Like touching a hot stove or feeling a pebble in your shoe, the ability to sense pain and discomfort is the first step in realizing there is a problem. But what if you couldn’t feel the pain? That’s how many patients end up developing a deformity called Charcot foot. This rare and disabling disorder is a progressive disease that can cause degeneration of the ankle joint and without functioning pain receptors, can lead to some very severe side effects.
“I stay motivated because you learn not to take walking for granted,” said Erica Hargens.
The steps are small, but they’re significant to Hargens' journey, one that began a year ago with an appointment to address back pain, but led her care team to take a closer look at her feet.
“Dr. Bellezza got involved and it just so happened he was on call when I was in for a bone biopsy. And when they did my X-rays, he found the problem that I had Charcot foot,” said Hargens.
“We don't know why it happens, but it is associated with neuropathy. It's basically just a cascade of events where the bones fracture and fragment and fall apart. Then they kind of coalesce and reconsolidate in a new form of foot. Her talus bone, which is the bone that sits between our long leg bone, the tibia and the heel bone, was pretty much broken in several pieces,” said Peter Bellezza, DPM, MS, with Avera Orthopedics.
“Most patients have diabetes and they have neuropathy. So according to what I understand, I was feeling all the pain,” said Hargens.
“So it's kind of like someone took a sledgehammer to her ankle and then she just decided to walk on that every single day after that,” said Dr. Bellezza.
A diagnosis like this can be devastating to hear, but for Erica there was actually some relief.
When you have that diagnosis in your hands, it's a relief actually because then you know it's not all in your head.
Because she still had sensation, Hargens' next step was surgery to fix each foot, one after the other.
“Our job was to fuse and stabilize the hind foot. And with a little bit of maneuvering and stabilization with wires, we were able to get the bones to sit on top. Then we fixated it with a long nail that went in through the heel all the way up into her tibia. And then we had interlocking screws in and out of the nail that locked it into place and also provided compression,” said Dr. Bellezza.
Consecutive surgeries is a lot for any patient, but collaboration between her care team ensured Erica’s healing continued.
“So with surgeries, when we're giving immunosuppression medications, it's very important that we coordinate with the surgeon because we don't want to increase the odds of infections and things like that because our medications can do that for people. So we end up holding and coordinating around her injections with the surgeries and then also helping control her pain in other ways when we can't give her medications,” said Kelsey Holkesvik, MD with Avera Rheumatology.
Now back to those steps. Every day Erica pushes a little further and works a little harder. It’s a long journey, but it’s filled with new possibilities.
“This has been over a year in the making, but now she's back in shoes. She can walk unassisted. She's no longer relying on strong pain medications. She's motivated to go back and work and get her lifestyle back,” said Dr. Bellezza.
“She's been a very complicated patient with a lot of moving parts, so it's been a real joy to watch her progress and get her strength back and get her mobility back,” said Dr. Holkesvik.
“Having this team on my side has been something to be able to keep going. They've been my cheerleaders. I love what Dr. Holkesvik and Dr. Bellezza have done for me. They've given me my life back,” said Hargens.
