Charcot Foot

Charcot foot is a rare but serious complication that can affect persons with peripheral neuropathy, especially those with diabetes mellitus. Charcot affects the bones, joints, and soft tissues of the foot or ankle.

Causes of Charcot Foot

  • Researchers have not found one, single cause for Charcot foot.

  • But there are certain known events that create the right conditions for it to develop.

  • One common known event is an unrecognized sprain or injury.

  • Because the individual has peripheral neuropathy, they cannot feel pain or other sensations and the injury can go unnoticed.

  • If a broken bone in the foot or ankle is not correctly treated, the deformity can worsen, lead to foot sores and infection.

  • Charcot foot has also been seen as a complication following organ transplantation in patients with diabetes.

Symptoms of Charcot Foot

In the early stages, the foot is red, feels warm to the touch, and there is significant swelling of the extremity.

Diagnosis of Charcot Foot

  • In its early stages, Charcot foot is difficult to diagnose. X-rays are often normal.

  • If X-rays and laboratory tests are normal, Charcot foot is diagnosed by knowing the signs of the condition.

  • Charcot foot is suspected in persons who have diabetes and peripheral neuropathy and the following signs: a red, hot, swollen foot (without a foot ulcer) and an increased skin temperature in the affected foot (compared with the other foot).

Treatment of Charcot Foot

Non-surgical treatment

  • The first and most important treatment is rest or to take the weight off of the affected foot (also called offloading).

  • In the early stage of Charcot foot, offloading helps prevent inflammation and stops the condition from getting worse and prevents deformity.

  • Protected weight-bearing (walking in a walking boot) in later stages can prevent complications from the existing deformity and avoid new deformities.

  • Offloading may involve putting the foot into a cast, which protects it and keeps it from moving.

  • The patient usually wears a series of casts or a removable cast walker over a total of 8 to 12 weeks.

  • Crutches, knee walker, or a wheelchair are used to avoid putting any weight on the affected foot.

  • The cast is changed several times as the swelling in the foot goes down.

  • A cast stays on the foot until the redness, swelling, and heat are resolved.

Surgical treatment

  • Surgery is recommended for those patients who have severe ankle and foot deformities that are unstable and at high risk of developing a foot ulcer.

  • In addition, if the deformity makes braces and orthotics difficult to use, surgery may be indicated.

  • After surgery, the patient will have to avoid putting full weight on the Charcot foot for an extended period of time.

Prognosis of Charcot Foot

  • All persons with diabetes who have been treated for Charcot foot should have regular foot care with a foot and ankle specialist or a specialist who focuses on foot problems in people with diabetes.

  • These specialists will watch for new changes related to Charcot and other diabetes-related foot complications.

  • Patients who have Charcot foot from other causes also should have regular follow up as recommended by the doctor.

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