Charcot's foot in diabetes

We have had a number of threads in this lately, so though I would write something on it:

Charcot Foot

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Charcot's foot is an uncommon complication of diabetes that almost always occurs in those with neuropathy (nerve damage). Even though it is almost exclusively a diabetes problem it can occur in any condition in which there is a lack of sensation to the foot. When neuropathy is present, the bones in the foot become weakened and can fracture easily, even without there being any major trauma. As the neuropathy is present, the pain is not felt and the person continues to walk on it. This can eventually lead to severe deformities of the foot. As this can be very disabling, early diagnosis and treatment is vitally important.

Another way to think about it - imagine spraining your ankle and not knowing you have done this. You will continue to walk on it - imagine the damage that this would do. This is what happens in a Charcot foot.

What causes Charcot Foot:
In those with Charcot foot the ability to sense pain is usually lost or impaired (as a result of diabetic neuropathy). The muscles lose their ability to support the foot correctly. As a result of this, minor trauma (eg sprains; stress fractures) to the foot go undetected and do not get treated. This leads to a slackness of the ligaments (laxity), joints being dislocated, bone and cartilage being damaged and deformity to the foot

What are the symptoms of Charcot Foot:
The most early signs of Charcot's foot include the foot or affected part of the foot being warmer than the other foot, there will be some swelling and there may be redness - this is often all that is initially present (this can come on quite suddenly). There will be no pain and the circulation is usually very good. A deformity then will start to develop (as a result of joint subluxation/dislocation) as the arch of the foot collapses if the midfoot of the foot is affected and is left untreated.

In most cases only one foot is affected, but both feet can be affected over time. Generally, the diabetes is usually long standing and diabetic neuropathy (loss of sensation) is always present and often severe. However, some people with Charcot's foot can develop a "deep" aching type pain, but it is as never as severe as what would be expected given the extent of the injury.

What is the treatment for Charcots Foot:
The prevention of further joint destruction and foot deformity is the primary initial aim in treatment of Charcot's foot. Rest and stabilization of the area are a key. Most cases should be put in a plaster or fiberglass cast ('total contact cast') to relieve pressure and to prevent further deformity. These need to be replaced periodically until there is no temperature difference between the two feet. This can take up to 6-9 months. Care needs to be taken of the other foot to prevent problems developing.

A drug (bisphosphonates) have been shown to be useful as an adjunct in the management of Charcot's foot.

After the Charcot foot has healed specialized footwear and foot orthoses may be needed to prevent it happening again (this may depend on the extent of deformity). If treatment was not started early enough and/or the foot is deformed, the possibility of an ulcer developing is high. Prevention with footwear and foot orthoses is then very important.

If the deformity is severe or ulcer recurrence is a problem, surgery can be used to reshape the deformity. This may vary from a simple removal of a bony prominence to a fusion of joints to realign the foot.

What can you do to help Charcot Foot:
If you have a Charcot foot, following medical advice is important. Charcot foot can be very disabling if not managed early and properly. Avoid weightbearing as much as possible.

If you do not have Charcot foot but have diabetes and neuropathy (loss of sensation), the risk of developing it increases. Avoid putting yourself in situations that may lead to trauma. Check your feet frequently for any swelling. Do not wait, seek professional help urgently if you notice any. The 'wait a couple of days to see what happens' could mean the difference between a good and poor outcome.

More information:
Threads tagged with Charcots here at FHF
Threads tagged with Charcots at Podiatry Arena