What exactly is Charcot foot?
Charcot foot is the medical term given to a condition known as “neurogenic arthropathy” which affects the foot joints. This is a degenerative form of arthritis which rapidly progresses. It causes joint and bone damage that may lead to foot deformities which are severe. This condition starts with “peripheral neuropathy” which is feelings that are decreased in the feet and is most common in diabetics.
Individuals with nerve sensation that is decreased can hurt the feet, causing fractures which are small and since they have feelings which are decreased, may have minimum if any pain. Therefore individuals continue to walk on this injured foot. Because of this the bones begin to unevenly heal which causes the foot to become deformed.
The muscles in the foot will also lose the ability to provide proper support for the foot. In the majority of cases only one foot is affected however, both feet may be affected over time.
With Charcot foot the bones most frequently affected are the metatarsals as well as the tarsals. Charcot foot most often occurs in individuals with diabetes.
Charcot foot was named after an individual named Jean-Martin Charcot. He was the very first individual to describe this degeneration of joint surfaces as well as ligaments caused by injury or disease.
Charcot Foot Causes
There are currently 2 theories about joint destruction with this condition and how it occurs. The first theory is neurotraumatic theory which believes that trauma which is mechanical because of loss of skin sensations as well as loss of pain can lead to destruction of the bone. The other theory is the theory of neurovascular which believes that the combining of trauma together with vascular changes lead to a reduction in osteopenia or mineral density in the bone.
The foot and ankle joint commonly involved include
- Tarsometatarsal
- Naviculocuneiform joints
- Subtalar
- Talonavicular or calcaneocuboid joint
- Tibiotalar joint
Neuropathic conditions which lead to the condition include
- Diabetic neuropathy
- Neurosyphilis
- Spinal cord injury
- Syringomyelia
- Perhipheral nerve injury
- Pemicious anemia
- Hansen’s disease
There is also a problem with frequent injections of hydrocortisone into the joint which can also lead to joint destruction and to this condition.
Charcot Foot Symptoms
Peripheral neuropathy normally takes decades to develop but the progression of Charcol foot can develop in a couple of weeks or months. Any minor trauma for instance, twisting of the foot, can start the process. Individuals with Charcot foot, the inability to feel pain as well as loss of the sense of the position of the foot will result in joint injuries which are repeated.
The early or acute signs of Charcot foot are:
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- Warmer than normal
- Redness over area
- Small hairline fractures of the foot bones
- Swelling over these injured areas
- Later – entire foot becomes inflamed as well as swollen
- There is very slight if any pain during this time.
Early detection, early diagnosis, total restriction which is immediate as well as lifelong preventive care therapy can generally lessen the probability of complication which can be destructive. If not recognized or not properly managed, Charcot foot can even often lead to amputation. This acute phase often mimics cellulitis or deep vein thrombosis.
If medical management is not started, the disease develops to the chronic stage. In this stage the following signs may be present:
- Foot is deformed and obviously looks unlike the other foot
- Arch which is collapsed
- Bones which unusually stick out against the skin causing this area of skin to collapse and develop ulcers
- Inflammation and swelling of the foot
- No pain to intense pain is present
Charcot Foot Treatment
Non-Surgical Treatment – It is enormously important to follow any doctor or surgeon’s plan for treatment for Charcot foot. The failure to do this often can lead to the loss of a foot, toe, leg as well as even their life. Non-surgical therapy for this condition can consist of:
Immobilization
Since the ankle and foot are so very fragile especially during the earlier stages of Charcot, feet must be protected while the weakened bones have time to repair. Total non-weight bearing is a necessity in order to keep the foot from further damage. The individual should not be able to walk on the foot that is affected as least until the surgeon decides if it is safe to do so. It is during this period that the individual needs to be fitted with a removable boot or brace, fitted with a cast or may have to use a wheelchair or crutches. It may take these bones months to heal but this is different in each individual.
Custom bracing and shoes
There may a need to be fitted with shoes that have special inserts after the bones have healed so that the individual can return to normal daily life – as well as prevent any reappearance of this problem, ulcers to develop as well as possibly amputation.
Activity modification
Modification in activities may also be needed to avoid any further trauma to both feet. An individual with Charcot in one foot is very likely to develop in the other foot, so care should be taken to protect both feet.
There are cases where the deformity is so severe that surgery is needed. The ankle and foot surgeon will decide the timing as well as the method which is suitable for each individual case.
The individual must play an important role in preventing Charcot foot and the complications by following the suggestions:
- Keep levels of blood sugar controlled in order to help reduce any further development of nerve damage in the feet.
- Get regular check-ups from a surgeon of ankles and feet
- Check feet daily and see your primary care physician or foot surgeon immediately if you see signs of Charcot foot
- Try to avoid any injury such as overdoing an exercise program or bumping the foot
- Follow your doctors’ instructions for long term care to prevent any recurrence, ulcers or amputation.
Charcot foot Pictures
