Patient Education

Charcot Foot

Description

Going to see the doctor (even your friendly neighborhood podiatrist) may be something you dread rather than look forward to. You may even consider it enough of a bother that, when you notice something starting to go wrong with your foot, you decide to wait for a few days or a week before going in, just to see if the problem clears up on its own. However, in many circumstances, this can lead to debilitating complications to already serious injuries or problems. Charcot foot definitely falls into this category.

Charcot foot (sometimes called Charcot’s foot or a diabetic arthritic foot) is a very serious condition. It occurs when someone has neuropathy (nerve damage) in the foot. Neuropathy is most often seen nowadays as a result of diabetes, but it can happen in conjunction with other neurological conditions. Neuropathy makes the bones of the foot more likely to fracture, fractures which then go unnoticed because there is little or no sensation in the foot. Often, if the fracture is not caught early, people with neuropathy will continue to walk on the injured foot, making the fracture worse and worse, until it develops into a rather severe deformity: Charcot foot, in which the arch may collapse, and the bottom of the foot begins to protrude, making the bottom of the foot convex rather than concave.

As you can imagine, this is not a pretty injury to have. This is why getting in to see your podiatrist early is essential, if you suspect you’ve injured your foot at all. People with diabetes need to be especially careful to check their feet daily for any sign of sores or injuries.

Symptoms

Let’s start with the symptoms that may indicate an injury at the beginning, since those are the signs you’ll want to be alert for. Because you’ve got neuropathy, you may not feel any pain at the point of injury, although sometimes people do experience a dull ache in the region, but nothing as bad as a fracture should make you feel. You might not even remember having injured your foot. But don’t let that fool you – this whole thing might start out as a stress fracture that occurs simply because you’ve been walking around for a long time, or maybe roller-skating a bit too much. However, there are symptoms other than pain: you may notice that one foot feels more warm to the touch than the other does, or your foot might become reddened or swollen. These are signs of inflammation, which means that your body’s sending extra blood into your foot to try to heal it. So something’s definitely up. There may also be some grinding (also called crepitus) present, which is an indication that the damaged bits of bone are grating against each other.

If you’re stubborn and refuse to go see your podiatrist right away, (but this isn’t going to happen, of course, because you’re already on your way to see the doctor, aren’t you) your foot might start to become deformed as you keep walking around on it. Your arch may collapse, and the bottom of your foot might start to take on a rocker-bottom appearance, which is definitely not the ideal shape for a foot. This is a sign that the condition has worsened, and that significant damage has occurred; if you haven’t seen your podiatrist yet, do so right away. Some other symptoms might include calluses and ulcers that develop as the deformity forms bony prominences, causing your foot to rub unusually against your shoes.

Diagnosis

Your podiatrist needs to know if you have a history of diabetes when you go in to see him or her. If you do, and if you’ve got an inflamed foot that isn’t painful, he or she will likely suspect Charcot foot. In order to make a diagnosis, your podiatrist will probably examine the foot visually, checking for signs of inflammation. He or she will also need to get an interior look at your foot, and will likely order X-rays, or some other imaging technology in order to see how the bones inside your foot are doing.

Treatment

Again, if you have diabetes, or lack of sensitivity in your extremities, see your podiatrist immediately if you notice any signs of swelling, warmth, or redness in one or both feet. Doing so will make it much more likely that your injury can be treated successfully. Not doing so may lead to severe complications, including amputation, which is hardly something to brighten your day. So check your feet every day for any signs of problems, and don’t wait to see your doctor if you notice anything wrong.

If Charcot foot is to blame for your inflammation, your podiatrist will probably want to immobilize your foot and make sure you don’t bear weight on it anymore. This will give the injury a chance to heal. You’ll likely get a cast of some sort, or possibly a brace or boot, and you may need to use crutches or a wheelchair. (Don’t be afraid of wheelchairs – they make lines at amusement parks wonderfully short, and any kids in your life will adore you for letting them play with yours.) This immobilization stage may last a while, so be patient. It often takes several months, or sometimes even a year to allow the bones to fully knit back together. However, waiting patiently for full healing will significantly reduce the likelihood of further injury and complications.

Once your foot has healed, your podiatrist may suggest treatments to prevent injury in the future. These may include using orthotics (prescription shoe inserts) or braces to support your foot so it doesn’t get injured again. Your doctor may also suggest a change in the activities you engage in, especially if you’re able to point to a particular activity that may have caused your injury in the first place. (In short, you’ll probably have to give up that recreational anvil-dropping you’ve become so fond of.)

If your foot doesn’t respond well to these treatments, or if your foot has deformed significantly enough, then surgery may be the best option to insure that your foot heals properly. This may involve removing any bony prominences that have developed, or your surgeon may feel it best to fuse the joint in order to assure that the bones of the foot are nicely aligned for healing.

Whatever the treatment, follow your podiatrist’s instructions to the T. Doing so will help prevent further complications, and will ideally enable you to retain the function of your foot. (Also, it will make your podiatrist smile. And that’s always a good thing.)