and deformity associated with the Charcot foot can be serious problems to deal with. There isn't an easy answer to treatment. Conservative care is always the first-line of treatment. Bracing, casting, or shoe inserts called orthoses are a few of the ways patients can get help before ulceration or fracture occur.
Sometimes surgery is needed to fuse the midfoot. This gives the patient a stable foot to walk on -- one that doesn't break down and form ulcers. It's true that patients with diabetes may be at increased risk for complications from surgery (any type of surgery). This could be any of the problems you mentioned (along with a few others!).
But with the right kind of care, you could end up with a stable foot and ankle that will support your weight and allow for standing upright and walking independently. A fusion procedure has its risk but with good surgical technique and proper patient compliance with postoperative instructions and rehab, the potential benefits usually far outweigh the risks.
V. James Sammarco, MD, et al. Midtarsal Arthrodesis in the Treatment of Charcot Midfoot Arthropathy. In The Journal of Bone & Joint Surgery. January 2009. Vol. 91A. No. 1. Pp. 80-91.
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