 Sharco is a disease process in the foot. It happens when the foot has no feeling, and then ultimately the bones start to spread apart. The reason the bones spread apart is because there's inflammation going on in the foot or ankle, which then causes the joint capsule, which is like the balloon that holds the bones together, starts to spread as well, and the bones start to not work together like they should. They don't fit like a perfect puzzle. And what happens is they collide, and you've got uneven pressure that's distributed across those bones, and the bones will then start to fragment and break apart. So you literally have bones that are dissolving in the middle of your foot or even inside your ankle, which can cause a lot of deformity, which is essentially when things just are not straight and well aligned. Oftentimes a patient will present after having been at the emergency department and sometimes or even at their primary medical provider's office, and they'll say, well I was diagnosed with cellulitis, which is inflammation of the skin, or they'll be diagnosed with even possible blood clot, or even diagnosed with infections in the joints, and sometimes even with bone infection. Sometimes patients will come to me and they'll call it shark toes or sometimes they'll call it like shark toes, kind of like lactose intolerance, but all in all it's basically in response to a lack of sensation from any medical problem, mostly dealing with diabetes, but can be from other problems such as alcoholism, spinal cord problems, or patients that have had any other issues with respect to their nervous system. The patients will complain oftentimes when it gets too late. When the swelling gets so bad that the saran wrap or deep lining over the muscles and tissue in the foot and ankle are swell up so badly that that causes pain. The surface sensation they usually don't feel, which is why it goes unnoticed for such a long period of time. First and foremost, because the inflammation is so revved up with Charco, it's best to immobilize the patient. It's interesting that you can put a patient in a boot, which is a called a cam walker boot, controlled ankle motion walking boot, which is a big boot that goes just below the knee, or the gold standard is actually to do what's called a total contact cast. And what that is, is a cast that literally hugs all areas of any bony prominence and prevents friction and skin breakdown to caress the foot, hold the foot, and have all the pressure and weight go down from the thigh, calf, and ankle to help support the weight. And that is what you do when a foot is red hot and flamed and at the early stages of Charco. After all that has calmed down and inflamed, I do believe this is a surgical problem. And ultimately these bones need to be reshaped and stabilized. And the old adage is to obtain the correction, and then we have to maintain the correction. And that's sort of where I come in by using plates, screws, orthobiologic materials, and even a circular ring fixator to help support that deformity and prevent it from breaking down further. With this disease process being in such a low proportion of the population, it requires somebody that has a good grasp and has been treating it often because of the high risk of amputation. I happen to see six to eight per month, and I do think that it's very important to do a critical assessment and figure out the signs of a Charco foot or ankle and go to a specialist that is able to manage it through immobilization and likely requiring the surgical correction that these things need to, like we discussed, to obtain and then maintain that correction through use of whether it be internal hardware or external devices and things of that nature.