Posts for: June, 2015

A growing number of diabetics are being diagnosed with a debilitating foot deformity called Charcot foot.     

Charcot foot often confines patients to wheelchairs, and in severe cases can require amputation.

Charcot foot patients from around the country come to Loyola University Medical Center orthopaedic surgeon Michael Pinzur, MD, for a surgical treatment that enables 91 percent of his patients to walk normally again. The technique secures foot bones with an external frame, made of stainless steel and aircraft-grade aluminum.

Dr. Pinzur has performed more than 560 Charcot foot operations with the external fixation device, which is believed to be the most such procedures performed by any surgeon in the world.

Charcot foot typically occurs in morbidly obese diabetics who have neuropathy (nerve damage), which impairs the ability to feel foot pain. Charcot foot usually develops following a minor injury, such as a sprain or stress fracture. Because the patient doesn't feel the injury, he or she continues to walk, making the injury worse. Bones fracture, joints collapse and the foot becomes deformed. The patient walks on the side of the foot and develops pressure sores. Bones can become infected.

In the United States, 29.1 million people (9.3 percent of the population) have diabetes, according to the Centers for Disease Control and Prevention. The growing number of diabetics, combined with the obesity epidemic, is increasing the incidence of Charcot foot. Excess weight increases the risk of diabetic neuropathy. Obesity also increases the risk that patients with diabetic neuropathy will develop Charcot foot.

There has been an alarming increase in morbid obesity among diabetics. About 62 percent of U.S. adults with Type 2 diabetes are obese, and 21 percent are morbidly obese, according to a study in the Journal of Diabetes and its Complications.

Traditional surgical techniques, in which bones are held in place by internal plates and screws, don't work with a subset of morbidly obese Charcot patients. Their bones, already weakened by complications of Charcot foot, could collapse under the patient's heavy weight.

A common treatment in such cases is to put the patient in a cast. But bones can heal in deformed positions. And, it is difficult or impossible for obese patients to walk on one leg when the other leg is in a cast. Patients typically have to use wheelchairs for as long as nine months. And after the cast comes off, they must wear a cumbersome leg brace.

Dr. Pinzur has done more than any other surgeon to popularize an alternative technique that uses a device called an Ilizarov circular external fixator. The device contains three rings that surround the foot and lower calf. The rings have stainless-steel pins that extend to the foot and secure the bones after surgery.

Following surgery, the device remains on the patient for 10 to 12 weeks. During that time, patients often are able to walk or at least bear some weight. After the fixation device is removed, the patient wears a walking cast for 4 to 6 weeks. The patient then progresses to a removable boot and finally to diabetic shoes.

"Charcot foot is a debilitating condition that is very challenging to treat," Dr. Pinzur said. "But with the proper surgical treatment, the vast majority of patients will be able to walk normally again."


A growing body of research indicates that exposure to bacteria and viruses affects one’s likelihood for developing a number of chronic health conditions. Increasingly, scientists are uncovering proof that certain features of the human microbiome may be a root cause of obesity and Type 2 diabetes.

A new study published this week adds to this evidence, implicating staph bacteria as one potential cause of the disease.

For the study, published in the journal mBio, a team of microbiologists at the University of Iowa Carver College of Medicine exposed rabbits to the toxin produced by Staphylococcus aureus bacteria. The researchers found that exposure to high levels of this toxin caused the animals to develop symptoms of the disease, including insulin resistance, glucose intolerance and inflammation.

Their study suggests that drugs that eradicate or neutralize staph bacteria in the body may hold some promise as a treatment for Type 2 diabetes, which affects close to 30 million people in the U.S.

Because obesity is one of the common risk factors for the condition, the authors suggest extreme weight gain has a cascade effect: Obesity alters the microbiome and makes a person—or in this case, a rabbit—more susceptible to staph bacteria. Then a higher than normal exposure to toxins produced by the bacteria will trigger the disease.

Prior research has found that the toxins produced by staph bacteria disrupt normal immune system functioning, which can result in sepsis, inflammation of the heart and toxic shock, all of which can be fatal. But this new study shows staph toxins also affect fat cells.

To test their theory, the team of researchers measured the amount of staph bacteria and staph-related toxins on the skin of four patients with diabetes. They then calculated that the amount of toxins on the skin was in proportion to what triggered diabetes in the rabbits.

The researchers say they’re now turning their efforts toward developing a Type 2 diabetes vaccine that targets the toxins from staph colonization, which they believe could halt the development of diabetes in people at high risk. In addition, they are looking to study whether a topical gel that contains an antimicrobial agent to kill staph bacteria might also be effective.

Other research on the subject suggests altering microbiome diversity can halt Type 2 diabetes and reverse obesity. One study, published in May 2013 in the Proceedings of the National Academy of Sciences, found that mice that ate a high-fat diet had 100 times less the amount of a bacteria known as Akkermansia muciniphila than mice that ate a regular diet. When researchers fed the obese mice foods with this bacteria—along with foods that encourage microorganism growth—the mice lost weight and their body mass index ratio improved.


A growing number of diabetics are being diagnosed with a debilitating foot deformity called Charcot foot. Charcot foot often confines patients to wheelchairs, and in severe cases can require amputation.

Charcot foot typically occurs in morbidly obese diabetics who have neuropathy (nerve damage), which impairs the ability to feel foot pain. Charcot foot usually develops following a minor injury, such as a sprain or stress fracture. Because the patient doesn't feel the injury, he or she continues to walk, making the injury worse. Bones fracture, joints collapse and the foot becomes deformed. The patient walks on the side of the foot and develops pressure sores. Bones can become infected.

In the United States, 29.1 million people (9.3 percent of the population) have diabetes, according to the Centers for Disease Control and Prevention. The growing number of diabetics, combined with the obesity epidemic, is increasing the incidence of Charcot foot. Excess weight increases the risk of diabetic neuropathy. Obesity also increases the risk that patients with diabetic neuropathy will develop Charcot foot.

There has been an alarming increase in morbid obesity among diabetics. About 62 percent of U.S. adults with Type 2 diabetes are obese, and 21 percent are morbidly obese, according to a study in the Journal of Diabetes and its Complications.




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