Charcot's foot is a complication of diabetes that almost always occurs in those with peripheral neuropathy (nerve damage). When neuropathy is present, the bones and joints in the foot do not have normal protective sensations like pain. Because of this patients with diabetes can overload their feet and can develop stress fractures in the bones of the feet even though they do not feel any pain. As patient do not have pain, they continue to walk overloading their feet thereby converting small stress fractures into complete fractures.
Another way to explain this is that imagine if you continue to drive your car with a punctured flat tyre, the pressure from the steel rim will cut through the tyre and completely destroy it.
As the fractured foot is loaded fractures get displaced leading to development of severe deformities.
Why does this disease happens to diabetic patients commonly?
The exact reason of what triggers the bone destruction is unkonwn. However it happens usually to the patients having uncontrolled diabetes with neuropathy. A trivial trauma starts the Charcot disease cascade and patient is usually unaware of the catastrophe as there is no pain.
How do I know if I have Charcot Foot?
It is often difficult to make diagnosis of Charcot foot until unless the foot deformity develops. However the affected foot is often swollen, red and warmer as compared to other foot. A deformity gradually develops as fractures displaces and joint dislocates due to disintegration of ligaments.
Which part of the my ankle or foot is commonly affected with Charcot disease?
Charcot disease in the foot can affect any part of the feet or ankle. A trivial trauma can lead to this devastating disease. Most common deformity is midfoot leading to complete disappearance of the tarsal bones and leading to a mid foot break causing rocker bottom deformity. As a result of deformity ulcers can develop over the newly developed bony prominences. The charcot disease also is seen after ankle fractures leading to unstable ankle.
What is the treatment for Charcots Foot?
The prevention of further joint destruction and foot deformity is the primary aim in treatment of Charcot's foot. Rest and stabilization of the foot is a key. In most early cases the limb should be put in a total contact cast to relieve pressure and to prevent further deformity. These need to be replaced periodically until there is no temperature difference between the two feet. This can take up to 6-9 months. Care needs to be taken of the other foot to prevent problems developing. After the Charcot foot bones has consolidated a customized footwear and foot orthoses may be needed to prevent it happening again (this may depend on the extent of deformity). Prevention with footwear and foot orthoses is then very important.
If the deformity is severe or ulcer recurrence is a problem, surgery is needed to reshape the deformity. This may vary from a simple removal of a bony prominence to a complete reconstruction of existing bones and joints to realign the foot and give a stable foot to walk. The surgery is a complex surgery and has to be done by those who are well versed in foot and ankle Charcot disease otherwise the chances of surgical failures are extremely high.
X-ray showing deformity of foot secondary to diabetic charcot foot. This young patient was having problems with recurrent ulcer. He underwent correction of deformity by midfoot fusion.
What will happen if I do not take any treatment as it is not painful?
The charcot foot will invariably lead to deformity which may be unstable and further leads to ulceration. If proper treatment is not taken then the bones of the feet self destroys and ultimately might need an amputation to save the life. This Catastrophe of amputation further leads to increased mortality. Hence it is very important to treat Charcot foot. However due to its complexity one needs to be treated by a proper foot and ankle surgeon who regularly deals with these disease.