What is Charcot foot?

Charcot or Charcot neuropathic osteoarthropathy is the progressive collapse of the foot and ankle joints. This is a very serious and potentially limb-threatening lower-extremity complication of diabetes and neuropathy. Charcot leads to degeneration of the joints: this can cause bony prominence which leads to open sore and lesions. These lesions can then cause bony infection (osteomyelitis). If left untreated charcot will often lead to below the knee amputations.

What Causes Charcot Foot?

Charcot is most common in patients with diabetes and underlying neuropathy. The loss of sensation leads to microtrauma of the foot and ankle joints. Without proper feedback, the bones and joints start to degenerate. Poor diabetic control can lead to faster wear and tear. Onset can be due to an injury that goes unrecognized, and without proper treatment, it leads to further degeneration. 

What are the Symptoms of Charcot?

Early Phase:

  • Red inflamed foot
  • Pain with ambulation
  • Feeling on instability 
  • Dislocation of the joints

Late Phase

  • Deformity
  • Rocker bottom foot
  • Hard stiff foot due to consolidation of the joints
  • Open wound at the level of the deformity

How to Diagnose & Treat Charcot Foot?

Diagnosis starts with a good history and physical exam. Your physician will take X-rays to assess for joint instability. Further imaging such as Bone scans/MRI/CT scans may be required for proper diagnosis and treatment.

Treatment depends on multiple factors such as the stage of Charcot, patient’s age, diabetes sugar control, patient compliance, presence of bone infection, and ulcers. 

Early Phase: For patients that are diagnosed in the early phase. The goal of treatment is to prevent further collapse of the joints. This can be accomplished with immobilization with a total contact cast or an external fixator.

Late Phase:  This is for patients who already have a collapse of the foot and ankle. 

  • Conservative treatment relies on the use of diabetic shoes with custom insoles or even a crow walker. This is for pressure redistribution to prevent foot sores and ulcers. 
  • Surgical intervention is for those that have failed conservative therapy. The procedure of choice is very patient dependent. Surgical interventions range from bone spur removal, reconstructive surgery, ankle joint fusion, midfoot fusion, limb lengthening, use of external fixator, TTC fusion.

How to prevent Charcot Foot?

The best treatment for charcot is prevention. The importance of doing daily foot checks to look for any deformity, redness, swelling. Glycemic control plays an important part in the progression of diabetes and Charcot. A good pair of diabetic shoes with insoles for better pressure distribution. A diabetic foot check with your podiatrist is key to preventing diabetes.