Charcot Foot

If you have diabetic neuropathy and thus reduced sensation in your feet, you are at a high risk for developing Charcot foot.

This abnormality of the foot, characterized by pain, redness, swelling and increased foot temperature, is a degenerative condition whereby the joints of the arch collapse due to impaired sensation to pain. Oftentimes, only minor trauma is present to initiate the sequence of events, so it's extremely important for diabetics to pay extra attention to their feet.

When these minor episodes go untreated, small fractures around the joint pass unrecognized, eventually leading to active bone resorption, or the washing out of mineral from the bone. Bone resorption compromises the area and produces larger fractures and joint damage.

Motor neuropathy, impaired nerves for control of the muscle, causes mechanical deformities and imbalance, and later results in the breakdown of the intrinsic musculature that acts as stabilizers of the foot. It may also affect larger, more proximal muscles, causing muscle imbalance and abnormalities in the feet.

As stated above, Charcot foot causes pain and swelling. For that reason, it is often mistaken for osteoarthritis, a much slower progressive deformity. It's important to talk to your doctor if you notice these symptoms – especially if you have diabetes.

Other signs and symptoms include the following:

• Pain, which may decrease or disappear for periods of
  time due to the neuropathic component of the deformity.
• Massive joint effusion or swelling.
• Bone destruction, which occurs at various locations
  in the rearfoot and midfoot areas.

Prevention in an at-risk patient is very important. Here are some tips for helping avoid the development of Charcot foot.

• Wear good, supportive shoes – like those from Drew or
  Apex – with a soft insole of micro cellular rubber to absorb shock. Extra depth oxfords are also a good choice.
• Do not walk around barefoot.
• Wear seam-free socks that won't irritate sensitive
  or diabetic feet.
• Maintain a high index of suspicion and check your feet often for early signs of Charcot foot to prevent further bone destruction. You may want to try using a good foot inspection mirror on a daily basis.

• Also, please note that this condition is often times missed by the best of doctors or left under treated as if it were something else, such as arthritis.

• Rest is often required.
• Immobilization and engaging in non-weight bearing activities
  is imperative with any fracture, whether it is painless or not.
  The use of compression dressings to reduce edema, special surgical shoes, splints, upright braces, casts, walkers or crutches, and wheelchairs will be necessary in varying degrees.

• Immobilization typically requires three to four months. Return
  to activity should be gradual with the use of an extra depth or custom molded shoes with added shock absorptive insole materials.

Surgical intervention is typically complex, involving arthrodesis (fusion) type procedures and the use of bone grafts and internal fixation devices to stabilize, restore position and function, and prevent further destruction.