Question
My question is what are the treatment options available for foot pain that has been ongoing since March 2013. I have a history of vitamin d deficiency, heavy prednisone use as well as type 2 diabetes. (last three A1C readings normal) The pain started when my foot slipped into the ditch under a snowbank while I was scuffing the mud making a drainage trench. The pain stopped shortly after it started, so I went for a walk that was at least 3 miles away. (Long walks for weight loss & diabetes management) It became very painful to bear weight on it. 1st DX was Charcot foot & micro fx. Did:4 months in a spree boot the pain 8
increased w/activity & has not gone away. 1st MRI dx ruptured lig. and a fx that split two bones lengthwise. The DPM tried Cort.inj. declined surgery. 2nd opinion w/2nd MRI: more micro fx. New DX: Charcot foot (non deformed). 5 months in big Charcot foot boot, diabetic shoes & orthotics. Constant pain still. Sometimes otc meds & lidoderm patch helps other times nothing works other than sedation w/melatonin. Pushing off, jumping, walking, jogging, standing, gardening, mopping floors and biking hurt. The pain keeps me awake all night at least 3-4 nights a week.

Answer
Hi, Rhonda,

Thank you for sharing your question with me.  I'm so sorry to hear that you're having so much pain!  Charcot is a mysterious disease, and we still don't fully understand why it happens.  The most important thing to remember during the active process is that it's really important to stay off that foot as much as possible.  Unfortunately, that doesn't seem to be a good option for you, but you might want to try exercises that cause less stress to your feet, such as swimming, water aerobics, and strengthening your arms/shoulders/back/legs using weight machines.

It sounds like you might have also had a Lisfranc injury when your foot slipped into the ditch.  That can be hard to diagnose, especially because Charcot causes micro fractures in the same area of your foot, and it's even more complicated because trauma (such as a mild Lisfranc fracture/dislocation) can trigger Charcot.  With the ruptured ligament and the micro fractures, as well as the pain with the activities you have mentioned, it sounds to me like you have both conditions.  Unfortunately, surgery can also trigger active Charcot, so I can understand why your doctor might be hesitant to take you to the OR.

Your case is pretty complicated, and I would usually recommend fusion of those joints that are causing the pain.  With diabetes, prednisone use, and what sounds like a pretty clear recent history of Charcot, the chances of a successful fusion are extremely low.  Surgery in general would not be recommended, but the alternative is to keep using devices such as offloading boots or custom-molded orthotics and try to manage the pain as well as possible.  

I wish I could give you better news, but I want to be honest with you about this.  If there's a doctor willing to do surgery, please make sure you follow all instructions to the letter, put absolutely no weight whatsoever on that foot for at least the first couple of months, and take really good care of yourself.  There's no guarantee with any surgery, and yours would be higher risk than some, but there may be some doctors who are willing to try.

I hope this helps.  It is definitely smart to ask around, and feel free to check with other physicians to get their opinions as well.  I hope you are able to find the relief that you are looking for.

Wishing you health, happiness, and peace,
Dr. Bodart