Charcot (French word pronounced charco, the ‘t’ is silent) foot is a disease that causes sudden softening and weakening of the bones in the foot in people with diabetes and nerve damage (neuropathy). The bones are weakened enough to break and with continued walking, as the disorder progresses, the joints collapse and the foot takes on an abnormal shape. The bottom of the foot can become convex, bulging like the hull of a ship, no longer having an arch.
The condition is named after Dr. Jean Martin Charcot, a French physician who, in 1868, described this condition first seen in patients with advanced syphilis. Now, diabetes is the number one cause of Charcot foot in the world.
Charcot foot is a very serious condition that can also lead to severe disability, and even amputation. Because of its seriousness, it is important for patients with diabetes to take preventive measures and seek immediate care if signs or symptoms appear.
Charcot foot develops as a result of neuropathy, which decreases sensation and the ability to feel temperature, pain, or trauma to the feet. Due to lack of sensation, the patient may continue to walk on the injured foot — making the injury worse.
People with neuropathy, especially those who have had it for a long time, are at risk for developing Charcot foot. Those with a tight Achilles tendon, also tend to have a higher risk of developing Charcot foot.
How to prevent Charcot foot
The diabetic patient plays a vital role in preventing Charcot foot and its complications by:
• Keeping blood sugar levels under control, which can help reduce the progression of nerve damage (neuropathy) in the feet.
• Getting regular check-ups from a podiatrist to monitor for changes in the feet.
• Checking both feet every day — and seeing a podiatrist immediately if you notice signs of Charcot foot.
• Being careful to avoid injury, such as bumping the foot or overdoing an exercise program.
• Following the podiatrist’s instructions for long-term treatment to prevent recurrence of the Charcot, ulcers, and amputation.
Charcot can be very destructive to the foot and can lead to a number of foot problems, including joint loss, fractures, collapse of the arch and foot, massive deformity, ulcers, amputation, and even death. The early symptoms of Charcot foot may include:
• Warmth to the touch (the affected foot feels warmer than the other).
• Redness in the foot.
• Swelling in the area.
• Pain or soreness sometimes occur, however it is most often painless.
• Change in the shape of the arch and foot comes later.
Because the symptoms can be a bit vague and may not be painful due to the neuropathy, it is very important for diabetics with any swelling to the feet, especially without history of injury, to be suspicious for Charcot foot and to see a podiatrist as soon as possible.
Early diagnosis of Charcot foot is extremely important for successful treatment. But because the symptoms can be a bit vague, it can also be misdiagnosed. To arrive at a diagnosis, the doctor will examine the foot and ankle and ask about events that might have occurred before the symptoms started. X-rays are done to look at the bones and other imaging studies such as CT or MRI tests may be ordered. Temperature monitoring of the feet with a digital thermometer can also be done.
Once treatment begins, x-rays are taken periodically to monitor and evaluate the condition of the bones and the healing of the condition.
Charcot foot cannot be reversed, but its destructive effects can be stopped if the condition is detected early. There are several stages of the condition and the treatment is based on the stage and the severity. Once the diagnosis is made, hopefully in the first stage, there are several important treatment goals. The first is to get the heat and swelling under control. The second is to support or stabilize the foot to stop further injury and minimize deformity.
Non-surgical 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 have time to repair themselves. Complete non-weightbearing is necessary to keep the foot from collapsing. The patient will not be able to walk on the affected foot until the doctor sees it is safe to do so. During this period, the patient may be fitted with a cast (Total Contact Cast), removable boot, or brace. They may be required to use crutches or a wheelchair or even be on bed rest. It may take the bones several months or longer to heal, but this is individual to each patient.
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 the Charcot foot, development of ulcers, and possibly amputation. In cases with significant deformity, bracing is also required.
Activity modification: Activity level must be modified to avoid repetitive trauma caused by continued walking or sporting activity on the feet. A patient with Charcot in one foot is more likely to develop it in the other foot because of all the extra pressure on that foot, so measures must be taken to protect both feet.
It is extremely important for diabetics to follow the doctor’s treatment plan for Charcot foot. Failure to do so can lead to serious consequences such as ulcers, and even loss of a toe, the foot, leg, or life.
When surgery is needed
In some cases, the Charcot deformity may become severe enough that surgery is necessary. The foot and ankle surgeon will determine the proper timing as well as the appropriate procedure for the individual case. Most times, it may involve extensive surgery where the foot is held together with plates, pins and screws and a long healing time is needed to be sure the bones are fused together solidly.
• For more information on foot conditions, visit www.apma.org, healthcentral.com, or email us at firstname.lastname@example.org. To see a podiatrist, visit Bahamas Foot Centre, Rosetta Street, or telephone 325-2996 for an appointment at Bahamas Surgical Associates Centre, Hilltop Medical, or call 394-5820 for an appointment. You can also visit Lucayan Medical Centre in Freeport, Grand Bahama, or telephone 373-7400 for an appointment.