What is Charcot foot?
Charcot foot is a problem which can affect the foot in people with neuropathy (nerve damage with numbness). The bones of the foot become very fragile and can start to break or dislocate in response to very minor forces – even in response to the forces which occur with standing or walking. Left untreated, the arch can collapse and the foot takes a convex shape giving it a rocker bottom appearance.
What causes Charcot to develop?
The commonest cause of the Charcot foot is diabetes. However it can occur in people who have a different cause of nerve damage. It is rare, and affects only about one per cent of people with neuropathy in diabetes. However, when it occurs, it can lead to gross deformity or ulceration of the foot. It may even result in amputation of the lower part of the leg.
How will I know if I’ve got Charcot foot?
The early signs of Charcot foot are inflammation (swelling, heat & redness) in the affected area of the foot or ankle. These symptoms are often mistaken for infection. Sometimes it is brought on by a minor injury (such as tripping over something), or recent foot surgery, but it often just starts for no obvious reason.
How is it diagnosed?
The diabetes foot multidisciplinary team (MDT) will examine your foot, and may carry out some simple non-invasive tests, such as temperature and neuropathy testing. You will be asked to have an X-ray of the affected foot (if your GP hasn’t already done so). This is the best way to see if there are any bony changes to the foot.
If there are no obvious changes on the X-ray, you may be asked to have an MRI (Magnetic Resonance Imaging) scan. This will show areas of inflammation within the bone, which is the earliest sign of the condition.
What is the treatment for Charcot foot?
The aim of treating the Charcot foot is to prevent foot deformity whilst the inflammation settles. If there has already been some change to the shape of the foot, then this is not reversible. However the aim would be to prevent any further deformity.
The most important thing you can do is rest. Immobilising (taking the weight off the foot) is the best way to help the inflammation settle and prevent deformity. This is normally done with some form of cast (in the same way as if you had broken a bone). The cast allows you to do minimal weight bearing, and prevents putting too much pressure on your foot.
Following the treatment plan for Charcot Foot is extremely important. It may involve a significant change in your lifestyle for months or years. Failure to do so may result in severe deformity or damage which cannot be successfully managed long term.
Who will ensure this happens?
You will have regular appointments with the diabetes foot multidisciplinary team (MDT) to monitor your foot. Appointments with the MDT will vary according to individual needs.
At these appointments, the cast will be removed and the team will regularly check the temperature of your foot (and compare it to the other foot). This lets us know if the inflammation is settling. You will then have a new cast applied.
You will be asked to have a follow-up X-Ray at some appointments. This will be done without the cast.
The plaster room staff will see you between the MDT appointments as required.
The Diabetes Podiatrist will see you as required, and be available if the Orthopaedic Technician believes podiatry treatment is required.
How long does the treatment take?
This is a very difficult question to answer, as everyone’s treatment takes different lengths of time. It can vary according to method of cast used, and how much rest you can have. What we do know is that the average length of time in a cast in the UK is 10 months.
Will it come back again?
Almost never on the same side, we think. It sometimes flares up again within in a year or so of apparent healing, this may be because it was never properly healed in the first place. On the other hand, the process may affect the other foot, and is thought to do in about 20 per cent of cases (ie. one person in five).
Does it get better?
Yes. But it can take a long time. No-one knows what causes the Charcot foot, but it is a condition which persists for several months (sometimes a year or more) before it eventually settles, and the bones regain their original strength.
However, it is very difficult to decide when the process has settled and the only clue lies in comparing the warmth of the skin of the two feet. There are no other tests which can be used.
When it has settled, your cast will be made into a removable cast and you can gradually start wearing shoes again, increasing the time in shoes daily if no signs of deterioration.
There may be some aching discomfort, or it may be painless (because of nerve damage). In most cases only one foot is affected. However, in some rare cases people can develop Charcot foot in both feet. Your foot may become deformed if you do not get appropriate treatment early enough and you continue to walk on it.
Unfortunately, many doctors and Emergency departments are unaware of Charcot foot and it is often misdiagnosed as an infection or ankle sprain.
I have questions, who can I speak too?
- Diabetes Podiatrist
- Orthopeadic Technicians
- You will also be seen regularly by the diabetes and orthopaedic consultants.