Saving Lives and Limbs, Too

THE ONLY REASON to believe it was a foot was that it was attached to the end of a leg. 

Cocooned in gauze and yellowing cotton, it carries the dimensions of a fist: small, rounded, no toes. A metal frame surrounds the foot, like scaffolding, as though builders had been tasked with constructing a foot but had clocked off without finishing the job. Thin metal rods spear into shin and heel, securing frame to flesh. 

The contraption belongs to Lorenzo Anderson, 47. He is delighted. Before he was offered the operation that put his foot in scaffolding, he had been told there was only one option: amputation. 

The frame on Anderson's foot is the telltale sign of a surgical technique now being used to salvage limbs that would otherwise be amputated. 

Dr. David Armstrong, professor of surgery at the Scholl College of Podiatric Medicine in Chicago, is one of the country's leading researchers on the feet of diabetics and amputation prevention. "Diabetics tend to lose the gift of pain," he explained, describing the gradual nerve loss that is known as neuropathy. 

Up to 70 percent of diabetics have some degree of neuropathy, according to statistics published by the American Diabetic Association. 

In simple terms, nerve damage deprives the body of its most effective alert: pain. Without pain signals to force corrective action, people with neuropathy can inflict severe damage on themselves. "They tend to wear a hole in their foot in the same way you might wear a hole in your sock," Armstrong said. 

According to Armstrong's research, ulcers in the feet are the most common reason for hospitalization of diabetics in the United States. Worse still, "one in five of those wounds will lead to an amputation," Armstrong said. "This is an extremely common, complex and costly problem." 

In the most severe cases, bones slip out of their proper alignment and joint fluid seeps into the limb. Armstrong has seen patients with "the sort of fractures people would only get if they were in an automobile accident." 

This severe damage to the bone structure is known as Charcot foot (pronounced SHAR-ko). In the medical lexicon, the condition is a species of neurogenic arthropathy. 

Although Charcot foot is an extreme consequence of neuropathy, it is still thought to affect about 70,000 Americans. Diabetics are estimated to account for about half of all nontraumatic lower limb amputations in the United States. In 2002, according to ADA figures, 86,000 such amputations were performed on diabetics around the country. 

Anderson's Charcot foot was diagnosed in late January. For more than 10 years he has been in and out the hospital for treatment of recurring sores and foot ulcers following the amputation of the toes on his right foot. 

Although the loss of Anderson's toes put an end to his career in construction, it did not keep him from his passion: stilt dancing. He has performed in a variety of events, like the Halloween parade in New York's Greenwich Village. Stilt dancing also gave him his nickname: Popcorn. "Cause I pops up!" he said, threatening to bounce out of his wheelchair. 

His last visit to the hospital came after he collapsed in a store near his home in Astoria, Queens. He was running a fever, a result of an infection in his foot. He was told his foot would have to be amputated. Anderson was lucky to have been admitted to one of the few hospitals in the country, St. John's Hospital in Queens, that offers an alternative. 

Dr. Nicholas Bevilacqua, 29, and Dr. Lee Rogers, 28, use a surgical technique known as "external fixation" to treat damaged feet. 

The idea behind the surgery is simple. Charcot foot is a joint disease, "so we remove the joint completely," Bevilacqua said. Having removed the diseased bone, surgeons reconstruct the structure of the foot. The remaining healthy bone is put back into its proper alignment; bone grafts may be used to restore the basic architecture of a functional joint.

(Source: Tri Valley Herald 3/20/2006)