Charcot arthropathy, also known as Charcot foot deformity (pronounced “shar-koh”), is a progressive disease where the bones in the foot or ankle joints deteriorate, fracture and weaken, eventually changing the shape of the foot. The condition is primarily found in patients with neuropathy, and is often associated with diabetes. This is because diabetic neuropathy causes nerve damage, especially in the foot and ankle, which can lead to other health complications such as Charcot foot.
Charcot foot usually begins with inflammation, followed by the destruction or disappearance of bone tissue. As the deformity progresses, it can cause pain, difficulty wearing shoes, skin breakdown, nonhealing ulcers, and infections. The foot can take on an abnormal shape, with a “rocker bottom” in place of the arch. Because this condition can be severe and debilitating, early diagnosis and prevention are important in the treatment of Charcot foot.
Symptoms of Charcot Foot
If you are experiencing these symptoms, make an appointment with a podiatric surgeon to discuss treatment options:
- Loss of sensation in the foot or ankle
- Swelling in the affected area of the foot or ankle
- Insensitivity to heat or cold
- The affected area is warm to the touch
- Redness of the foot/ankle affected
- In severe cases, deformities of the foot and ankle will appear, including collapse of the midfoot arch (“rocker bottom”)
Causes and Factors Leading to Charcot Foot
Neuropathy, a disorder of the nerves, is the most common factor that can predispose you to developing Charcot foot. Because neuropathy decreases sensation and the ability to feel temperature, pain, or trauma in the affected area, you may be walking on the foot without realizing you are causing further damage.
What to Expect at Your Appointment
At your appointment you will receive a complete evaluation so your treatment team can develop a unique treatment plan specifically for you. After a careful physical exam and review of your symptoms, the podiatrist may order X-rays or other imaging studies to determine the severity of your condition and whether you are a good candidate for non-surgical treatment versus surgery.
Non-surgical treatment seeks to promote recovery of the bones by offloading the foot through immobilization and by preventing further foot fractures.
Immobilization: The Charcot foot is very fragile, and you should protect the weakened bones so that they can repair themselves. Your podiatric surgeon could recommend a long-term immobilization in order to avoid putting weight on the foot while it recovers. In some cases, you may be given a boot or brace to wear, and/or crutches or a wheelchair to move around. The recovery time can be several months, or longer for some patients.
Custom shoes and bracing: After the bones have healed, you can wear shoes with special inserts to help support your bones in daily activities. These inserts help to protect and prevent the reoccurance of Charcot foot, and to prevent the development of non-healing ulcers on the skin. In severe cases with significant deformity, bracing may also be used.
Activity modification: It may be suggested that you modify activity level in order to avoid repeated trauma to your foot and ankle. Because Charcot foot could also develop in your other foot, you must take care to protect both feet.
Surgical Treatment and Post-Treatment
For straightforward cases, the deformity can be corrected in a single procedure to alleviate pressure points associated with foot ulcers. After surgery, the patient is in a cast for several weeks, followed by a transition to a boot, and later, to supportive shoes, over the course of several months.
For more complicated cases a more extensive, reconstructive surgery may be required to realign and fuse the foot in a more anatomic position. Only in severe cases would amputation be necessary in order to get rid of a dangerous infection to restore your overall health and wellbeing.
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