Charcot Foot

What is a Charcot Foot?

A Charcot [shar-koh] foot, sometimes called Charcot joint, is a complex syndrome characterized as a foot with multiple fractures and joint dislocations in a patient with neuropathy (loss of sensation) and a history of minimal or no known trauma. It is named after Dr. Jean-Martin Charcot, a 19th century French neurologist.

Peripheral neuropathy is required in order for a Charcot foot to develop. Peripheral neuropathy can develop in patients with uncontrolled diabetes mellitus (Type 1 or 2), neuropathic alcoholics, cerebral palsy, syphilis, and spinal cord injuries, just to name a few. A patient may have peripheral neuropathy and never develop Charcot. Charcot events are usually initiated with repetitive microtrauma.

Charcot neuroarthropathy has 3 distinct stages.

Stage 1: Acute/Fragmentation – Swelling, warmth, redness, painless. Early X-rays can show soft tissue swelling, while X-rays taken a few weeks after the onset of symptoms may show bony fragmentation and dislocations.

Stage 2: Subacute/Coalescence – Decreased swelling, warmth, and redness. X-rays may show early signs of bone healing.

Stage 3: Chronic/Reconstruction & Consolidation – Swelling, warmth, and redness are resolved. Bony healing, non-unions, and residual deformities are seen radiographically.

Repeated Charcot events may take place before a clinically noticeable foot deformity occurs.

Treatment

Treatment for Charcot is patient specific. During an active Charcot event, the patient should be non-weight-bearing to the affected limb and the limb should also be immobilized. Once the active stage has subsided, the resultant foot deformity needs to be evaluated and proper offloading measures need to be taken to minimize the risk of ulceration. This may include the use of diabetic shoes and accommodative inserts,  Surgical intervention may be warranted if conservative measures are unsuccessful, there are unhealed fractures, continued instability, or as a preventative measure against further deformity.

Prevention

For a diabetic patient, controlling blood sugars is essential to preventing Charcot. Diabetic shoes and accommodative inserts are useful to all neuropathic patients in order to diminish increased plantar foot pressures caused by foot deformities. All neuropathic patients should also perform daily foot checks and see a podiatric physician immediately if they have any concerns. Lastly, physically-demanding activities with prolonged weight-bearing or walking which are typically out of the norm for the patient should be avoided.

Summary

A Charcot foot is one of the most complex conditions we treat. The initial clinical presentation can be very similar to that of cellulitis (an infection) and it may be misdiagnosed as such when the foot is red, swollen, and warm.  Secondly, there is no way to predict which neuropathic patients will develop Charcot. The Charcot foot is ever-changing, leading to new and/or different areas of increased pressure on the foot. This can often result in ulcerations and therefore infection.  We strive to work together with our patients to help them get through this condition and encourage them to seek medical attention with us when there are flare-ups.