Charcot Foot

Charcot foot is a chronic, degenerative, inflammatory syndrome that involves the bones, joints and soft tissues of the foot and ankle. It can result in deformity of the foot. Severe cases may result in disability or amputation.

Charcot neuropathic osteoarthropathy (CN) is also known as Charcot Foot or Charcot arthropathy.

This disorder is not limited to those with diabetes. Any disease that results in damage to the peripheral nerves may put a patient at risk of CN. It does, however, appear most often in diabetic patients.

What Causes Charcot Foot

Diabetes is a disorder that can result in damage to the peripheral nerves, particularly those in the feet. Nerve damage can lead to loss of sensation, so that small injuries to the foot are not felt. This can result in a delayed response to injury or infection.

Diabetes also damages blood vessels, impairing circulation in the feet. Poor circulation can lead to weakening of bones, allowing small breaks in the foot and ankle to occur more easily.

The combination of these factors means that a small break or cut can quickly become something much more serious. If the diabetic patient is unable to feel the damage they may continue to walk on the broken bone. This leads to additional fracturing and some degree of joint dislocation. Sharp edges of the fractured bones may point downward, creating irritation to the tissues at the bottom of the foot, or even puncturing the skin. This can create an environment for serious inflammation and infection.

If prompt treatment is not provided, the continuing disintegration of the bony structure creates stress on the joints, deforming them. The underlying bony integration of the foot collapses, causing the bottom of the foot to sag at the midfoot. This deformity is known as "rocker foot" because of its shape.

Diagnosis and Treatment

Charcot foot can be difficult to diagnose and difficult to repair.

The symptoms of CN can be subtle at the start. Because of the deterioration of pain sensation, damage can accrue for a period before anything becomes evident. Initial symptoms of acute inflammation may be mistaken for such other disorders as gout, cellulitis or deep vein thrombosis.

X-rays are the most common initial diagnostic tool, but they might not reveal small breaks or inflamed tissue. They do tend to show subtle dislocations and distortions. Subsequent x-rays may be used in comparison to plot the progress of the disease. MRIs, nuclear scans and bone density scans, used in combination, can give a more detailed picture of the extent of damage.

Treatment initially includes casting the foot, with the patient restricted to crutches or a wheelchair to avoid placing weight on the affected foot. After removal of the cast, weight bearing on the affected side should be limited, perhaps with the use of prescription shoes, boots or braces.

More serious cases will require surgery, to correct deformities that cannot be addressed with prescriptive footwear, or to resect diseased or damaged bone. Surgery is considered the best first option for those who suffer Charcot ankle.

Prevention of Charcot foot comes from daily foot inspection and excellent control of blood sugar levels.

Sources: Ortho Info , American Diabetes Association and Foot Care MD

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