Charcot joint disease was given its name by the French neurologist Jean-Marie Charcot in 1868. He noted an unusual pattern of bone destruction in patients with tertiary syphilis and the absence of sensation. William Jordan described a similar pattern in diabetic patients since 1936.
Certain predisposing factors appear to be necessary for Charcot to develop. First, Neuropathy or total absence of sensation. Second, the circulation in most commonly normal. Third, preceding injury to the foot, however minimal. In general, any disease process that results in a loss of sensation in the lower extremity can lead to Charcot joint disease. Today, the leading cause of Charcot is Diabetes Mellitus. The Second key component to the development of Charcot is a preceding injury to the foot or ankle. Due to lack of discomfort the patient continues with normal activity leading to further fracture and dislocation of involved joints and bones. Another feature is “grinding” of the joints. The represents unstable bone fragments rubbing together. Patients who have Charcot have excellent circulation in their feet. Patients most commonly will notice painless swelling in their foot or ankle. There maybe redness to the top of the foot or ankle. This is often misdiagnosed as cellulitis, osteomyelitis, tendinitis and/or gout. Failure to diagnose Charcot joint disease and treated appropriately can lead to foot and ankle deformity.
X-rays can often confirm the Charcot diagnosis as the often show bone fragmentation and disruption of joints. Bone scars can be helpful in diagnosing Charcot joint disease. Once the diagnosis is made, initial treatment should consist of total non-weightbearing and immobilization of the extremity. The use of crutches, a walker, a removable cast or brace should be used to immobilize and protect the foot and ankle.
Serial x-rays and resolution of clinical features of the disease determine the healing of involved joints. Weightbearing can be increased gradually.
The most common complication of Charcot joint disease is foot and ankle deformity. This can occur even if early treatment has been done. This results from bone and joint destruction. Orthotic inserts and/or orthotic shoes may alleviate ulcers to form due to abnormal wear.
If you suspect that you may have this condition, please call our office to make an appointment. Our professional podiatrists at Pueblo Ankle and Foot Care can assess how your feet are functioning and make the appropriate diagnosis and treatment plan.
Wendy Taggart, PMAC & Insurance Verification