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It’s cold outside…..

This has been an exceptionally cold winter here in Nebraska.  We are seeing lots of foot problems associated with the cold weather, including thermal injuries such as frostbite.  Your feet need protection in cold conditions!  Not doing so can lead to long-lasting problems.

It doesn’t take very long – brief exposure to the cold can cause foot problems.   Previous frostbite and cold exposure will certainly make any subsequent cold exposures worse.  People with a history of frostbite are much more susceptible to reinjury.

Cold weather injuries are especially a concern for those in outdoor occupations, outdoor enthusiasts, and people with certain health conditions such as diabetes, Raynaud’s disease, and especially with those that have poor circulation.

Key factors that can increase risks of cold injury

  1. Poor circulation
  2. Previous frostbite
  3. Alcohol
  4. Smoking
  5. Inadequate protective gear
  6. Dehydration
  7. Exposure to moisture
  8. Sweaty feet
  9. Medical conditions
  10. Diabetes
  11. Peripheral neuropathy
  12. Cardiovascular disease
  13. Raynaud’s

Recommendations for protecting your feet

  1. Appropriate shoe gear and socks
  2. Things to look for in shoes

Shoes (or for that matter, socks) that are too tight cause pressure which can decrease blood flow. Shoes that are too loose, or that are made of a mesh, will allow for wind exposure and heat loss.  We recommend being fitted by a professional.  Boots are even better than shoes in the cold weather, especially hunting or hiking boots that come above the ankle.  Look for boots that have insulation like Thinsulate®, and waterproofing such as Gore-Tex®.  You might need to travel to the hunting/hiking/workboot section of your retailer.  ALWAYS fit your cold weather shoes or boots with the accessories you plan to wear (socks, inserts, orthotics).

  1. Things to look for in socks

I like a 2 layer sock regimen for the cold.  The sock against the skin should be a synthetic liner sock made from a material such as polypropylene.  This will allow moisture to be carried away from the skin, and help prevent blisters.  This can be worn under a thicker, full-length sock designed for colder weather, with materials such as Coolmax®, Smartwool®, and Dacron®.

  1. Appropriate clothing

You need to keep warm head to toe.  If the body is cold, the feet will be colder.  Dress in layers, again with a base layer that is synthetic in nature (cotton will hold sweat against the skin), and the outer layer being waterproof.  Modern materials have really changed cold weather gear options!

  1. Change shoes or socks when they become wet

Moisture is the enemy and accelerates heat loss.  This can be avoided with a good waterproof boot.  If you have a condition which your feet are excessively sweaty, your podiatrist may prescribe an antiperspirant.

Charcot Foot

What is Charcot foot?

Like diabetic foot ulcers, Charcot foot is one of the many complications that can arise from nerve damage caused by diabetes. The nerve damage, also called peripheral neuropathy, leads to a loss of sensation in the feet and can throw off one’s sense of balance, which can raise the risk of injury. Such injuries, when occurring repetitively over time, can cause the weight-bearing joints to break down. In severe cases, it can even lead to a total collapse of the foot. With time, the foot may take on an abnormal shape and make walking increasingly difficult.

The condition is often detected well into the late stages, sometimes when damage is so severe that amputation is necessary. This is unfortunate, as detecting Charcot foot early on can allow clinicians to properly treat the bone damage. Casts are generally used to help the bones heal, after which point special orthopedic footwear may be utilized to protect the bones after they’ve healed.  Sometimes, surgical correction is necessary to stabilize the foot.

The biggest problem with Charcot is the lack of awareness.

The American College of Foot and Ankle Surgeons warns that, due to low sensation in the foot, diabetics with neuropathy are less likely to notice sensations of pain or recognize trauma to the feet. They may experience a breakdown of the joints and continue walking on the damaged foot without realizing they have the condition, thereby worsening the situation. As such, people with diabetes need to be more alert to the possibility of damage to the feet and be on the lookout for symptoms of Charcot foot.  The lack of sensation in the feet causes one to be unaware that they may have Charcot foot.

People think they don’t have a problem because they feel no pain, but that isn’t the case. Anyone at risk for neuropathy, including diabetics, alcoholics and some chemotherapy patients, should see a foot and ankle surgeon early and at least once every year, even if they are considered low risk.


Symptoms of Charcot foot

Detecting the condition early on is the key to minimizing damage, deformity and the risk of amputation. For that reason, knowing and being on the lookout for signs of Charcot foot is essential. In the first stage of Charcot foot, you may experience swelling, redness and warmth in the feet. X-rays may show swelling in the tissues as well as joint dislocation and bony fragmentation. If untreated, fractures or dislocation may occur, causing severe deformities if the ankle, hindfoot and midfoot arch. In the second stage of the condition, these symptoms may decrease as the damaged bone begins to heal on its own. However, as the foot heals and enters the third stage of Charcot foot, there will be residual deformities that may make it difficult to walk and require extreme medical intervention.

Heightened awareness can help people with diabetes avoid additional complications, such as foot deformity and amputation, caused by Charcot foot.

Anyone who notices a difference – discomfort, unexplained swelling or redness, or changes to the shape of the foot – should seek care right away.

If you are concerned about Charcot, come and see the experts at Capital Foot and Ankle.