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.FAQ
Charcot Foot is a very serious condition that should be treated by your podiatrist and may result in the foot appearing red, warm and swollen without any pain. Clinical exam and visit to your podiatrist is absolutely necessary to begin prompt treatment but also to rule out other sources of redness, pain and swelling such as gout and foot infection.
The simplest way to evaluate for Charcot is to perform an X-ray to evaluate the bones and joints in the foot for normal alignment. X-rays can be used to track Charcot through the many phases to assure proper healing and resolution. If warranted the treating physician may order additional imaging studies such as an MRI, CT Scan or bone scan.
Typically the acute phase of Charcot lasts 4-6 months and immobilization is paramount in treatment to provide serious foot collapse and limb loss.
It is common for podiatrists to treat Charcot as they are specialists in the feet and treatment of foot conditions. The podiatrist typically will immobilize the foot and leg for a period of time during the acute phase of swelling, redness and warmth and later may depending on results consider surgical reconstruction if necessary.
