Description

Most foot problems that people with diabetes face arise from two serious complications of the disease: nerve damage and poor circulation. Charcot Foot is one of the more critical foot problems and complications can cause Charcot arthropathy, which can deform the shape of the foot and lead to disability.

Nerve damage (neuropathy) is a complication of diabetes that leads to a loss of sensation in the feet. Diabetes also damages blood vessels, decreasing the blood flow to the feet. Poor circulation weakens bone, and can cause disintegration of the bones and joints in the foot and ankle. As a result, people with diabetes are at a high risk for breaking bones in the feet.

When a diabetic fractures a bone in the foot, he or she may not realize it because of nerve damage. Continuing to walk on the injured foot results in more severe fractures and joint dislocations. The combination of bone disintegration and trauma can warp and deform the shape of the foot. This condition is called Charcot arthropathy, and is one of the most serious foot problems that diabetics face.

Classification

The Eichenholtz classification is most commonly used to describe charcot changes within the foot.

• Stage 1: Fragmentation phase – characterized by the destruction of the bone, fractures, joint subluxation and potential risk of instability
• Stage 2: Transitional period of coalescence – osseous destruction can occur with resultant deformity leading to risk of ulceration
• Stage 3: Period of consolidation – bone heals in a suboptimal position with deformity. This can lead to shoewear difficulty, increased risk of ulceration and deep infection

Symptoms

Although a patient with Charcot arthropathy typically will not have much pain, they may have other symptoms.

• The most sensitive sign of early charcot foot is swelling of the foot. This can occur without an obvious injury
• Redness of the foot can also occur in the early stages
• Increase in temperature compared to other foot

Treatment

Casting
The early stages of Charcot are usually treated with a cast or cast boot to protect the foot and ankle. The use of a cast is very effective in reducing the swelling and protecting the bones.
Casting requires that the patient not put weight on the foot until the bones begin to heal. Crutches, a knee-walker device, or a wheelchair are usually necessary. Healing can sometimes take 3 months or more. The cast will usually be changed every week or two to make sure that it continues to “fit” the leg as the swelling goes down. Accommodations for work and school will have to be made.

Custom shoes or boots
After the initial swelling has decreased and the bones begin to fuse back together, a specialized custom walking boot or diabetic shoe may be recommended. The specialized shoe is designed to decrease the risk of ulcers (sores that do not heal). Some diabetics may not be able to wear regular, over-the-counter shoes because they do not fit the deformed foot correctly.

Diabetic control
Being aware of the diabetes is essential to limit for active pathology. Sugar control is imperative to prevent the recurrence of Charcot in the future along with proper diabetic style show wear and orthotics. Regular follow up will be necessary

In rare cases, Charcot foot may lead to amputation of the foot.