Charcot Foot information

What Is Charcot Foot?

Charcot foot is a sudden softening

of the bones in the foot that can

occur in people who have significant

nerve damage (neuropathy). The bones

are weakened enough to fracture, and

with continued walking the foot

eventually changes shape. As the

disorder progresses, the arch collapses

and the foot takes on a convex shape,

giving it a rocker-bottom appearance,

making it very difficult to walk.

Charcot foot is a very serious

condition that can lead to severe

deformity, disability, and even

amputation. Because of its seriousness,

it is important that patients with

diabetes—a disease often associated

with neuropathy—take preventive

measures and seek immediate care

if signs or symptoms appear.

Symptoms

The symptoms of Charcot foot can

appear after a sudden trauma or

even a minor repetitive trauma (such

as a long walk).A sudden trauma

includes such mishaps as dropping

something on the foot, or a sprain or

fracture of the foot. The symptoms of

Charcot foot are similar to those of

infection.Although Charcot foot and

infection are different conditions,

both are serious problems requiring

medical treatment.

Charcot foot symptoms may include:

• Warmth to the touch (the foot

feels warmer than the other)

• Redness in the foot

• Swelling in the area

• Pain or soreness

What Causes Charcot Foot?

Charcot foot develops as a result of

neuropathy,which decreases sensation

and the ability to feel temperature,

pain, or trauma. When neuropathy is

severe, there is a total lack of feeling

in the feet. Because of neuropathy,

the pain of an injury goes unnoticed

and the patient continues to walk—

making the injury worse.

People with neuropathy (especially

those who have had it for a long time)

are at risk for developing Charcot

foot. In addition, neuropathic patients

with a tight Achilles tendon have

been shown to have a tendency to

develop Charcot foot.

Diagnosis

Early diagnosis of Charcot foot is

extremely important for successful

treatment. To arrive at a diagnosis, the

surgeon will examine the foot and

ankle and ask about events that may

have occurred prior to the symptoms.

X-rays are also essential for diagnosis.

In some cases, other imaging

studies and lab tests may be ordered.

Once treatment begins, x-rays are

taken periodically to aid in evaluating

the status of the condition.

Treatment

It is extremely important to follow the

surgeon’s treatment plan for Charcot

foot. Failure to do so can lead to the

loss of a toe, foot, leg, or life.

Treatment for Charcot foot

consists of:

• Immobilization. Because the foot

and ankle are so fragile during

the early stage of Charcot, they

must be protected so the soft

bones can repair themselves.

Complete non-weightbearing is

necessary to keep the foot from

further collapsing. The patient

will not be able to walk on the

affected foot until the surgeon

determines it is safe to do so.

During this period, the patient may

be fitted with a cast, removable boot,

or brace, and may be required to

use crutches or a wheelchair. It

may take the bones several months

to heal, although it can take considerably

longer in some patients.

• Custom shoes and bracing. Shoes

with special inserts may be needed

after the bones have healed to

enable the patient to return to

daily activities—as well as help

prevent recurrence of Charcot

foot, development of ulcers, and

possibly amputation. In cases

with significant deformity, bracing

is also required.

• Activity modification. A modification

in activity level may be needed

to avoid repetitive trauma to both

feet.A patient with Charcot in

one foot is more likely to develop

it in the other foot, so measures

must be taken to protect both feet.

• Surgery. In some cases, surgery

may be required. The foot and

ankle surgeon will determine the

surgical procedure best suited for

the patient based on the severity

of the deformity and the patient’s

physical condition.

Preventive Care

The patient can play a vital role in

preventing Charcot foot and its complications

by following these measures:

• Diabetes patients should keep

blood sugar levels under control.

This has been shown to reduce

the progression of nerve damage

in the feet.

• Get regular check-ups from a foot

and ankle surgeon.

• Check both feet every day—and

see a surgeon immediately if

there are signs of Charcot foot.

• Be careful to avoid injury, such

as bumping the foot or overdoing

an exercise program.

• Follow the surgeon’s instructions

for long-term treatment to

prevent recurrences, ulcers,

and amputation. ▲