Charcot Foot

What Is Charcot Foot?
Charcot foot is a
condition causing weakening of the bones in the foot that can occur in
people who have significant nerve damage (neuropathy). The bones are
weakened enough to fracture, and with continued walking the foot
eventually changes shape. As the disorder progresses, the joints
collapse and the foot takes on an abnormal shape, such as a
rocker-bottom appearance.

Charcot foot is a very serious condition that can lead to severe
deformity, disability, and even amputation. Because of its seriousness,
it is important that patients with diabetes—a disease often associated
with neuropathy—take preventive measures and seek immediate care if
signs or symptoms appear.

flatfoot3Charcot

Causes
Charcot foot develops as a result of
neuropathy, which decreases sensation and the ability to feel
temperature, pain, or trauma. Because of diminished sensation, the
patient may continue to walk—making the injury worse.

People with neuropathy (especially those who have had it for a long
time) are at risk for developing Charcot foot. In addition, neuropathic
patients with a tight Achilles tendon have been shown to have a
tendency to develop Charcot foot.

Symptoms
The symptoms of Charcot foot may include:

  • Warmth to the touch (the affected foot feels warmer than the other)
  • Redness in the foot
  • Swelling in the area
  • Pain or soreness

Diagnosis
Early diagnosis of Charcot foot is
extremely important for successful treatment. To arrive at a diagnosis,
the surgeon will examine the foot and ankle and ask about events that
may have occurred prior to the symptoms. X-rays and other imaging
studies and tests may be ordered.

Once treatment begins, x-rays are taken periodically to aid in evaluating the status of the condition.

Non-Surgical Treatment
It is extremely important
to follow the surgeon’s treatment plan for Charcot foot. Failure to do
so can lead to the loss of a toe, foot, leg, or life.

Non-surgical treatment for Charcot foot consists of:

  • Immobilization. Because the foot and ankle
    are so fragile during the early stage of Charcot, they must be
    protected so the weakened bones can repair themselves. Complete
    non-weightbearing is necessary to keep the foot from further
    collapsing. The patient will not be able to walk on the affected foot
    until the surgeon determines it is safe to do so. During this period,
    the patient may be fitted with a cast, removable boot, or brace, and
    may be required to use crutches or a wheelchair. It may take the bones
    several months to heal, although it can take considerably longer in
    some patients.
  • Custom shoes and bracing. Shoes with
    special inserts may be needed after the bones have healed to enable the
    patient to return to daily activities—as well as help prevent
    recurrence of Charcot foot, development of ulcers, and possibly
    amputation. In cases with significant deformity, bracing is also
    required.
  • Activity modification. A modification in
    activity level may be needed to avoid repetitive trauma to both feet. A
    patient with Charcot in one foot is more likely to develop it in the
    other foot, so measures must be taken to protect both feet.

When is Surgery Needed?
In some cases, the
Charcot deformity may become severe enough that surgery is necessary.
The foot and ankle surgeon will determine the proper timing as well as
the appropriate procedure for the individual case.

Preventive Care
The patient can play a vital role in preventing Charcot foot and its complications by following these measures:

  • Keeping blood sugar levels under control can help reduce the progression of nerve damage in the feet.
  • Get regular check-ups from a foot and ankle surgeon.
  • Check both feet every day—and see a surgeon immediately if you notice signs of Charcot foot.
  • Be careful to avoid injury, such as bumping the foot or overdoing an exercise program.
  • Follow the surgeon’s instructions for long-term treatment to prevent recurrences, ulcers, and amputation.

Excerpted from www.footcarefacts.org

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