How Can Charcot Foot Treated?
Charcot foot is the most important management strategy and could arrest the progression to deformity. A Charcot’s foot is characterized by varying degrees of bone and joint disorganization secondary to underlying neuropathy, trauma, and perturbations of bone metabolism. Early diagnosis of Charcot’s foot is extremely important for successful treatment
Charcot’s foot is a condition causing weakening of the bones in the foot that can occur in people who have significant nerve damage (neuropathy). A Charcot’s foot is a serious condition that can lead to severe deformity, disability, and even amputation. The acute Charcot foot is usually painless and may mimic cellulitis or deep venous thrombosis.A Charcot’s foot is a neuro-arthropathic process with osteoporosis, fracture, acute inflammation and disorganization of foot architecture.
What is Charcot Arthropathy? Charcot foot, as it is commonly referred to, is a chronic progressive disease of the bone and joints found in the feet and ankles.
Your patient with Charcot foot will present with a painless, warm, reddened and swollen foot. You may see dependent rubor, bounding pedal pulses, and feel or hear crackling of the bones when moving the foot. If a patient were to continue to bear weight on the Charcot foot there is a high chance for ulceration that could potentially lead to infection and/or amputation.
What leads to this Charcot foot? Having long standing diabetes for greater than 10 years is one contributing factor. Having autonomic neuropathy leads to abnormal bone formation and having sensory neuropathy causes the insensate foot, or foot without sensation and thus susceptible to trauma, this is another contributing factor. These bones in the affected foot collapse and fracture becoming malformed without any major trauma.
One common malformation you see related to Charcot foot is the “rocker bottom” where there is a “bulge” on the bottom of the foot where the bones have collapsed. Continued, on-going weight-bearing can result in a permanently deformed foot that is more prone to ulceration and breakdown. See more here.
The Charcot foot is characterized by erythema, edema and elevated the temperature of the foot that can clinically mimic cellulitis or gout.
Signs and Symptoms of Charcot Foot
While peripheral neuropathy often develops over decades, the progression of Charcot foot can occur in a matter of weeks or months. Minor trauma, such as twisting the foot, can initiate the process. In patients with Charcot foot, the loss of pain perception and loss of the sense of foot position can result in repeated joint injuries.
Symptoms of Charcot foot include the following:
- Dislocation of the joint
- Insensitivity in the foot
- Instability of the joint
- Strong pulse
- Swelling of the foot and ankle (caused by synovial fluid that leaks out of the joint capsule)
- Subluxation (misalignment of the bones that form a joint)
Nerve damage causes muscle weakness and slack ligaments, which result in joint instability and subsequent subluxation and/or dislocation. Subluxation initiates the process of degenerative joint disease (arthropathy). The ends of misaligned bones grind against each other and fragments of bone and cartilage enter joint and often produce a coarse grating sound (audible crepitus) when the joint is moved. The physician may be able to feel these fragments in the joint. Read more here.
Charcot’s foot is treated by reducing pressure on the foot and wearing a plaster cast to allow the foot to set and heal in the correct position.
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.
Nonsurgical 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 nonweightbearing 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. Read full article here.
Charcot Foot Can Lead To Changes In The Bone Structure Of The Foot
A Charcot’s foot is a condition that affects the bones, joints, and soft tissues of the foot or ankle. The initial manifestations of the Charcot’s foot are frequently mild in nature but can become much more pronounced with unperceived repetitive trauma. Causes of Charcot Foot are tied to neuropathy, which reduces the nerves in the foot, specifically the ability to feel temperatures, pain, and trauma. Other conditions that can cause Charcot foot are leprosy, alcoholism, syphilis, and smoking.
Charcot’s foot is a progressive, degenerative condition that affects the joints in the feet and is most commonly associated with vascular complications and nerve damage (neuropathy). Bones affected by Charcot’s foot are weakened to the point of fracture, causing joints to collapse and the foot to change shape. The gold standard for treatment of early stages of Charcot’s foot is immobilization with a full contact plaster cast, whereby different periods and loading concepts are described in the literature, you may call us here: (619) 831-8777.