What is Charcot Foot?
This is a condition that occurs in joints that do not have normal feeling due to abnormal nerves. This is a common complication of diabetes. Charcot joint usually occurs in the feet, but can occur in other joints. It is a very serious condition, and can lead to disintegration of the joint, change of the shape of the foot and ulceration.
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Causes
Charcot foot is caused by abnormal nerves in the joint, called 'neuropathy'. Science has not determined why it exactly happens to some people and not others. It is rare, and occurs in about 1% of people with diabetes. Because the foot shape changes or 'collapses', there is increased pressure on the prominences of the foot and because there is no pain, people continue to walk. This can lead to ulceration, bone infection and potential amputation.
Risk Factors
- Diabetes
- Increased alcohol intake
- Smoking
Symptoms
- Redness
- Swelling
- Warmth
- Some people may feel pain
- It can be triggered by a trauma
- In later stages, the foot shape changes and can lead to ulcers and infection
Diagnosis
Early diagnosis is difficult but very important! A patient with diabetes that has a red hot swollen foot needs to have immediate treatment. Before any bony changes on ray, and MRI may be needed to help with the diagnosis. Blood tests will be required to rule out infection.
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Management
Charcot foot is an emergency. It needs to be treated immediately to prevent foot collapse as the foot and ankle bones are very fragile during the early stages of charcot.
- Strict diabetic control, usually with the help with an endocrinologist
- Complete non weight bearing immediately; this can require admission to hospital
- Total contact casting (This is a specialised form of casting that needs to be changed every week to prevent deformity of the joint)
- Once the foot has healed in the final position, it is important to continue seeing a diabetic foot clinic on a regular basis. Any ulceration is an emergency.
- CROW boot (CROW stands for Charcot Restraint Orthotic Walker. It is a custom made clam shell boot to offload pressure)
Surgery can be considered if the foot shape is at risk of ulceration and amputation. If you would like an opinion on this condition, please book an appointment with Dr Christy Graff.
Useful Websites
Healthline
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