Charcot foot

Charcot foot, also known as neuropathic osteoarthropathy, is a degenerative complication that can arise due to diabetes. Charcot foot is commonly associated with conditions that lead to peripheral neuropathy, such as diabetes mellitus.

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Overview

Charcot foot is a serious condition that affects the bones, joints, and soft tissues of the foot and ankle. It often develops in people with nerve damage, particularly those with diabetes. This condition causes neuropathy or numbness and reduced sensitivity.

Signs and symptoms to watch for:

  • Changes in foot shape or size
  • Redness or swelling in the foot or ankle
  • Abnormal or painless cracks or calluses on the foot
  • Unstable or wobbly feeling when walking

Charcot foot occurs in stages:

  • Inflammation from acute or chronic trauma leads to breakdown of the bone (osteolysis)
  • 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 which leads the diabetic patient to continue with normal motion, causing further irreversible damage to the foot

Charcot foot can result in the destruction of bone, complex fractures, and unrelenting structural 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, often mistaken for adult-acquired flatfoot disorder (AAFD). Symptoms can also be mistaken for conditions like cellulitis, deep vein thrombosis, and acute gout.

What Happens If Charcot Foot is Unaddressed?

Due to the lack of sensation, charcot foot can lead to open pressure sores, recurrent wounds and ulcers. Bacteria can penetrate deep into the wound, leading to bone infection and a reduction in the function of joints and limbs. In severe cases, it may result in amputation. Even without the development of foot ulcers, patients with Charcot foot may experience a loss of mobility and an increased risk for falls due to the dysfunctional shape of the foot.

How Can a Podiatrist manage Charcot Foot?

Podiatrists are trained to recognise subtle symptoms of a foot undergoing destructive Charcot changes. They conduct a thorough physical examination and diagnostic imaging for an accurate and intervention plan. Key management approaches include:

  • Stabilisation of foot deformity using removable or fixed casts
  • Use of advanced non-invasive modalities such as extracorporeal shockwave therapy to reduce pain, swelling, and other symptoms
  • Offloading and redistribution of abnormal pressure across the feet through specialised orthotic devices
  • Management of open wounds
  • Prompt referral for surgical intervention if required

If you think you may have Charcot foot, it is crucial to see a foot specialist or podiatrist promptly. Early diagnosis and intervention can prevent progression and reduce the risk of complications. Regular foot checks and early diagnosis are essential for individuals with nerve damage.


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Common Symptoms

Swelling
Warmth
Inflammation
Mild to moderate pain and discomfort
Temperature difference between two feet

How It Looks Like

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I came in for foot pain which lasted for about 2+ months. I was only managing with painkillers throughout this period till I decided to give a shot at East Coast Podiatry. My podiatrist, Ari, was very warm since the beginning and assessed my condition, afterwhich she was able to pinpoint the underlying cause of my pain. After a few sessions , I'm glad that the pain has been resolved. Another key highlight about Ari is that she assessed my condition and manage it for the long run also. Based on my condition, she planned out a 1 year program to help optimise my current condition (e.g. Customised insoles, regular reviews). Overall, Ari and the team have done a superb job in ensuring i get the best solution possible. I would strongly recommend East Coast Podiatry for those who have lower limb problems!

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An ankle specialist, such as a podiatrist, will be able to perform a thorough foot assessment using diagnostic tools, such as a musculoskeletal diagnostic ultrasound to determine the source of your ankle pain. If surgery is required, your podiatrist will refer you to a trusted foot and ankle doctor for surgical solutions.

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