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.