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Charcot Foot

What is Charcot foot?

A Charcot Foot is a gradual destruction of the joints in the foot due to one of a number of conditions that cause damage to the nerves (neuropathy). The process occurs in stages where the joints gradually break down, then reform into a permanent deformity. It is a very serious condition that can result in deformity, ulceration, and amputation.

A Charcot foot occurs with conditions that result in nerve damage (neuropathic conditions) to the foot. The most common cause is uncontrolled diabetes. Other conditions that can cause neuropathy are alcoholism, vitamin B deficiency, spinal cord injury, various viruses, and some medications.

There are two processes that responsible for the development of a Charcot foot. The first is due to damage sustained by repetitive physical trauma to the joints. Neuropathy, or nerve damage, may prevent the patient from identifying something is wrong due to a lack of pain stimulus. Without this pain feedback, the patient may continue to put weight on the damaged foot, promoting further damage. Damage to the nerves that regulate blood flow to the foot is the second process by which this can occur. The bones receive an increase in blood flow. This promotes increased activity in the cells that break down bone. Combined with the physical damage to the joints; bony breakdown occurs.

A Charcot foot may or may not be painful to the patient experiencing it. It may appear hot, swollen, and red. The patient may experience instability when walking on it. Often it is this instability may prompt the visit to see their GP or podiatrist in the first place.

Management for Charcot Foot

A Charcot foot, if left to run its natural course, undergoes stages which generally involve destruction, reabsorption of bony fragments, and finally a reorganisation of bone into a stable deformed structure. A deformity of the foot can alter the distribution of pressure which can develop into ulcerations at area that experience high levels of force.

Treatment for a Charcot foot usually requires complete immobilisation of the foot in a cast or brace. To minimise furtherl damage to the foot, minimal weight bearing is recommended until the Charcot process has settled. Footwear and orthotic modification is required to accommodate the altered foot. Surgical intervention may be required in extreme cases.