TIP OF THE MONTH: February/March 2013
Understanding Charcot Foot

by Kristie Woolems, OTC

Charcot foot is a condition that refers to progressive degeneration of bones and weight bearing joints in the foot. The condition is a complication of neuropathy (nerve damage) that commonly occurs in patients with diabetes. Charcot disease gets its name from French neurologist and anatomical pathologist Jean-Martin Charcot (1825-1893), who was the first to describe the condition. Charcot foot should not be confused with Charcot-Marie-Tooth disease.

The onset of Charcot foot is generally subtle and worsens with time and increased diabetic neuropathy. Neuropathy decreases the patient’s ability to feel temperature, pain, and trauma in the foot. When weight-bearing bones weaken and fracture, the pain goes unnoticed by the patient, and they continue to walk on the foot, which ultimately worsens the condition. Eventually, joints collapse and the foot becomes abnormally shaped, often taking on a rocker-bottom appearance. Charcot foot can lead to severe deformity, disability, and possible amputation.

The cause of Charcot foot is a result of neuropathy, which decreases the ability to feel temperature, pain, or trauma. When a patient has neuropathy, pain goes unnoticed, and a patient continues to walk on the affected foot, ultimately worsening the condition. Due to the seriousness of Charcot disease, patients with diabetes should take preventative measures and immediately seek care if symptoms present.

Other conditions that may contribute to Charcot disease may include:
•Osteopenia: a condition that refers to lower-than-normal bone mineral density, often found in patients with vascular disease.
•Neuropathy combined with a tight Achilles tendon.
•Other neuropathic conditions, such as Neurosyphilis, spinal cord injury, Syringomyelia, peripheral nerve injury, Pernicious anemia, and Hansen’s disease.
•Frequent cortisone injections, which lead to joint destruction.

Early common symptoms of Charcot foot may include:
•The affected foot feels warmer to the touch than the other foot
•Redness in the foot
•Small hairline fractures may be visible on radiographs
•Swelling in the area
•Later the entire foot becomes inflamed
•Little pain, if any, will be felt during this period

This acute stage can often mimic cellulitis, so it’s important for the patient to seek immediate attention to get a clear diagnosis.. Cellulitis symptoms include: fever, pain or tenderness in affected area, skin redness, and inflammation.

Late symptoms (chronic) of Charcot foot include:
•Foot deformity and a clear difference in appearance than opposite foot.
•Collapsed arch.
•Bones unusually sticking out against skin, causing this area of skin to collapse and develop ulcers.
•Inflammation and swelling of affected foot.
•Pain experienced by the patient can range from none to severe pain.
•Ulcerations can become infected and spread to the bone and joint.
•Tiredness and fever.

The chronic stage presents a very big cause for concern, due to the advancement in disease and complications that occur. The dangers of losing a foot, toe, or leg can be extremely high at this stage.

Early diagnosis of Charcot foot is extremely important to treat the patient successfully. Arriving at a diagnosis will involve the surgeon examining the foot and ankle and inquiring about the history of events leading up to the symptoms. The surgeon will most likely order X-rays and other diagnostic tests to arrive at a definitive diagnosis.

Treatment of Charcot foot is vital to prevent continued advancement. Rest and stabilization of the affected area are key to protect the weakened bones to facilitate in their repair. The patient should be instructed to follow strict non-weight bearing status, and may be fit with a total contact cast to relieve pressure and prevent further deformity. The cast will need to be replaced periodically until there is no temperature difference between the two feet. This period can last six to nine months (time varies with each specific case). Removable boots may also be used to immobilize the affected foot.

The opposite foot on the patient must be closely watched and protected to prevent problems from developing. Once the Charcot foot has healed, specialized footwear and foot orthosis may be needed to prevent the condition from recurring. This will depend on the extent of deformity that has occurred. Progression to custom footwear and orthosis will enable the patient to return to daily activities.

Some patients with severe Charcot deformity may require surgery. The surgeon will determine if surgical intervention is necessary, proper timing, and the appropriate procedure.

Prevention of Charcot foot should involve protection of both feet, due to the high likelihood of developing the condition in the opposite foot. Patients play a critical role in preventing Charcot foot and should be advised to follow these measures:
•Keep blood sugar levels under control to help reduce the progression of nerve damage in the feet.
•Get regular check-ups by a foot and ankle surgeon.
•Check both feet daily, and see a foot and ankle surgeon immediately if any signs of Charcot foot are present.
•Avoid injury, such as bumping feet or overdoing an exercise program.
•Follow your practitioner’s instructions for long-term treatment and prevention of recurrence, ulcers, and amputation.