Charcot Foot

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Charcot Foot

http://www.footphysicians.com/footankleinfo/charcot-foot.htm

What is Charcot Foot?

Charcot foot is a sudden softening of the bones in the foot that can

occur in people who have significant nerve damage (neuropathy). The

bones are weakened enough to fracture, and with continued walking

the foot eventually changes shape. As the disorder progresses, the

arch collapses and the foot takes on a convex shape, giving it a

rocker-bottom appearance, making it very difficult to walk.

Charcot foot is a very serious condition that can lead to severe

deformity, disability and even amputation. Because of its

seriousness, it is important that patients with diabetes—a disease

often associated with neuropathy—take preventive measures and seek

immediate care if signs or symptoms appear.

Symptoms

The symptoms of Charcot foot can appear after a sudden trauma or

even a minor repetitive trauma (such as a long walk). A sudden

trauma includes such mishaps as dropping something on the foot, or a

sprain or fracture of the foot. The symptoms of Charcot foot are

similar to those of infection. Although Charcot foot and infection

are different conditions, both are serious problems requiring

medical treatment.

Charcot foot symptoms may include:

Warmth to the touch (the foot feels warmer than the other)

Redness in the foot

Swelling in the area

Pain or soreness

What Causes Charcot Foot?

Charcot foot develops as a result of neuropathy, which decreases

sensation and the ability to feel temperature, pain or trauma. When

neuropathy is severe, there is a total lack of feeling in the feet.

Because of neuropathy, the pain of an injury goes unnoticed and the

patient continues to walk—making the injury worse.

People with neuropathy (especially those who have had it for a long

time) are at risk for developing Charcot foot. In addition,

neuropathic patients with a tight Achilles tendon have been shown to

have a tendency to develop Charcot foot.

Diagnosis

Early diagnosis of Charcot foot is extremely important for

successful treatment. To arrive at a diagnosis, the surgeon will

examine the foot and ankle and ask about events that may have

occurred prior to the symptoms.

X-rays are also essential for diagnosis. In some cases, other

imaging studies and lab tests may be ordered. Once treatment begins,

x-rays are taken periodically to aid in evaluating the status of the

condition.

Treatment

Following the surgeon's treatment plan for Charcot foot is extremely

important. Failure to do so can lead to the loss of a toe, foot, leg

or life.

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 soft bones can

repair themselves. Complete non-weightbearing 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. Bracing is required

in cases with significant deformity.

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.

Surgery. In some cases, surgery may be required. The foot and ankle

surgeon will determine the surgical procedure best suited for the

patient based on the severity of the deformity and the patient's

physical condition.

Preventive Care

The patient can play a vital role in preventing Charcot foot and its

complications by following these measures:

Diabetes patients should keep blood sugar levels under control. This

has been shown to reduce the progression of nerve damage in the

feet.

Get regular check-ups from a foot and ankle surgeon.

Check both feet every day—and see a surgeon immediately if there are

signs of Charcot foot.

Be careful to avoid injury, such as bumping the foot or overdoing an

exercise program.

Follow the surgeon's instructions for long-term treatment to prevent

recurrences, ulcers and amputation.