What is Charcot Arthropathy? Charcot foot, as it is commonly referred to, is a chronic progressive disease of the bone and joints found in the feet and ankles of our diabetic patients with peripheral neuropathy.

What leads to this Charcot foot? Having long standing diabetes for greater than 10 years is one contributing factor. Having autonomic neuropathy leads to abnormal bone formation and having sensory neuropathy causes the insensate foot, or foot without sensation and thus susceptible to trauma, this is another contributing factor. These bones in the affected foot collapse and fracture becoming malformed without any major trauma. One common malformation you see related to Charcot foot is the “rocker bottom” where there is a “bulge” on the bottom of the foot where the bones have collapsed.

Your patient with Charcot foot will present with a painless, warm, reddened and swollen foot. You may see dependent rubor, bounding pedal pulses, and feel or hear crackling of the bones when moving the foot. If a patient were to continue to bear weight on the Charcot foot there is a high chance for ulceration that could potentially lead to infection and/or amputation.

Continued, on-going weight-bearing can result in a permanently deformed foot that is more prone to ulceration and breakdown. Prompt treatment is necessary using total contact casting, where no weight bearing will occur on the affected foot for 8-12 weeks. Our job as wound care clinicians is good foot assessment with prompt identification and treatment of this acute Charcot foot to prevent foot deformity and further complications in the diabetic patient.

You are getting ready to trim your diabetic patients toenails. What exactly does that all involve? Well, first you need the proper tools for diabetic toenails. A set of toenail nippers, nail file, and orange stick are typically used. Always follow your facility or healthcare’s settings policy for infection control. Single use disposable equipment is favorable.

You have gathered your equipment to trim the patients diabetic toenails, now what? Nails are easiest to trim after a bath or soak for 10 minutes to soften nails. The soaking of diabetics feet should only be done by a healthcare professional. You can clean under the patients toenail with an orange stick (wearing gloves), wiping on a clean washcloth in between each toe during soaking. .

After soaking and washing of the feet are completed, dry the patients feet completely. Wash your hands and put on gloves to trim the toenails. Use your dominant hand to hold the nipper. Start with the small toe and work your way medial toward the great toe. Squeeze the nipper to make small nips to cut along the curve of the toenail. Be careful not to cut the skin. Use your index finger to block any flying nail fragments. Nippers are used like a pair of scissors – make small cuts, never cut the nail in one clip all the way across the nail. Never use two hands on the nipper. The nail is trimmed in small clips in a systematic manner. The nail should be cut level with the tips of the toes, never cut so short or to break the seal between the nail and the nail bed. The shape of the nail should be cut straight across and an emery board should be used to slightly round the edges. When filing diabetic toenails always use long strokes in one direction, avoid using a back and forth sawing motion.

When all toes have been trimmed and filed, remove your gloves and wash your hands. Apply clean gloves and apply lotion to the top of the foot and to the soles of the feet, rubbing lotion in well, and wipe excess lotion off with a towel. Put the patient’s socks and shoes back on as needed. Wash your hands and smile, you are done!

For your patients who are trimming their own diabetic toenails at home teach them the following simple instructions: Be sure you have good lighting. Trim toenails after bathing, dry feet well, especially in between the toes. Start with the little toe and work your way into the great toe. Use small cuts, never cut the toenail across all at once. Cut straight across and use a nail file to smooth edges. Apply lotion to the bottom and tops of the feet, never in between the toes. For patients with thickened toenails or yellowed toenails, recommend a foot care specialist like a podiatrist cut their toenails.