Volume 4 Issue 5
International Journal of Trend in Scientific Research and Development (IJTSRD) Volume 5 Issue 6, September-October 2021 Available Online: www.ijtsrd.com e-ISSN: 2456 – 6470 @ IJTSRD | Unique Paper ID – IJTSRD47631 | Volume – 5 | Issue – 6 | Sep-Oct 2021 Page 1287 A Single Case Study of Diabetic Ulcer with Charcot’s Deformity Dr. P. V. Vijay Guptha 1 , Dr. Syeda Ather Fathima 2 , Dr. Shivalingappa J. Arakeri 3 , Dr. Mohasin Kadegaon 4 , Dr. Geethanjali Hiremath 5 1PG Scholar, 2Principal, 3Professor & HOD, 4Assistant Professor, 5Assistant Professor, 1,3,4,5Department of Shalya Tantra, Taranath Government Ayurvedic Medical College, Ballari, Karnataka, India 2Taranath Government Ayurvedic Medical College, Ballari, Karnataka, India ABSTRACT In patients with diabetes the incidence of acute charcot arthropathy of the foot and ankle ranges from 0.15-2.5%. It occurs as a result of arthritis in joint in diabetic patients. In contemporary science the management of wound is by oral and topical antibiotics along with use of betadine solution and eusol are in practice for wound care. Gomutra Arka been widely practiced for Vranshodhana and most of the time it is not accepted by group of people, because of smell and religious factor. So, there is a need for alternate simple and effective formulation which can be used in all wound for Vranashodhana. Hence here is an effort to find better substitute for the wound care and healing. A male patient 62 years old visited OPD Taranath Government Ayurvedic Medical College with complaint of Wound in right foot 3rd toe tip and got diagnosed as T2DM/HTN/Diabetic Ulcer with Charcot’s Deformity. Successfully treated the wound with Karanja Arka Prakshalana for wound care. Few internal medication and Pathya Apathya for 21 days. Keywords: Charcot’s arthropathy, Prakshalana, Pathya Apathya How to cite this paper: Dr. P. V. Vijay Guptha | Dr. Syeda Ather Fathima | Dr. Shivalingappa J. Arakeri | Dr. Mohasin Kadegaon | Dr. Geethanjali Hiremath "A Single Case Study of Diabetic Ulcer with Charcot’s Deformity" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456- 6470, Volume-5 | Issue-6, October 2021, pp.1287- 1291, URL: www.ijtsrd.com/papers/ijtsrd47631.pdf Copyright © 2021 by author (s) and International Journal of Trend in Scientific Research and Development Journal. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) (http://creativecommons.org/licenses/by/4.0) 1. INTRODUCTION The diabetic Charcot foot syndrome is a serious and potentially limb-threatening lower-extremity complication of diabetes. First described in 1883, this enigmatic condition continues to challenge even the most experienced practitioners. Now considered an inflammatory syndrome, the diabetic Charcot foot is characterized by varying degrees of bone and joint disorganization secondary to underlying neuropathy, trauma, and perturbations of bone metabolism. The Charcot foot in diabetes poses many clinical challenges in its diagnosis and management. Despite the time that has passed since the first publication on pedal osteoarthropathy in 1883, there is much to learn about the pathophysiology, and little evidence exists on treatments of this disorder. Charcot neuropathic osteoarthropathy (CN), commonly referred to as the Charcot foot, is a condition affecting the bones, joints, and soft tissues of the foot and ankle, characterized by inflammation in the earliest phase. The hallmark deformity associated with this condition is midfoot collapse, described as a “rocker-bottom” foot although the Charcot syndrome may occur in a variety of conditions; diabetes is clearly the most common worldwide. Diabetes may predispose to its occurrence through a number of mechanisms. Apart from the presence of neuropathy and possible osteopenia, these include the effects of advanced glycation end products, reactive oxygen species, and oxidized lipids, which may all enhance the expression of RANKL1 (Receptor activator of nuclear factor kappa-B ligand) in diabetes. Treatment2 in its early stage is towards reducing swelling and heat in the area, stabilizing the foot by keeping it immobile. Non-surgical (wearing a protective splint, walking brace, off-loading etc.,) and surgical treatments (reconstructive osteotomy, ankle fusion, exostectomy and amputation and prosthetic fitting). CASE REPORT A 62 year old male patient visited to out-patient department (OPD) at Taranath Government IJTSRD47631 International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD47631 | Volume – 5 | Issue – 6 | Sep-Oct 2021 Page 1288 Ayurvedic Medical College, Ballari, Karnataka on 11/08/2021 presented with complaints of wound, pain in right foot 3rd toe tip since 6 months. History of Present Illness: Patient was said to be apparently alright 10 years back. Then he had nail injury to right foot. Which caused pain and swelling in anterior 1/3rd of foot with swelling extending upto ankle. He operated for the same from VIMS, Ballari. Then he underwent 5th toe right foot amputation. Recently he developed ulcer in 3rd toe tip region along with pain and swelling. Visited Taranath Government Ayurvedic Medical College, Ballari for the same. History of Past History: K/C/O type 2 DM (14years)/HTN (6years) Drug History: 1. Tab. Glycomet GP1 morning A/F 2. Tab. Glycomet 500 night A/F 3. Tab. Atenolol 50 BID A/F Personal History: Appetite: poor Diet: mixed Bowel: Regular Sleep: Disturbed due to pain Micturition: 4-5 times/ day 2-3 times/ night Habits: occasional alcohol intake, Smoking present Occupational History: X-Servicemen, Farmer Examination: 1. Built: moderate 2. Vitals were normal 3. General examination: Pallor- Absent Cyanosis- Absent Icterus- Absent Lymphadenopathy- Absent Clubbing- Absent Edema- pitting edema + (Right Leg and Foot) 4. Systemic examination: CVS: S1S2 heard, no any added sounds RS: normal vesicular breath sounds P/A: soft, normal bowel sounds, no organomegaly Local Examination: Inspection Smell: absent Site: 3rd right foot toe tip Palpation Size: 2cm * 1.5cm Tenderness: absent Shape: oval Swelling: present in right leg and foot, pitting Edge: sloping Induration: Absent Floor: pale granulation with unhealthy tissue seen Temperature: Absent Discharge: mild serous Pulsation: Surrounding area: blackish Dorsalis pedis- good pigmentation with callosity Posterior tibial- feeble Margin: regular Anterior tibial- good Diagnosis: T2DM/HTN/DIABETIC ULCER with Charcot’s Deformity Treatment Adopted: Days 1 to 21 Karanja Arka Prakshalana followed by dressing. Internally 1. Kaishora Guggulu 1 TDS 2. Kokilaksha Kashayam 10ml TDS Before Food Strict Pathya Apathya as adviced. International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD47631 | Volume – 5 | Issue – 6 | Sep-Oct 2021 Page 1289 Fig: 01 Fig: 02 Before Treatment during and After Treatment Fig: 03 Fig: 04 Blood Investigation Blood Investigation International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD47631 | Volume – 5 | Issue – 6 | Sep-Oct 2021 Page 1290 Fig: 05 Fig: 06 Arterial Doppler X- Ray foot Table No. 01: Findings of Ulcer Before and After Treatment Symptom BT 7 th Day 14 th Day 21 st Day 1.Pain Present Present Reduced No pain 2.Itching Absent Absent Absent Absent 3.Foul smell Absent Absent Absent Absent 4.Size 2cm*1.5cm 1.5cm*1cm 1cm*0.5cm Healed 5.Edge Sloping Sloping Sloping Sloping 6.Margin Regular Regular Regular Regular 7.Floor Slough with beafy granulation tissue Beafy granulation tissue Pinkish granulation tissue Healed 8.Discharge Mild sero-purulent Mild serous Serous Absent DISCUSSION The prevalence of Charcot’s arthropathy ranges from 0.1% to as high as 13% in specialized foot clinics. In patients with diabetes the incidence of acute charcot arthropathy of the foot and ankle ranges from 0.15- 2.5%. Epidemiological studies do not distinguish between acute and post acute disease. The 62 year old male patient approached our hospital with complaints of wound in right foot 3rd toe tip with charcot deformity. Got successfully treated for the wound. PROBABLE MODE OF ACTION: He was treated with karanja arka3 for vrana prakshalana which has vrana shodhana and ropana action. Kaishora guggulu has rakta gata dosha pachana, rakta prasadana and medo hara action, which helped in managing the diabetic ulcer microcirculation and atherosclerotic changes in arteries. Kokilaksha kashayam is a know formulation in the management of Vatarakta. Which is used to treat Gout and many types of arthritis. The charcot’s deformity is a result of arthritis of joint occurring in diabetic patient. So, the combination of kaishora guggulu and kokilaksha kahshayam been used to manage the condition. CONCULSION: Diabetic ulcer with charcot deformity is rare presentation and often the diagnosis is missed. This patient was having atherosclerotic changes in lower limb arteries, T2DM, HTN which was interfering with wound healing. He was diagnosed with diabetic ulcer with charcots deformity and was treated the wound successfully with Ayurvedic medicine like International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD47631 | Volume – 5 | Issue – 6 | Sep-Oct 2021 Page 1291 internally Kaishora Guggulu and Kokilaksha Kashayam. Externally, Karnja Arka Prakshalana followed by dressing to manage wound. As it was single case study it needs further evaluation and efficacy of the drug and procedure. BIBLIOGRAPHY  Boyce BF, Xing L. Functions of RANKL/RANK/OPG in bone modeling and remodeling. Arch Biochem Biophys 2008; 473: 139-146  https://www.healthline.com/health/charcot-foot  Tripathi Indradeva, Arka prakasha of Lankapathy Ravana. 2nd ed. Varanasi: Chowkhamba Krishnadas Academy; 2006.