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Charcot Foot


Charcot Foot

Charcot foot is a limb-threatening complication of diabetes.  Considered an inflammatory disease, the osteoarthropathy is categorized by varying degrees of bone, joint, and soft tissue breakdown.  This condition develops when there are underlying neuropathy, trauma, and abnormal bone metabolism.  The result is bone destruction, complex fractures, and a relentless deformation of the foot and ankle; the hallmark rocker-bottom foot deformity of a diabetic patient is a common late-stage presentation in Charcot osteoarthropathy. This is often mistaken for and termed as “flatfoot” in a diabetic patient.

 

What exactly is Charcot foot/ Charcot osteoarthropathy?

  • Inflammation leading to osteolysis (breakdown of bone).
  • Abnormal vascular reflex increasing active bone resorption, making bones weaker.
  • Spontaneous bone fractures prompting the body to release pro-inflammatory cytokines.  Some degree of pain may be felt, even in diabetics with numb feet.
  • Lack of sensation means the diabetic patient will continue to ambulate, causing further irreversible damage to the foot.

X-ray of Severe Charcot Foot

 

What does Charcot foot look like?

Typically, the foot presents as swollen, warm, and inflamed.  To the patient, there may be only mild to moderate pain/ discomfort.  Charcot foot may be mistaken for cellulitis, deep vein thrombosis, acute gout or a musculoskeletal issue such as ‘flatfoot’.  Very often there is a marked temperature difference between the two feet, due to the increased blood flow to the affected side.

 

What happens if Charcot foot is left untreated?

Leaving a Charcot foot untreated can lead to open pressure sores on the deformed foot, which progress and worsen to bone infection, eventually resulting in foot or leg amputation.  Even without foot ulcers, patients will lose mobility with the dysfunctional foot shape and be more prone to falls.  Patients become at higher risk for subsequent complications, from recurrent wounds to worsening foot and ankle deformities.

 

Podiatrists are trained to understand the subtle differences between a normal diabetic foot and one undergoing destructive Charcot changes.  Early intervention is key to avoiding severe debilitating deformity.

 

How can a podiatrist help with Charcot foot?

Podiatrists are specially trained to recognised subtle changes in a diabetic’s feet.  Depending on the stage that the Charcot foot deformity is discovered, our podiatrists may:

  • Stabilize the foot using removable or fixed casts.
  • Use in-clinic treatment to reduce pain, swelling and other changes using advanced non-invasive modalities (focal or radial ESWT, PEMF, etc).
  • Offload and redistribute abnormal pressures across the feet using specialized orthotic devices.
  • Manage the wound care if the skin has broken down.
  • Obtain X-ray or diagnostic ultrasound scans to confirm the diagnosis.
  • Prompt referral for surgical intervention if required.

If you suspect that you have Charcot foot, do not delay in seeing your podiatrist.  It is a serious condition; early intervention reduces the amount of bone deformity and subsequent complications that can occur.