Charcot’s foot is a complication of diabetes that almost always occurs in those with neuropathy (nerve damage). When neuropathy is present, the bones in the foot become weakened and can fracture easily, even without there being any major trauma. As the neuropathy is present, the pain goes unnoticed and the person continues to walk on it. This can lead to severe deformities of the foot. As this can be very disabling, early diagnosis and treatment is vitally important.
This disease begins with peripheral neuropathy (decreased feeling in the feet), most commonly seen in diabetics. People with decreased nerve sensation may injure their feet, producing small fractures in the bones; and because they have decreased feeling, they may have minimal or no pain, and they continue walking on the foot. This causes the bones to heal unevenly, causing the foot to become deformed.
Symptoms & Treatment
The acute, or early symptoms of Charcot Foot are: small fractures of the bones of the foot, swelling over these areas, and later the entire foot may become swollen and inflamed. There is little, if any pain during this stage. Treatment during this stage is imperative, and includes: complete rest of the foot by using a non-weight bearing cast, crutches, and bed rest. If treatment is not initiated, this disease progresses to its chronic stage. During this stage the following symptoms may be present: a foot which is deformed, and noticeably different then the other foot; a collapsed arch; bones which abnormally protrude against the skin, possibly causing the skin to breakdown and ulcerate; swelling and inflammation of the foot; and there may be no pain present, or in some patients the pain is intense, due to the amount of bone and joint destruction present. Treatment during this stage involves non-weight bearing casts until the swelling subsides, physical therapy, and custom-made shoes and orthotics.
Many patients will require a cast boot or cam walker to accommodate the deformity and to keep the deformity from progressing. Also during the acute phase a surgical shoe may be necessary to allow the patient to partially ambulate with crutches/walker while they have dressing over the affected site.
Prevention of Charcot Foot:
- Anyone who has peripheral neuropathy, especially diabetics, should be treated with custom-made orthotics to help guard the feet against injuries; to support the bones and joints of the feet, thus preventing deformities from occurring; and to protect the bottom of the feet from friction, calluses, and ulcers of the skin. The special custom-made orthotics we make are designed to accomplish the above, and they are made out of comfortable, long-lasting, space-age materials.
- Examine your feet daily including the tops, bottoms, and between your toes. Look for inflamed areas, cuts, peeling and breaks in the skin, rashes, and swelling. Press on your nail to see if they are painful or ingrown. Touch your feet and make sure the temperature is the same in both, and that they are not cooler then the rest of your body. Test to see that you have good feeling in the bottom of both feet, by gently moving your finger from heel to toes. If any of the above is abnormal, see a podiatrist immediately.
- Wear properly fitted shoes, with uppers made of soft materials, the toe box (the area where the toes lie in the shoe) should be deep and wide to reduce pressure on the toes, and the heels should be no higher than 3/4 inch. Seamless socks and shoes cause fewer problems then those with seams. Always wear shoes and socks; they protect the feet from injury. Do not walk barefoot.
- We recommend that you discuss all foot changes with your doctor as soon as they occur. Frequent foot exams by your doctor are also recommended.