CHARCOT FOOT
Charcot foot is an insidious condition characterized by weakening of the weight bearing bones, destruction of the joints and eventually collapse of the foot joints leading to a characteristic rocker-bottom (boat shaped) foot.
Charcot foot is a pathology results from neuropathy. Any condition that causes neuropathy may lead to Charcot foot. Since patients with Charcot neuropathy are insensate to pain, they continue walking on their deformed feet causing ulceration. Therefor, treatment and preventive measures are must to prevent further deterioration, infection, amputation or even death.
Causes
Any condition that causes neuropathy may lead to Charcot foot. These may include:
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Diabetes Mellitus Neuropathy.
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Alcoholic Neuropathy.
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Spinal Cord Injuries.
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Syphlis.
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Cerebral Palsy.
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Myelomeningocele.
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Leprosy.
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Hereditary Sensory and Autonomic Neuropathy
How does Charcot Foot Develop?
There are two theories on how Charcot foot develop.
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Neurotrauma: Repetitive micro trauma to the insensate foot causes painless damage to the foot. These traumatic event may lead to inflammation and weakening of the traumatized bones resulting into collapsed bones and joints.
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Neurovascular: As neuropathy affect the autonomic nerves that regulate the circulation to the foot. The blood vessels may dilate causing hyperemia (increased blood flow) to the foot. Hyperemia may lead to increased osteoclastic activities that resorb the bones especially at the joints regions. The foot bones and joints become very weak to overcome the normal biomechanics stress forces and eventually collapse.
The most common joint involved in the foot is the Tarsometatarsal joint at the midfoot. However, the ankle and the metatarsophalengeal joints may also get involved.
Symptoms
Symptoms may vary depends on the severity and the stage of the disease. This may include:
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Increased foot temperature.
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Redness.
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Swelling.
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Soreness.
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Foot deformity (Rocker Bottom).
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Foot ulcers
Diagnosis
Your physician will evaluate your foot and insure about the history before symptoms presented. X-rays and MRI will be requested for staging the disease and evaluate for any possibility of infection. A series of periodic x-rays are very helpful afterward to follow up with the progression of disease stages.
Conservative Treatment
Nonsurgical treatment for Charcot foot consists of:
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Immobilization. During early disease stages, the bones are very weak and can be easily deformed with walking. Therefor, it is very important to protect the bones during the early stages. Absolute non-weight-bearing on the affected foot to prevent any further damage is a must. Patient may be fitted in a cast and trained to walk on his other foot supported by crutches or rolling walker, or use a wheel chair to ambulate. Series of x-rays is taken upon follow up to help determine if the active Charcot is in remission, therefor, to decide if patient can return to walking on his foot. Active stage of Charcot may take several months to subside.
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Custom shoes or custom boots. As the bones in Charcot foot is healed, a custom shoes with offloading inserts may be necessary to accommodate h deformed bones and offload pressure areas from rubbing against the ground that might break down to ulcers. In some cases, a custom boot (crow boot) is needed to support the loose joints. At these stages, prevention of ulcers is the goal as ulcers carry high risk of infection and amputation.
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Activity modification. Avoiding trauma and modify activities to protect both feet as patient with a Charcot foot has high risk to develop the disease in the other foot.
Surgical Treatment
Severe cases of Charcot deformity may necessitate surgical correction. Your physician will determine the proper timing during the disease process as well as the most appropriate procedure for each case.
Preventive Care
The patient play the major role in preventing Charcot foot and its complications by following these measures:
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Keeping blood sugar levels under control in order to reduce the progression of nerve damage.
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Regularly follow up with a podiatric physician.
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Check both feet daily. Notify your physician for any signs of redness, warmth, or swelling in the feet.
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Avoid any injury to the foot and avoid any exercises that might cause foot trauma.
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Follow your physician's instructions for long-term care to prevent recurrences, ulcers and amputation.