Charcot foot is a disorder that leads to the destruction of joints in the foot. Charcot Foot commonly affects patients in the 50-60 age bracket and about 3% of all people with diabetes. A person who suffers from Charcot’s Foot often loses the sense of pain and positioning. As a result, the foot is unable to respond to abnormal stress subsequently leading to joint collapse and disintegration.
You will notice the following typically on one foot only:
- Localized redness
- An area on the foot feels warm
- Occasional loss of sensation on the foot
- Collapsing of the arch
- Bounding pedal pulses
- Ulceration-Changes in foot shape causes pressure points in the feet and poor healing which would eventually lead to ulceration
- Dislocation-Because of weakened joints
- Fracture- As a result of bone loss
- Deformity-The structure of the foot is no longer stable which causes the foot to collapse
- Amputation-As a last result for a severely ulcerated and gangrenous foot
The exact cause of Charcot’s foot is still unknown. There are 2 main theories. The first relates to lack of sensation.
- Loss of Sensation. Diabetics’ often develop neuropathy which is where they lose certain sensations. If damage is done to the joint and the patient cannot feel this then they will continue to walk on an injured area further compounding the damage. There is a high incidence of trauma to the joint before the onset of this disorder.
- Increased Blood Flow. Diabetes can actually increase the blood flow by enlarging the diameter of arteries (autonomic neuropathy). Increased blood flow increases the rate of bone reabsorption. This decreases the density of the bone and makes it more vulnerable to fracture.
- Combination. Most practitioners believe the truth involves a combination of the above two theories.
Treatment for Charcot Foot
- Aircast. Aircast with wound surveillance for 6-24 months.
- Footwear Selection. Extra depth of about ½ inch and width would be required to accommodate the deformed foot.
- Custom made Foot Orthotic. Essential to offload the pressure on the foot where bones have collapsed to prevent wounds.
- Surgery.If,There is severe joint/foot deformity and conservative measures have been exhausted
What does the surgical procedure usually involve?
The surgical procedure often involves one or more of the following procedure:
- Fusing of the bones in the foot to prevent further collapsing of the foot structure. This increases the stability of the foot structure
- Removing and cleaning the joint space in the foot to prolong and preserve movement in the joints
- Removal of bony areas which may causes excessive rubbing with shoes that may lead to ulceration
- Amputation as a final option if the foot could not be saved
Are there any risks associated with surgical procedures for a Charcot’s Foot?
Since most diabetic patients with Charcot’s foot also suffer from poor circulation to the feet, there is a high risk of delayed healing and possible postoperative infection. There is also a possibility of post operative complications such as:
- Stump Neuromas
- Recurrence of symptoms
- Incomplete release of metatarsal ligaments
- Small percentages of permanent numbness
What can you do?
The key to proper treatment of Charcot Foot is prevention. This could be achieved by visiting your podiatrist for regular screening. Your podiatrist would screen for:
- Changes in the way you walk
- Instability-Prevention of instability could be achieved by a custom made foot orthotics.
- Possible loss of sensation
- Any foot deformity
- Any excessive shock forces going through your foot. Your podiatrist would then prescribe cushioning insoles to reduce these forces.
The screening process helps you to be aware of the current condition of your feet. This would indefinitely minimize the risk of suffering from a more severe progression of this disorder.