Education for patients with Charcots osteoarthropathy

Patients should be warned of the dangers of unprotected walking. Even one step without cast or brace can injure the foot irrevocably. They should be told always to wear the cast or walker, even in bed at night, otherwise the temptation to go to the lavatory in the middle of the night without bothering to don it may be too great. Patients should walk as little as possible: the more the foot is rested and elevated the sooner it will recover. Patients should be advised to borrow or hire a folding wheelchair so that they can get out without overloading the foot. The foot should be elevated whenever possible, so the wheelchair should be fitted with an extending plank on which to support the leg.

The clinician should never underestimate how difficult a diagnosis of acute Charcot's osteoarthropathy is for patients. Following advice and keeping off the foot is certain to have profound effects on their daily life, at home and at work, socially and emotionally.

During the rehabilitation period the patient will be under particularly great stress, when he knows the foot is recovering and the urge to get back to a normal life will become very strong. This is a dangerous period since failure to rehabilitate slowly and gently can trigger the destructive phase into action again.

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