Novel method of aut o-photo elicitation and qualitative interviews in people with diabetes and active Charcot foot demonstrate the severe impact of diagnosis of a Charcot foot and its long-term management with total contact casting on patient's perceived quality of life and sense of wellbeing

Aim: The aim of this research was to enhance the understanding of the lived experience of active Charcot foot in people with diabetes. Method: We studied prospectively patients recently diagnosed with an active Charcot foot. We applied a novel method of auto- photo elicitation and qualitative interviews. Participants were asked to bring in 3-5 of their own photographs to demonstrate how the diagnosis and management of active Charcot foot had affected their lives. These photographs were used as the basis of a discussion in a semi-structured interview and evaluated using interpretive phenomenological analysis. Results/Discussion: We interviewed 8 patients with diabetes and active Charcot foot (6 males and 2 females; age range 46-73 years; 2 with Type 1 and 6 with Type 2 diabetes). All patients were treated with total contact casting. Patients identified several areas of concern including non-recognition of symptoms and misdiag- nosis, lack of available information, the challenges of acceptance, effects on diabetes, depression and suicidal thoughts, isolation, loss of meaningful activity and employment, changing sense of self, effects on relationships, and fear of the future. All patients saw being diagnosed with a Charcot foot as a marker of overall decline in health and wellbeing. Conclusion: This is the first study that explored the patient’s perspective of the lived experience of active Charcot foot and its treatment. It demonstrated that both the diagnosis of Charcot foot and its long-term management with total contact casting, had an immediate and severe impact on patient’s perceived quality of life and sense of wellbeing