The lived experience of acute Charcot foot – developing an educational tool for patients

The deadline for 2012 Doctoral College Studentships has now passed.

The Brighton Doctoral College is pleased to welcome applications from self-funded or externally sponsored students for programmes of research in this or a closely related area, beginning from September 2012. Applications are welcome from students wishing to study full time or part time, and applications are welcome from students in employment who have the support of their employers.

• Based in the Faculty of Health and Social Science
• Supervisors: Dr Simon Otter; Professor Adrian Bone; Dr Sarah Hardcastle.

Application deadline

The university cannot guarantee that students can start at their requested date unless deadlines are met.

• UK/EU students: The deadline for the university to receive applications for an entry date of October is the 1 August, for January entry it is the 1 November and for May it is the 1 March.
• International students: The deadline for the university to receive applications for an entry date of October is the 1 June, for January entry it is the 1 September and for May it is the 1 January.

Apply now.

Charcot foot is recognised complication of diabetic neuropathy and is devastating complication of insensitive feet, seen almost exclusively in the foot/ankle in diabetes mellitus it severely reduces overall quality of life and dramatically increases the morbidity and mortality (Jeffcoate et al. 2005, Gazis et al., 2004).

The pathology consists of simultaneous presence of bone/joint destruction, fragmentation and remodeling and it is thought that peripheral neuropathy is a key pre-requisite in the development of Charcot as this allows repeated insensate injury (Mabilleau & Edmonds 2010, Boulton 2008).  A typical patient with acute Charcot is usually in their mid-fifties, may have a vague history of trauma in recent days/weeks, and has a warm insensate foot with easily palpable foot pulses, initial imaging with X-ray is often unremarkable (Boulton 2008). Early identification and diagnosis with expert management is key including total contact casting, insoles and specialist footwear. This process can take several months but is necessary to prevent deformity. A study by Armstrong et al (2003) showed that only 28% of daily activity was taken whilst wearing an offloading cast. Indirectly, patients who are emotionally distressed, by the presence and severity of this complication, but also by its chronicity are probably less likely to adhere to treatment advice such as wearing a walking cast for prolonged periods Vileikyte (2007)

Given the long-term nature of the intensive management required, patient concordance and involvement is paramount yet little or no patient education materials are available for this complaint or to aid with management. This project aims to identify patients’ lived experience of being diagnosed with Charcot foot engaging with a qualitative exploration of the lived experience of acute Charcot foot using an appropriate underpinning philosophical standpoint.  These data would underpin the development of patient education tools for those with acute Charcot foot.

References:

Armstrong DG, Lavery LA, Kimbriel HR, Nixon BP, Boulton AJM. 2003 Activity patterns of patients with diabetic foot ulceration: patients with  active ulcers may not adhere to a standard pressure offloading regimen. Diabet Care 2003;26:2595–7.

Gazis, A., Pound, N., Macfarlane, R., Treece, K., Game, F., & Jeffcoate, W.(2004). Mortality in patients with diabetic neuropathic osteoarthropathy (Charcot foot). Diabetic Medicine, 21, 1243−1246.

G. Mabilleau, M.E. Edmonds 2010 Role of neuropathy on fracture healing in Charcot neuro osteoarthropathy J Musculoskelet Neuronal Interact  10(1):84-91 

William J Jeffcoate, Fran Game, Peter R Cavanagh 2005 The role of proinflammatory cytokines in the cause of neuropathic osteoarthropathy (acute Charcot foot) in diabetes Lancet; 366: 2058–61 

Vileikyte L. 2007 Stress and wound healing. Clin Dermatol;25:49–55.

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