Foot & Ankle Charcot
What Is a Charcot Foot?
Charcot foot is a condition causing the 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 serious condition that can lead to severe deformity, disability, and even amputation. Because of its seriousness, it is important that patients living with diabetes, often connected with neuropathy, take preventive measures and seek immediate care if signs or symptoms appear.
Charcot foot develops as a result of neuropathy, which decreases sensation and the ability to feel temperature, pain, or trauma. Because of decreased sensation, the patient may continue to walk and make 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 tend to develop Charcot foot, as well as runners due to repeated impact.
Warmth to the touch (the affected foot feels warmer than the other)
Redness in the foot
Pain or soreness
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 before 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.
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.
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 nonweightbearing 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 the recurrence of Charcot's 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.