What is Charcot Foot?
Charcot foot, (officially known as “Neuropathic Arthropathy”) is a progressive degeneration of a weight bearing joint. It is often has bony destruction, bone resorption, and eventual deformity.
It’s reported in 29% of diabetic patients who present with peripheral neuropathy and a loss in proprioception. The survival rates for diabetic amputations at 5 years are only 50%.
Internationally, Diabetes is the most common root cause of Charcot Arthropathy.
Charcot Foot Causes
- Diabetes
- Alcoholism
- Syphilis
- Syringomyelia
- Cerebral Palsy
- Poliomyelitis
- Spina Bifida
- Peripheral Nerve Injury
Not so fun facts about diabetes in the United States
- It affects 3 % of population
- It’s 7th leading cause of death
- The cause of 60% non-traumatic lower limb amputation
- It costs $245 billion a year to treat
And now some “not fun facts” about Charcot Foot
- Foot disorders are a leading cause of hospitalization amongst individuals with diabetes.
- Charcot neuroarthropathy can be a devastating complication of diabetic neuropathy.
- Early intervention is critical to preventing amputation.
- Below the knee amputation is often the recommended treatment for the diabetic Charcot foot patient with no healing ulcers or significant deformity. However surgical treatment and limb salvage procedures provide an alternative option to treat this complicated disease.
- The direct mechanism of Charcot neuroarthropathy is unknown, but many believe that trauma is the primary precipitating factor.
Charcot Foot Pathophysiology
There are two theories are widely accepted.
- Neurovascular: Increased peripheral circulation causes bone resorption and demineralization.
- Neurotraumatic: Repetitive injury to the foot is masked by loss of sensation.
Important Clinical Factors about Charcot Foot
- Only about one-third of patients complains of pain or discomfort in the acute stage.
- A history of recent trauma is a red flag for a Charcot process.
- Early in the deformity, a patient may complain of not being able to fit into an everyday shoe.
- Misdiagnosed at this point, the patient may not present again until a change in foot anatomy has occurred.
Diagnostic Studies
- The diagnosis of Charcot neuroarthropathy is mainly clinical.
- Support diagnostic tool include: X-rays, CT, Bone Scan, MRI and Lab study.
Differential Diagnosis
- Cellulitis
- Osteomyelitis
- Deep Vein Thrombosis
- Gout
Charcot Foot Treatment
Treatment options for Charcot neuroarthropathy depend on the stage at diagnosis.
In an acute Charcot neuroarthropathy, strict immobilization and stress reduction are the mainstays of treatment.
Non-weight bearing can be achieved with the use of crutches, a walker or a wheelchair. During this period of changing foot anatomy, cast changes are needed at least every 2 to 3 weeks. Immobilization is typically required for 3 to 6 months.
Non-Surgical Treatments for Charcot Foot
- Total contact casting
- CROW boot (removable device)
- CAM Walker boot (removable device)
- Shoe Modifications
- Medications: Bisphosphonates, neuropathic pain medications, antidepressants, topical anesthetics
Charcot Foot Surgical Treatments
Charcot foot reconstruction is a limb salvage procedure with multiple complications to realign and stabilize the architecture of the foot.
- Internal Fixation
- External Fixation
- Both
Why choose University Foot and Ankle Institute for your foot and ankle care?
If you’re experiencing foot problems, we’re here to help. Our nationally recognized foot and ankle specialists offer the most advanced podiatric care and the highest success rates in the nation. We are leaders in the research and treatment of all foot and ankle conditions. Our nationally recognized foot and ankle specialists offer the most advanced podiatric care and the highest success rates in the nation. We are leaders in the research and treatment of all foot and ankle conditions.
For more information or to schedule a consultation, please call (877) 736-6001 or visit us here to make an appointment online.
When not tending to patients at University Foot and Ankle Institute, Dr. Jafary utilizes his surgical expertise assisting those less fortunate. As a member of the Yucatan Crippled Children Foundation, he has traveled to Mexico several times and performed hundreds of limb correction surgeries on children with disabling foot and ankle disorders. Dr. Jafary also participates in Podiatry Overseas, which takes him to underserved countries to treat patients with lower extremity deformities
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