What is Charcot Foot?

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Named after the French neurologist Jean-Marie Charcot (pronounced “shar-ko”), Charcot disease affects the bones, joints, and surrounding soft tissues of the foot or ankle. Because of this, it is commonly referred to as ‘Charcot foot.’

This condition gradually weakens your bones, which in turn can cause them to fracture, break, or even dislocate the joints of your foot or ankle.

charcot

If left untreated for too long, the joints will collapse and your foot will become deformed, which can create even worse problems further down the line.

Symptoms of Charcot Foot


Charcot foot typically goes through three stages. In the earliest stage, the afflicted foot may become red, warm to the touch to indicate inflammation, or swollen but inexplicably painless.

If you do feel any soreness or pain, it may be from possible bone fragmentations or joint dislocations. Unfortunately, due to the nature of Charcot foot, you may not even notice these injuries until several weeks after the initial fragmentation or dislocation.

This is because a key component of Charcot foot is the loss of sensation in the foot, so you may go on with your normal routine and risk further injury without even being aware of it.

Of course, the above symptoms may be signs of other foot problems as well. You should consult your doctor or physician to confirm whether you have Charcot foot or if your symptoms indicate another disease or condition.

However, because the early symptoms can be applicable to any number of conditions, namely cellulitis, osteomyelitis, tendonitis, or gout, your Charcot’s foot may be initially misdiagnosed.

Unfortunately, early detection of Charcot foot is key to preventing the deformation of your foot, as well as for successful treatment of the condition, so this wrong diagnosis may prove problematic.

The second stage is what appears to be a healing stage. The redness and warmth should begin to fade and the swelling should go down.

Radiographs may even show the bones healing. Keep in mind that just because you appear to be recovering, you should not throw yourself straight back into your normal routine, especially if that routine requires that you constantly be on your feet.

Always give yourself enough time to heal first, and always be sure to follow your doctor’s instructions in regards to your healing process.

The continuous pressure on your foot caused by walking or standing for long periods of time may then lead to the last stage of Charcot foot, which is when the afflicted foot becomes deformed.

Typically, this is when the arch located in the middle of your foot’s underside collapses as the joints within this area are put under great pressure. This condition is often referred to as rocker-bottom foot, and will look as if there is a large bump or growth in the arch of your foot.

what is charcot foot

By J. Terrence Jose Jerome (Creative Commons Attribution-Share Alike 3.0 licence)

Your ankle or hind-foot may also become unstable, and your toes may begin to curve in like claws.

This deformity may cause sores or ulcers to form on your foot. In turn, these sores or ulcers may also lead to dangerous infections that could result in an amputation of the foot, if left untreated for too long.

Charcot foot may affect any part of your foot or ankle, though it most commonly affects the mid-foot region.

You may also experience this condition in your hind-foot, ankle, heel, or forefoot, and even in multiple regions of the foot simultaneously.

Charcot Foot Causes

Neuropathy

Charcot foot typically develops as a result of neuropathy, or when your nerves become damaged, leaving you with a total loss of sensation in the afflicted areas. This is why you may not feel any pain from the initial swelling, bone fractures, or joint dislocations.

While this lack of pain may sound desirable, keep in mind that our bodies feel pain to warn us about any existing problems within us.

Therefore, if you end up repeatedly breaking the bones or joints of your foot without noticing it, then the joints will eventually wear down, resulting in severe foot deformities or infections.

The development of neuropathy can itself be the result of several other diseases, with the most common being diabetes mellitus.

In fact, it is estimated that 1 out of 700 people who suffer from diabetes mellitus will also develop Charcot foot at some point in their lives. As such, doctors may be quicker to catch onto the early symptoms of Charcot foot in a patient if they also have diabetes mellitus.

Other diseases and conditions such as syphilis, leprosy, chronic alcoholism, hereditary insensitivity to pain, syringomyelia, and multiple sclerosis may also lead to neuropathy in the foot or ankle, which, in turn, can lead to the development of Charcot foot.

Previous Injuries

Unhealed foot sores or ulcers, infection, or slow-to-heal foot surgeries may also cause Charcot foot.

Furthermore, a contributing factor may be a sprain or broken bone in the foot or ankle that is left untreated or that has been treated improperly.

These injuries are especially heinous to those who suffer from peripheral neuropathy, as the lack of pain may not alert you to these injuries in time to heal. Additionally, patients who suffer from tendonitis or tight Achilles tendons have shown tendencies to also develop Charcot foot.

Another cause is the presence of crepitus, or grinding in the joints in your foot. The unstable bone fragments constantly moving or rubbing against each other may cause the joints to eventually collapse.

Diagnosis and Treatment for Charcot Foot

Diagnosis

The diagnosis of Charcot foot depends on the current stage your foot is at. As stated previously, Charcot foot is typically misdiagnosed in its earliest stage, and, as such, the condition may worsen over time.

Of course, if you do believe that your doctor or physician has misdiagnosed your symptoms, you can feel free to ask for a second opinion or to have them order an X-ray, bone scan, or other various lab tests for you – to be on the safe side.

If you have a history of diabetes mellitus, your doctor may be more inclined to order these tests early on, to confirm if your symptoms are indeed a result of Charcot foot.

They may also ask you about any previous foot injuries you have had, your daily routine, and your hobbies to determine the cause of your Charcot foot.

Treatment Options

There are both nonsurgical and surgical treatment options for Charcot foot. The nonsurgical treatment options are advised only in the early detection stages of this condition or if the deformity is not severe enough for surgery.

One such treatment is to simply bear no weight whatsoever on the afflicted foot. This means that you cannot walk, stand, or put any pressure on this foot at all until your doctor assures that it is safe.

charcot disease

Your foot may be encased in a protective cast or splint, or your doctor may advise you wear a walking boot or brace for as long as it will take your foot to heal. Your doctor may also suggest you use a wheelchair, a knee walker, or crutches instead. Keep in mind that it will take several months for your bones to heal.

After you are fully healed, your doctor will suggest that you still wear custom orthotics or shoe inserts to help you get back to your daily routine without too much worry.

However, do not take on too much immediately after recovery, as this may bring the symptoms or pain back. Bracing may be required if the previous deformity was significant enough.

However, if the deformity caused by Charcot foot is too severe for these treatments to be effective, you may need to undergo surgery to correct it. The healing time for post-surgical treatments may take even longer than nonsurgical treatments.

Always remember that, whether you must undergo surgery for Charcot foot or not, you should listen to your doctor’s or surgeon’s instructions about your care.

Failure to heed these instructions may lead to terrible consequences, such as a loss of a toe, foot, the entire afflicted leg, or even your life.

Follow-Up

Follow-up care is key to both the overall treatment of this condition as well as your safety. Even if you believe you are fully healed, do not undertake any extensive or strenuous activity right away.

Be sure to take good care of your feet during and long after the initial treatments of Charcot foot.

Here are a few tips to follow to ensure your Charcot foot does not resurface:

  • Inspect your feet every day for any blisters, cuts, cracks, sores, or other open or internal wounds.
  • Wash your feet every day using warm water. Always be sure to check the temperature with your hands and not your feet. When you dry your feet again, pat them with a towel rather than rubbing them. Dry your feet well, especially between the toes. Bacteria or fungus can grow in these areas if they remain too moist, which can result in infection.
  • Keep your feet soft. Use approved skin cream to prevent any calluses or cracks. Do not put any cream between your toes.
  • Clean underneath your toenails carefully every day. Do not use a sharp object, but a round, blunt tool like a nail file to clean them instead. Be sure to also trim and file your nails to prevent ingrown toenails.
  • Be sure to wear socks that are thick, cushioned well, and fit loosely around your feet. Change them daily. Do not wear stockings, garters, or socks that go up to your thigh or knee unless your doctor tells you it is alright to do so, as such garments may cut off the blood flow to your feet. Never, ever go barefoot if you can help it.

Here’s a video showing more details on Charcot foot.


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