Charcot foot is a condition causing weakening 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 joints collapse and the foot takes on an abnormal shape, such as a rocker-bottom appearance.
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.
Causes
Charcot foot develops as a result of neuropathy, which
decreases sensation and the ability to feel temperature, pain, or trauma.
Because of diminished sensation, the patient may continue 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.
Symptoms
The symptoms of Charcot foot may include:
•Warmth to the touch
(the affected foot feels warmer than the other)
•Redness in the foot
•Swelling in the area
•Pain or soreness
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 and other imaging studies and tests may be ordered.
Once treatment begins, x-rays are taken periodically to aid
in evaluating the status of the condition.
Non-Surgical 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.
Non-surgical 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 weakened 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.
When is Surgery Needed?
In some cases, the Charcot deformity may become severe
enough that surgery is necessary. The foot and ankle surgeon will determine the
proper timing as well as the appropriate procedure for the individual case.
Preventive Care
The patient can play a vital role in preventing Charcot foot
and its complications by following these measures:
•Keeping blood sugar
levels under control can help 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 you notice 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.
