How to

Shoes serve many functions. They protect our feet. They cushion our body weight. They can make our feet feel comfortable or fashionable — hopefully both! Finding the proper shoes and making sure they fit are important for keeping your feet and your body happy. Poorly fitting shoes can be painful and cause foot problems like bunions, corns, calluses, hammertoes, plantar fasciitis, stress fractures, and more.

The Charcot Restraint Orthotic Walker, or CROW, is a rigid boot designed to accommodate and support a foot with Charcot neuroarthropathy (CN).

CROW consists of a fully enclosed ankle/foot orthotic with a rocker-bottom sole. It is a common treatment used to minimize further deformity and prevent ulcer development after acute CN has calmed down.

CN occurs when bones and joints in the foot fracture, break up or pop out of place with minimal or no known direct injury. In the United States, this deformity most commonly occurs in people with diabetes. The foot first enters an acute stage of swelling, warmth and redness, that can be mistaken for an infection. Broken bones and dislocations can occur, causing severe deformities of the foot and ankle. Some patients develop pain or ulcers when the affected foot becomes deformed. CN can affect the other foot or happen again in the same foot. The foot does not regain its normal shape. 

People who suffer from diabetes can have problems with circulation, nerves, immunity, and deformity. Occasionally one or more of these may exist as an isolated issue but often people suffer from more than one at the same time.

• Circulation: People with circulation problems don’t have as much oxygenated blood supplying their feet as other individuals and therefore have difficulty healing any wounds.
• Nerves: Those who have nerve problems can develop a blister and oftentimes not even know it is there until they take off their shoes.
• Immunity: Some individuals with diabetes have a diminished response of their immune system. Because of this, they can get an infection from a cut or blister more easily and have more difficulty treating it.
• Deformity: People who suffer from diabetes can have collapse of the arch of their foot or other deformities which makes the foot more difficult to place into off-the-shelf shoes because of the risk of blisters developing over areas of high pressure.

Proper footwear is therefore very important for people with diabetes. Your foot and ankle orthopaedic specialist can help you choose proper footwear and recommend shoe modifications to protect your feet.

About 30 million people in the US have diabetes, according to the American Diabetes Association. A possible complication of the disease is nervous system impairment (neuropathy), which may cause you to lose feeling in your feet or hands. This means you won't know right away if there is a problem. Diabetic neuropathy affects about 60 to 70 percent of people with diabetes.

People with diabetes are at risk for developing foot problems that can be severe. If you have diabetes, make sure to learn about these potential conditions, monitor your feet regularly, and see your foot and ankle orthopaedic surgeons if you suspect a problem.

Diabetes can cause serious foot problems. These conditions include the loss of nerve function (diabetic neuropathy) and loss of circulation (peripheral vascular disease). These two conditions can lead to: 

• Diabetic foot ulcers: wounds that do not heal
• Infections: skin infections (cellulitis), bone infections (osteomyelitis) and pus collections (abscesses)
• Gangrene: dead tissue resulting from complete loss of circulation
• Charcot arthropathy: fractures and dislocations that may result in severe deformities
• Amputation: partial foot, whole foot, or below-knee amputation

There are 26 bones in the foot, all of which can be fractured. There are different types of fractures. Sometimes a bone breaks but stays in place (non-displaced). Sometimes a bone breaks into two pieces that move apart from one another (displaced). Other types of fractures include a bone that is broken in multiple places (comminuted) and a bone that breaks through the skin after fracturing (open fracture).

If you injure your foot, your orthopaedic foot and ankle specialist will take X-rays to see if you have a fracture. X-rays will identify most fractures but some smaller and more subtle fractures may require CT or MRI scans to be seen. Not all fractures require surgery, and your foot and ankle orthopaedic surgeon will help determine how your fracture should be treated.

If you need surgery for your foot fracture, the goals are to restore the fractured bone to its correct position, stabilize the bone in this position, encourage healing, restore function and reduce the risk of future problems such as persistent pain, loss of motion, and arthritis.

Patients with diabetes are prone to major foot problems. This is because the foot expresses many of the underlying effects of diabetes, including neuropathy, vascular disease, and diminished response to infection.

As a result of the neuropathy, the foot can develop an ulcer. This happens for two reasons. The first is that the neuropathy causes paralysis of small muscles in the foot, which results in clawing of the toes. Clawing of the toes causes prominence of the metatarsal heads (bones closest to the toe) on the bottom of the foot as well as the knuckles on the dorsum (top) of the foot.

The gastrocnemius and the soleus are two muscles that make up the calf. The gastroc is the larger and more superficial of the two muscles. The soleus is a deeper muscle within the lower leg. The gastroc tendon combines with the soleus tendon to form the Achilles tendon.

Tightness in the calf can limit how for the ankle can flex up. This may make it difficult to walk with the heel on the floor. Over time this can cause problems such as pain and deformity. Calf tightness may contribute to many foot problems, including heel pain, Achilles tendon pain, flatfoot deformity, toe pain and bunions.

Many patients have questions about the hardware that is used in foot and ankle surgery. If you are having foot or ankle surgery, ask your physician if you will need implants like those discussed below.

Every mile you walk puts tons of stress on each foot. Your feet can handle a heavy load, but too much stress pushes them over their limits. When you pound your feet on hard surfaces playing sports or wear shoes that irritate sensitive tissues, you may develop heel pain, the most common problem affecting the foot and ankle.

A sore heel will usually get better on its own without surgery if you give it enough rest. However, many people ignore the early signs of heel pain and keep on doing the activities that caused it. When you continue to walk on a sore heel, it will only get worse and could become a chronic condition leading to more problems.