Charcot foot is a condition which affects people with nerve damage (neuropathy), usually as a result of diabetes. It is rare but it can be extremely serious and cause long term complications. If you are at risk, it’s important to take steps to prevent Charcot foot and to seek medical help as soon as possible if you notice any symptoms.
This article covers the symptoms and causes of Charcot foot, treatment options and recovery time, and answers the most frequently asked questions about the condition.
Charcot neuropathic osteoarthropathy, which is commonly known as Charcot foot, is a condition where the bones in your feet become very fragile. This makes them susceptible to breaking or dislocating easily, even from minor forces that come from everyday activities like standing or walking. Over time, the joints can collapse and the foot can change shape, leading to permanent deformity and disability.
Charcot foot affects people who have significant nerve damage, also called peripheral neuropathy. This is usually a complication of diabetes although other factors can cause it, including alcohol or drug abuse, syphilis, an infection, spinal disease or injury, HIV, or Parkinson’s. It is a rare condition, affecting around 1% of people with diabetes.(1) It usually develops in one foot although in some people, both feet can be affected.
Many patients with Charcot foot have had poorly controlled diabetes for 15 to 20 years.(2) There is often a trigger, such as a foot or ankle injury or an infection or sore that doesn’t heal. If you have neuropathy it causes numbness and loss of feeling, which means you may not realize you have hurt yourself and continue to stand and walk. This then makes the injury worse and can lead to the bones becoming dislocated or fractured.
As the bones weaken, the joints can collapse, which changes the shape of your foot. Depending on the location of the bone break, the arch of your foot may collapse – known as a rocker bottom foot – the toes may start to curve under, or your ankle may become unstable. It can also cause foot sores and infection. If left untreated, Charcot foot can lead to permanent deformity, disability and, in some cases, amputation.
Charcot foot can be difficult to diagnose at first, which means it may go unnoticed for some time. The early sign is inflammation in your foot or ankle, which can cause swelling, heat and redness. You may experience some aching or discomfort, although for many people it is painless because of the effect of nerve damage.
If you continue to walk with the condition you may begin to notice your foot changing shape and becoming deformed. The longer Charcot foot goes undetected the harder it is to treat, so if you have neuropathy it’s important to seek medical help as soon as possible if you have any foot or ankle issues, no matter how minor you think they are.
You will probably need to see a specialist who is experienced at diagnosing Charcot foot. The doctor will examine your foot for changes in appearance and may carry out some painless tests, such as temperature testing. You may be asked to stand and walk so that they can look at how your weight is distributed. They will ask about your medical background and when you first noticed symptoms.
X-rays will allow the doctor to examine the bones and joints in your feet. If the results aren’t clear or your doctor needs more information to make a diagnosis, they may suggest an MRI scan which is more a sensitive imaging test and can detect smaller bone fractures and inflammation, an early sign of Charcot foot.
Charcot foot needs to be treated as soon as possible. Any delay may make the deformity in your foot much worse. Treatment involves reducing pressure on your foot and wearing a cast to allow it to set and heal.
It can take several months to treat Charcot foot. You will need to wear a cast or walking brace for up to eight months. This will immobilise your foot and help to prevent any further changes in shape. During this time, you will be completely or partially non-weight bearing, which means not putting weight on your foot, so you will need to use a mobility device like crutches, a wheelchair, knee scooter, or hands-free crutch.
Once your doctor gives you the go-ahead, you will be able to start bearing weight again. You will need to wear special shoes and insoles, and you may be advised to modify your activities to avoid repetitive trauma to your feet.
If your condition is severe, your doctor may want to repair the bones through surgery. During the operation, they will realign or fuse bones to make your foot more stable. They may also smooth sharp bones that could cut into your skin and cause sores.
Studies have shown good outcomes for people who have surgery to treat Charcot foot. Nearly four out of five diabetic patients(3) with severe cases of Charcot foot were able to walk normally again after surgery.
In severe cases, Charcot foot may require amputation. This is usually the result of ulcers and infections developing because the foot has become deformed. Studies have found that 2.7% of people (4) with Charcot foot will need to have amputation.
Charcot foot should be diagnosed and treated as soon as possible to avoid the chance of ulcers developing, as this increases the likelihood of needing amputation.
The length of time it takes to recover from Charcot foot varies depending on the individual patient and the severity of the condition, but it can be many months. You will need to have regular check-ups with a specialist to monitor your progress.
You may need to wear a cast for up to eight months. This can be an incredibly frustrating time but it’s essential not to ‘cheat’ and put weight on your foot if you have been instructed not to as this could delay your recovery and cause further problems.
During this period, you’ll need to use a mobility device to help you get around. There are a number of options available to you:
Wheelchairs can be a good option for people who have Charcot foot in both feet or who are unable to use other devices for physical reasons. The two main types are manual and power wheelchairs. Manual chairs require a lot more upper body strength which can put strain on your back, shoulders and neck. Power wheelchairs make it easier for you to move around and are better if you want to get out and about more.
However, if you can use them, other mobility devices will help to keep you more active during your recovery, which can have a huge effect on your physical and mental health.
Traditional crutches are easy to find and inexpensive, however, they can be tiring to use and can cause pain in other parts of your body, particularly your arms and hands. They are also restrictive because you can’t carry anything, which prevents you from carrying out normal day to day activities. Crutches increase the motivation to be non-compliant in your non-weight bearing, which can cause additional problems.
Knee scooters or “knee walkers” are more efficient than crutches and require less upper body strength. They are great on flat surfaces as you can scoot easily from point A to point B without getting exhausted, but they don’t work on stairs, slopes or uneven terrain. You also need to use your hands to operate the scooter so you still can’t carry things around, and they are bulky which makes them difficult to transport. It’s also difficult to navigate tight environments when on a knee scooter.
The iWALK2.0 is a hands-free crutch that enables you to walk around unaided with full use of your hands and arms. It functions like a temporary lower leg so that you can go about your daily life as usual, while your foot remains safely and securely elevated. It can be used on stairs, slopes, uneven terrain, and in the shower. A 2019 medical study(5) found that nine out of 10 patients prefer the iWALK2.0 to traditional crutches. This quick test can help you decide if the hands-free crutch is a good option for you.
Although you can’t entirely prevent Charcot foot, there are a number of things that you can do to help reduce the risk. They include:
Here are the most commonly asked questions about Charcot foot:
If Charcot foot is detected and treated quickly, it can get better with time. However, if your foot has already changed shape, this is permanent and unfortunately can’t be reversed. The condition may come back, although the correct treatment will help to reduce the chances of this happening.
Patients who develop Charcot foot have neuropathy which causes loss of feeling. This means that many people don’t feel any pain at all, which is why the condition can get significantly worse before it is detected. However, some people have reported feeling pain and soreness in their foot.
Many people continue to walk at first because they don’t realize they have Charcot foot. Once it has been diagnosed, you will need to be completely or partially non-weight bearing to give your bones a chance to heal. Your doctor will advise you on your treatment plan. It’s essential that you stick to this because any attempt to walk earlier can prevent recovery and may make the condition worse.
Yes. Charcot foot develops in people with nerve damage, usually as a result of diabetes. Around 1% of people with diabetes are thought to develop the condition.
Yes, although this is rare. Charcot foot affects people with nerve damage and although the most common cause of this is diabetes, other causes include alcohol or drug abuse, syphilis, an infection, spinal disease or injury, HIV, or Parkinson’s.
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