The Charcot Foot in Diabetes

The diabetic Charcot foot syndrome is a serious and potentially limb-threatening lower-extremity complication of diabetes. Charcot neuropathic osteoarthropathy (CN), commonly referred to as the Charcot foot, is a condition affecting the bones, joints, and soft tissues of the foot and ankle, characterized by inflammation in the earliest phase.

The interaction of several component factors (diabetes, sensory-motor neuropathy, autonomic neuropathy, trauma, and metabolic abnormalities of bone) results in an acute localized inflammatory condition that may lead to varying degrees and patterns of bone destruction, subluxation, dislocation, and deformity. The hallmark deformity associated with this condition is midfoot collapse, described as a “rocker-bottom” foot, although the condition appears in other joints and with other presentations.

Figure 1

The Charcot foot commonly goes unrecognized, particularly in the acute phase, until severe complications occur. Early recognition and diagnosis, immediate immobilization and a lifelong program of preventive care can minimize the morbidity associated with this potentially devastating complication of diabetic neuropathy. If unrecognized or improperly managed, the Charcot foot can have disastrous consequences, including amputation. The acute Charcot foot is usually painless and may mimic cellulitis or deep venous thrombosis. Although the initial radiograph may be normal, making diagnosis difficult, immediate detection and immobilization of the foot are essential in the management of the Charcot foot. A lifelong program of patient education, protective footwear and routine foot care is required to prevent complications such as foot ulceration.

Studies show 9 percent of patients with diabetic neuropathy had Charcot foot.

Symptoms of charcot foot

Symptoms of Charcot foot may include:

  • Swelling or redness of the foot or ankle
  • Skin feeling warmer at the point of injury
  • A deep aching feeling
  • Deformation of the foot

People with diabetes should report any signs of foot damage to their doctor as foot conditions for people with diabetes are more serious and can result in amputation if not treated by a doctor or specialist.

Causes of charcot foot

Charcot foot typically develops over a period of time and requires a number of factors to occur.

People with neuropathy have diminished feeling in their feet and may also have reduced muscle control as a result of motor neuropathy. Both of these factors can increase the risk of developing Charcot foot.

The trigger for Charcot foot can be a sprain or twisted ankle that goes unnoticed because of reduced feeling from nerve damage.

If the person continues to place pressure on the foot through walking, the injury can worsen and could lead to dislocation or fractures in one or more bones of the foot or ankle.

Treatment for charcot foot

Charcot foot is treated by reducing pressure on the foot and wearing a plaster cast to allow the foot to set and heal in the correct position.

Whilst your foot is healing you will need regular appointments with a podiatrist and x-rays.

Recovery from charcot foot

Whilst the affected foot is recovering, check your other foot for any signs of damage or strain as this foot is likely to be taking more pressure whilst the affected foot heals.

Depending on how much damage has been sustained, you may experience a change of shape in your foot.