What is Charcot Foot/ Charcot Osteoarthropathy?
Charcot foot, also known as neuropathic osteoarthropathy, is a degenerative complication that can arise due to diabetes. High glucose levels in the body damage the nerves in the lower limbs, causing neuropathy, or numbness and reduced sensitivity.
This lack of sensation then leads to breakdown in the bones, joints, and soft tissues due to the continuous and unintentional pressure on the lower limbs.
Charcot foot occurs in stages:
- Inflammation from acute or chronic trauma leads to osteolysis (breakdown of bone)
- Abnormal vascular reflex increases active bone resorption, making bones weaker
- Spontaneous bone fractures prompt the body to release pro-inflammatory cytokines that promote inflammation, leading to some degree of pain within neuropathic diabetics
- Lack of sensation leads the diabetic patient to continue with normal motion, causing further irreversible damage to the foot
What Does Charcot Foot Look Like?
Charcot foot can result in the destruction of bone, complex fractures, and unrelenting structure deformation of the foot and ankle. The hallmark rocker-bottom foot deformity is a typical late-stage presentation of a diabetic patient with Charcot osteoarthropathy, and can often be mistaken for adult acquired flatfoot disorder (AAFD). Symptoms of Charcot foot can also be mistaken for conditions like cellulitis, deep vein thrombosis, and acute gout.
Symptoms of Charcot foot include:
- Mild to moderate pain and discomfort
- Temperature difference between two feet
What Happens If Charcot Foot Is Left Untreated?
Due to the lack of sensation brought about by neuropathy, a delay or lack of treatment can lead to open pressure sores or recurrent wounds and ulcers on the deformed foot. Bacteria can penetrate deep into the wound, leading to bone infection and a reduction in the function of joints and limbs, which would eventually result in amputation.
Even without the development of foot ulcers, patients with Charcot foot will experience a loss of mobility and an increased risk for falls due to the dysfunctional shape of their foot.
How Can a Podiatrist Help With Charcot Foot?
Podiatrists are trained to recognise the subtle symptoms of a foot undergoing destructive Charcot changes. A thorough physical examination and diagnostic imaging will be conducted to obtain an accurate diagnosis and treatment plan.
Your podiatrist will then customise your mode of treatment according to how far the foot deformity has progressed. Forms of treatment include:
- Stabilisation of the foot deformity using removable or fixed casts
- Use of advanced non-invasive modalities such as extracorporeal shockwave therapy treatment to reduce pain, swelling, and other symptoms
- Offloading and redistribution of abnormal pressure across the feet through the use of specialised orthotic devices
- Management of open wounds
- Prompt referral for surgical intervention if required
If you suspect that you have Charcot foot, seek prompt medical help from a local podiatrist in your area as soon as possible. Early intervention is key to reducing the progression of severe bone deformities and the occurrence of subsequent complications.