Charcot foot is one of the many complications that can occur from diabetes. Charcot is a form of arthritis that affects the joints and bones in the feet. Patients with diabetes often have decreased sensation in their lower legs and feet, a condition known as peripheral neuropathy. Because of the decreased sensation, someone with neuropathy does not have the ability to sense pain like someone with full sensation would. This means that repetitive injury to the feet can occur without the patient even knowing it. Continued trauma combined with the resulting increased blood flow to the area causes the bones and joints to weaken.
Acute Charcot is recognized clinically by warmth, swelling, and redness of the skin. X-rays show massive destruction, fractures, and dislocation of bone. As Charcot progresses, the bones will remodel, but the foot will remained deformed. Most commonly Charcot results in a “rocker-bottom foot,” aptly named because of the arch collapse that creates a bony prominence on the sole of the foot. It is common to have a foot ulcer form beneath the collapsed arch. The ulcer forms because of the increased pressure beneath the bones in the arch.
Early diagnosis is key for decreasing the complications of Charcot foot. By recognizing the problem quickly, progression of the deformity can be slowed or halted by staying off of the foot until the acute phase of the disease is over. Reducing the amount of trauma to the foot allows the body a chance to start the healing process. This can often take quite a bit of time, but maintaining a complete non-weight-bearing state is crucial for healing to occur.
After the acute phase of Charcot is over, preventive care is needed to promote further healing and to avoid recurrence. Custom bracing, and or prescription orthotics are needed to accommodate the new foot shape and prevent injury to the foot. Patients should keep blood sugar levels in check, and inspect their feet daily to identify any injuries that could lead to further problems.