What’s Charcot Foot?
Charcot foot (also known as “Neuropathic Arthopathy“) is when your foot starts to “soften.” This happens because of progressive degeneration of the weight-bearing joints of the foot.
This is the bones in the foot weakening. It occurs in people who have significant nerve damage (neuropathy), most often those who are diabetic. It has been reported in 29% of diabetic patients who present with peripheral neuropathy and a loss in proprioception.
The bones weaken enough to actually fracture (or break). If you continue to walk without corrective treatment, the foot eventually changes shape. It’s a serious condition that may lead to deformity, disability and, possibly, amputation. Immediate preventive care and treatment are a must at the first sign of symptoms.
Some Facts About Diabetes
9.3 % of the population in the U. S. has diabetes, and it is the 7th leading cause of death. 60% of non-traumatic lower-limb amputations are caused by diabetes. Diabetes is considered internationally to be the most common root cause of Charcot arthropathy.
Foot disorders are a leading cause of hospitalization amongst individuals with diabetes. It’s important to understand that, for a patient with Charcot, early intervention is critical to preventing amputation. Below the knee amputation is often the recommended treatment for the diabetic Charcot foot patient that presents with no healing ulceration and significant deformity. However, surgical treatment and limb salvage procedures seem to provide alternative options to treat this complicated disease.
The direct mechanism of Charcot foot is unknown, but many believe that trauma is the primary precipitating factor. Often patients with early stages of Charcot are diagnosed with Cellulitis, Osteomyelitis, Deep Vein Thrombosis, or Gout.
What Causes Charcot Foot?
Neuropathy, decreasing sensation and loss of ability to gauge temperature, pain, or trauma, are causes of Charcot foot. In severe cases of neuropathy, you can lose all sensation in the feet. Because of neuropathy, the pain of an injury goes unchecked and the patient continues normal activity, which worsens the injury.
Those suffering from neuropathy are at high risk for developing Charcot foot. In some cases, neuropathic sufferers with tight Achilles tendons are more prone to developing Charcot foot.
Some of the other main causes of Charcot disease are Syphilis, Syringomyelia, Cerebral Palsy, Poliomyelitis, Spina Bifida, and Peripheral Nerve Injury.
There’re Two Main Theories About How Neuropathic Arthopathy Happens:
- Neurovascular: Increased peripheral circulation causes bone resorption and demineralization
- Neurotraumatic: Repetitive injury to the foot is masked by loss of sensation
Charcot Foot Symptoms
Charcot foot symptoms may appear after a sudden injury or a minor repetitive stress (such as strolls in the park). A sudden injury, such as dropping something on the foot, or a fracture, or even a slight foot sprain, can lead to Charcot foot. Even though infection and Charcot are two very different conditions, and both require medical treatment, the symptoms are quite similar.
Charcot foot symptoms include:
- Warm to the touch
- Redness
- Swelling
- Pain
- Cannot fit into everyday shoes
How to Diagnose Neuropathic Arthopathy
Early diagnosis is of utmost importance for the successful treatment of Charcot foot. To properly diagnose Charcot foot, a thorough examination of the foot and ankle by the surgeon, as well as answers to a series of questions to determine what events may have led to its present condition, are required.
X-rays are an essential tool for the proper diagnosis of Charcot foot. Other imaging studies and lab tests may be ordered by the surgeon. During the treatment procedure, X-rays are taken regularly to help evaluate the status of treatment.
Important Clinical Factors:
- Only about one-third of patients complain 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.
- If Charcot foot is misdiagnosed, the patient may not present again until a change in foot anatomy has occurred.
Charcot foot treatments
Charcot Foot Treatments
It is an absolute must that you follow the surgeon’s treatment instructions for Charcot foot. You may lose a toe, foot, leg, or maybe your life. Treatment options for Charcot foot depend on the stage at diagnosis. In an acute Charcot foot, 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
Immobilization. The foot and ankle are very fragile in the early stages of Charcot. It is important that they are protected, so the bones have a chance to heal themselves. Non-weightbearing is necessary to keep the foot from further damage. Walking will not be allowed on the affected foot until the surgeon says it’s safe. You may be fitted with a cast, removable boot, or brace, and may have to use crutches or a wheelchair. It may take several months to heal. For some, it may be even longer.- Custom shoes and bracing. Special inserts for your shoes may be prescribed, enabling you to return to daily activities after recovery. They will also help to prevent a recurrence, development of ulcers, and, possibly, amputation. With significant deformity, bracing is a must.
- Activity modification. Because you are more likely to develop Charcot foot on your healthy foot if you already have Charcot in the other, your activity must be modified to avoid repetitive trauma to both feet. You must take care to protect both feet at all times.
- Surgery may be required. Your foot and ankle surgeon will determine the best procedure suited for you, based on your condition and overall physical health
Charcot Foot Surgery
Charcot foot reconstruction is a limb salvage procedure with multiple complications. This procedure realigns and stabilizes the architecture of the foot. A well-trained surgeon can use different techniques such as: Internal Fixation, External Fixation, or both, to treat the Charcot foot.
Charcot Foot Preventative Care
You can have an impact in preventing Charcot foot and its complications by following these rules:
- If you’re diabetic, keep blood sugar levels under control. This will reduce the progression of nerve damage in the feet.
- Schedule regular check-ups with a foot and ankle surgeon.
- Check your feet every day, and don’t wait to see a surgeon if there are any signs of Charcot foot.
- Take care to avoid injury, such as bumping the foot, or an over-strenuous exercise program
- Prevent recurrences, ulcer, and amputations by following your surgeon’s instructions
UFAI is the best choice for care for diabetic foot conditions
If you’re diabetic and experiencing any problems with your feet, we’re here to help. Our nationally recognized foot and ankle specialists offer the most advanced podiatric care with 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 at www.footankleinstitute.com.
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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I had Charcot Reconstructive surgery on my right foot by Dr. Ira Wiener two months ago.The surgical site healed well and he discharged me. However I still have pain in the lateral side of the foot and the heel. Dr. Wiener referred me to a pain management Dr. that recommends a spinal implant. I’ve not gone forward with that yet. Also the calf of my right leg has swollen to twice the normal size. It’ s painless. My sugars are in good control on no medication: A1C 6.1 to 6.9. I would like to travel from my Las Vegas home for treatment by you. What do you recommend. I am 73 years old and otherwise healthy. Stephen Lyons
I recommend a virtual consult first which includes a complete record and films review and then a consultation so we can discuss what we can truly do to help. If you were local, coming in for an appointment would obviously be easier, hence this suggestion.
There is information about this here: https://www.footankleinstitute.com/podiatric-virtual-consultation-foot-ankle-second-opinion
Bob Baravarian
Assistant Clinical Professor:
UCLA School of Medicine
Director and Fellowship Director:
University Foot and Ankle Institute
Los Angeles, California