About Charcot Foot – diagnosis, treatment and post treatment

Although Charcot foot can occur in connection with a variety of conditions, worldwide it is most commonly associated with diabetes and it’s one of the most serious foot problems that diabetics can face.  First described in 1883, the syndrome still poses many clinical challenges both in its diagnosis and in its management.

Effectively a progressive degeneration of the joints in the foot, the condition is often unrecognised in its earliest phase. This is because it simply manifests itself as a very swollen, warm and reddened foot which is slightly uncomfortable and with a loss of sensation in the immediate area.

The condition is sometimes mistaken for deep vein thrombosis however the foot is prominently more swollen than in DVT. And the existence of little or no pain can mislead both doctors and patients who may use the level of pain as an indicator to the seriousness of a condition.

Left unmanaged Charcot foot leads to ulceration of the skin and to a significant disruption of the bony architecture of the foot through bone destruction/misalignment /dislocation. Its hallmark deformity is mid-foot collapse – commonly described as “rocker-bottom” foot.

If unrecognised or improperly managed there can be severe consequences of the condition including amputation.

Diagnosis

Trauma seems to play a part in the onset of the condition - in about 50% of cases the patient will remember a preceding slip or trip or they may have had unrelated foot surgery.

Whilst X Rays can provide information on bone structure and alignment they may not pick up the condition in the early stages and will appear normal. For this reason an MRI scan is recommended for diabetic patients where there is a suspicion of Charcot foot as this will pick up on bone and tissue changes in more detail.

Treatment

The most important initial treatment involves taking the pressure off the foot (off-loading) by immobilising it in a specialist cast which redistributes the weight and pressure in the lower leg and foot.  This cast should be replaced every 1 to 2 weeks as the swelling can subside significantly in the first few weeks. It can take between 6 to 9 months for the swelling and temperature to entirely recede and the total healing process typically takes between 1 and 2 years.

Total non-weight bearing is the ideal treatment but this is not always possible.  However, crutches, a Zimmer frame or a wheelchair are usually necessary until the bones begin to heal.

The combination of weight bearing versus non weight bearing and the length of time in a cast can only be guided by clinical assessment which will be monitoring the individual swelling, redness, healing and skin temperature of the foot.

Alongside off-loading the condition also requires treatment of any abnormally functioning blood vessels and of infection/ulceration.

In severe cases where earlier treatment has not taken place or is unsuccessful there are surgical procedures that can be applied. These include the removal of bony protuberances; the lengthening of the Achilles tendon or gastrocnemius tendon or the surgical immobilisation of the ankle. However,  all of these methods are avoided during any period of inflammation because of the increased risk of infection.

Post Treatment

After the swelling has been reduced and the bones start to re-fuse a specialised walking boot or diabetic shoe is likely to be recommended as over the counter-shoes will not correctly fit the deformed foot. It is vital to have lifelong protection of the foot.

Patients who have suffered from Charcot Foot will be advised to have lifetime monitoring to watch out for new episodes of the syndrome or indeed other diabetic foot complications. This is crucial since 25% of patients will develop a similar condition in the other foot.

Although every effort is made to ensure that all health advice on this website is accurate and up to date it is for information purposes and should not replace a visit to your doctor or health care professional.

 As the advice is general in nature rather than specific to individuals Dr Vanderpum cannot accept any liability for actions arising from its use nor can he be held responsible for the content of any pages referenced by an external link.