Understanding Charcot Foot
I read your article about foot health in the Dec. ’07 issue (p. 67). I noticed that the article doesn’t mention Charcot foot. What is the cause of Charcot foot in people with diabetes, and how can it be prevented?
Arthur Barraza
South Pasadena, Calif.
Lee J. Sanders, DPM, responds: The Charcot foot is a rare condition that can occur in some people with diabetes. The underlying factor that contributes to the development of this condition is a loss of sensation in your feet—nerve damage that is referred to as peripheral sensory neuropathy. Neuropathy is a common complication of diabetes, seen in people with both type 1 and type 2. The earliest sign of the Charcot foot may be a sudden and unexpected change in the appearance of your foot or ankle, characterized by redness, swelling, and warmth. You may have no recollection of injury.
X-rays of the foot may initially look perfectly normal, or there may be very subtle changes that can be easily missed. This is the most important stage of the Charcot foot for the physician to recognize the problem and to start treatment immediately. Treatment involves rest, elevation of your foot, and, most important, staying off of the affected foot until inflammation subsides and the foot is stable. Sometimes there is collapse of the arch with the development of bony deformity, a “rocker-bottom foot,” with formation of an open sore (ulcer) on the bottom of the foot. Your doctor will first need to confirm the diagnosis by eliminating other conditions that might have a similar appearance, such as infection or gout. Most diabetic foot specialists will apply a short non-weight-bearing cast and monitor the condition closely. Serial X-rays are taken to evaluate the healing of fractures and dislocations of one or more joints.
Although we have not yet learned how to prevent the development of a Charcot foot, we can sometimes minimize the extent of deformity with early recognition and prompt treatment. The likelihood of success decreases as the patient passes through the chronic stage of this condition. Immobilization in a cast can sometimes take three months or longer. Patients are often transitioned from a cast to a removable walking brace, and then to a special shoe. In most cases, patients can be treated with non-surgical care; in the most difficult cases, surgery may be necessary.
Treatment of the Charcot foot is often prolonged, challenging, and frustrating. If you are at high risk—if you have peripheral neuropathy and loss of protective sensation—you should learn the implications of sensory loss, as well as the importance of diabetes self-management. Foot inspection should be an important part of your daily routine. Compare one foot to the other and look for changes in size or shape. Is one foot swollen? Are there changes in the color or temperature of the skin? If you notice any of these changes, call your podiatrist, diabetes specialist, or family physician, and request an appointment as soon as possible.
Comments
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I have Charcot foot. My right foot goes to the right, and I have a lot of ankle pain. What is the newest type of surgery being developed? How can I have a better quality of life?
SG of PA
Jackie
My husbands doctor said he had Charcot in his left foot. He had surgery done ..all the ligaments were gone in his foot so they went to surgery and placed a pin to try to hold it together . It didn't work the bone shifted down. Now the doctor is saying since the cast and surgery didn't work there is nothing else they can do. The doctor said its been 3 months go ahead and walk in a custom shoe. I'm trying to find some help out there to see if anyone has had this problem and what they did if anything.
Swollen foot pad
A month ago after walking an hour a night for 4 nights my left foot pad under my big toe was very, very swollen and puffy.
It didn't hurt but felt like I was walking on a pillow.
It has not gone away.
I went to dr and they took xray but said it just showed degenerative joint disease.
I have a podiatry appt next week because I want to try to fix it before it gets worse and serious.
Could this be Charcot Foot?
Charcots Foot
My left foot has a swollen foot pad for over a month.
I have had type 1 Diabetes for over 40 years.
Can this be Charcots foot?
knuckle bone removel
i had a knuckle bone removed from my right foot a few years ago and the bone split down from my big toe to the middle of my foot, the result is my right foot is 1&1/2 inch shorter then the left foot, my doctor is saying i should have all the knuckle bones removed from my right foot to prevent future foot ulsers. she says i will have no problems walking, what are the chances this happning again ? thanks.
bone surgery on foot
My experiences with foot surgery is that the results do not measure up to expectations, and the foot is worse after surgery. Please do get other doctors' opinions before letting a surgeon remove more bones from the other toes. Smetimes a betterremed an be found in over-the-counter foot devices.
There Is A Domino Effect To The Damage Caused By Diabetes!
Charcot's Syndrome Diagnosed Only After 3rd and Final Stage!
I am diabetic and have been seeing my MD all the time for my diabetes for more than three years.
Today I met a physiotherpaist for the first time.
She told me I have "Charcot's Foot," a term I have never heard before, so I Googled it as soon as she left.
Having neuropathy is the precondition for Charcot's Foot I found out.
I have neuropathy in my left foot.
My left foot swelled up three years ago.
I went to my MD and he took some measurements of the swelling.
He sent me to emergency, and they did sonar and sent me home.
So much for that.
After a few months, pain in the arch was so bad I couldn't walk to the grocery store without pausing on a bench in the mall.
The swelling largely subsided except for a lump under the arch.
My MD thought little of it.
I told his intern I felt like I was walking on broken bones.
Intern examined my foot and said I had no broken bones.
About a month ago, I was talking with my Diabetes Nurse and decided to ask the MD for an X-Ray.
The radiologist couldn't make head or tail of my X-ray.
It looked as if I didn't have an arch in my foot.
MD sent me to a foot surgeon.
Surgeon told me I had an arthritic rearrangment of the bones, but that it could be corrected with surgery which would require no weight at all on the foot for six months, and with a 25% chance of losing the foot.
MD got the report, and told me it is a good thing my situation can be corrected with surgery.
Having the precondition of neuropathy I wish my MD had sent me to the foot surgeon as soon as the swelling took place to be sure if it was Charcot's Syndrome.
There is a domino effect to the damage caused by diabetes.
Now I'm stuck with this "rocker" under the arch of my foot for the rest of my life.
There Is A Domino Effect To The Damage Caused By Diabetes!
Charcot's Syndrome Diagnosed Only After 3rd and Final Stage!
I am diabetic and have been seeing my MD all the time for my diabetes for more than three years.
Today I met a physiotherpaist for the first time.
She told me I have "Charcot's Foot," a term I have never heard before, so I Googled it as soon as she left.
Having neuropathy is the precondition for Charcot's Foot I found out.
I have neuropathy in my left foot.
My left foot swelled up three years ago.
I went to my MD and he took some measurements of the swelling.
He sent me to emergency, and they did sonar and sent me home.
So much for that.
After a few months, pain in the arch was so bad I couldn't walk to the grocery store without pausing on a bench in the mall.
The swelling largely subsided except for a lump under the arch.
My MD thought little of it.
I told his intern I felt like I was walking on broken bones.
Intern examined my foot and said I had no broken bones.
About a month ago, I was talking with my Diabetes Nurse and decided to ask the MD for an X-Ray.
The radiologist couldn't make head or tail of my X-ray.
It looked as if I didn't have an arch in my foot.
MD sent me to a foot surgeon.
Surgeon told me I had an arthritic rearrangment of the bones, but that it could be corrected with surgery which would require no weight at all on the foot for six months, and with a 25% chance of losing the foot.
MD got the report, and told me it is a good thing my situation can be corrected with surgery.
Having the precondition of neuropathy I wish my MD had sent me to the foot surgeon as soon as the swelling took place to be sure if it was Charcot's Syndrome.
There is a domino effect to the damage caused by diabetes.
Now I'm stuck with this "rocker" under the arch of my foot for the rest of my life.
Charcot foot
I was diagnosed with Charcot Foot four years ago. My podiatrist was only interested in selling orthotics. I went on my own to a foot institute and was then diagnosed. After a second opinion, I chose the latter surgeon. What a Mistake. He fused my mid-foot with ten 2 1/2" screws to hold my arch place. The real result was that my foot is improperly fused. The arch should have been raised higher so that my bones would be in proper position and the rocker bottom joint would be raised up. At this moment I cañnot move my mid-foot, which is Very restrictive and SWELLS if I don't leave a shoe on at all times. I put on sneakers first thing in the morning and only take them off at bedtime. I roll to the outside of my foot and since the surgery the lump on the bottom of my foot is larger. If I walk barefooted on a hard floor I lose my balance. I WAS FINALLY TOLD THAT HAVING BACK PROBLEMS (SCOLISOSIS) IS A CAUSE FOR CHARCOT, NOT DIABETES (which I don.t have).
I am getting opinions after opinions before I have surgery again. I regret the choice of a doctor for my past surgery.
His answer now is that I wear rocker bottom shoes and take ant
I-inflammatorie---after he altered my foot!!!!!!!!! There is a safe surgery for Charcot but you must first do your homeworkers.
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