This condition, first described in 1881 by Jean-Martin Charcot, is also known as “neuropathic osteoarthropathy,” which can literally be translated into “a joint destructive process from the body’s inability to adequately feel normal sensation.”
This most frequently occurs in individuals with the inability to feel normal stimuli to the feet such as pressure, warmth, cold or irritation. It is believed that more than half of the cases of Charcot develop as a result of the smallest of injuries in patients with neuropathy.
Initial symptoms of Charcot may include warmth and swelling that may often mimic other conditions such as blood clot or infection. During periods of swelling and warmth, pressure placed on the foot can cause its structure to change and in some cases, in an irreversible manner with permanent deformity. This deformity can result in boney prominences and skin break down that lead to ulceration and infection of skin or bone resulting in amputation.
Treatment is centered around off-loading or taking pressure away from the affected leg by use of a removable boot, or a specially molded boot called a CROW which shields the foot from excess pressure. More recently, manufactures have offered fiberglass systems and boots that are considered the “gold standard” for off-loading that can be applied in your doctor’s office and have shown more promise in promoting wound healing than removable boots. These methods are used to shield the foot and ankle until the inflammation has subsided and gone through a less acute stage to become more consolidated at which point the removable walker, CROW or Total Contact Cast is removed.
Depending on the deformity that remains, custom molded shoes and insoles or special bracing may be utilized to protect the foot from future ulceration and limb loss. If conservative measures are not able to keep the foot free of ulceration and infection, surgical intervention may be utilized to prevent recurrent ulceration and skin break down.