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Charcot's Foot (Charcot's arthropathy or neuroarthropathy)

Information for health professionals on

Charcots neuroarthropathy


What is a Charcot Foot (Charcot's joints; Charcot arthropathy; Neuroarthropathy)?

Charcot's foot is a complication of diabetes that almost always occurs in those with neuropathy (nerve damage). When neuropathy is present, the bones in the foot become weakened and can fracture easily, even without there being any major trauma. As the neuropathy is present, the pain goes unnoticed and the person continues to walk on it. This can lead to severe deformities of the foot. As this can be very disabling, early diagnosis and treatment is vitally important.

Another way to consider it - imagine spraining your ankle and not knowing you have done this. You will continue to walk on it - imagine the damage that this would do. This is what happens in a Charcot foot.

The Charcot's foot should not be confused with the foot deformity that can occur in those with Charcot-Marie-Tooth disease - they are very different conditions.

Charcot's foot or Charcot disease takes it name from Jean-Martin Charcot (1825-1893) who was the first to describe the disintegration the occurs to the ligaments and joints. In the medical literature it is often called Charcot's arthropathy or Charcot neuroarthropathy.


What causes Charcots Foot:

In those with Charcot's foot the ability to sense pain is usually lost or impaired (as a result of diabetic neuropathy). The muscles lose their ability to support the foot correctly. As a result of this, minor trauma (eg sprains; stress fractures) to the foot go undetected and do not get treated. This leads to a slackness of the ligaments (laxity), joints being dislocated, bone and cartilage being damaged and deformity to the foot.


What are the symptoms of Charcot Foot:

The most early signs of Charcot's foot include the foot or affected part of the foot being warmer than the other foot, there will be some swelling and there may be redness - this is often all that is initially present (this can come on quite suddenly). There will be no pain and the circulation is usually very good. A deformity then will start to develop (as a result of joint subluxation/dislocation) as the arch of the foot collapses if the midfoot of the foot is affected and is left untreated.

In most cases only one foot is affected, but both feet can be affected over time. Generally, the diabetes is usually long standing and diabetic neuropathy (loss of sensation) is always present and often severe. However, some people with Charcot's foot can develop a "deep" aching type pain, but it is as never as severe as what would be expected given the extent of the injury.

Calluses and diabetic foot ulcers may occur as a result of bony protrusions (due to the deformity that develops) causing pressure inside the shoes. The ulceration can become infected and spread to the bone (stoneflies) and joints (septic arthritis) - this can cause tiredness and a fever.


What is the treatment for Charcots Foot:

The prevention of further joint destruction and foot deformity is the primary initial aim in treatment of Charcot's foot. Rest and stabilization of the area are a key. Most cases should be put in a plaster or fiberglass cast ('total contact cast') to relieve pressure and to prevent further deformity. These need to be replaced periodically until there is no temperature difference between the two feet. This can take up to 6-9 months. Care needs to be taken of the other foot to prevent problems developing.

A drug (bisphosphonates) have been shown to be useful as an adjunct in the management of Charcot's foot.

After the Charcot foot has healed specialized footwear and foot orthoses may be needed to prevent it happening again (this may depend on the extent of deformity). If treatment was not started early enough and/or the foot is deformed, the possibility of an ulcer developing is high. Prevention with footwear and foot orthoses is then very important.

If the deformity is severe or ulcer recurrence is a problem, surgery can be used to reshape the deformity. This may vary from a simple removal of a bony prominence to a fusion of joints to realign the foot.


What can you do to help Charcot Foot:

If you have a Charcot's foot, following medical advice is important. Charcot's can be very disabling if not managed early and properly. Avoid weightbearing as much as possible.

If you do not have Charcot's but have diabetes and neuropathy (loss of sensation), the risk of developing it increases. Avoid putting yourself in situations that may lead to trauma. Check your feet frequently for any swelling. Do not wait, seek professional help urgently if you notice any. The 'wait a couple of days to see what happens' could mean the difference between a good and poor outcome.


Links of relevance to Charcots Foot:

Information on the diabetic foot

ePodiatry's database on Charcot's neuroarthropathy

ePodiatry's database on the diabetic foot

Find a Podiatrist

Ask a question in the foot health forum about Charcot joints

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ePodiatry is purely a source of information on Charcot foot, Charcots joints, Charcots arthropathy or neuroarthropathy and should at no time be considered as replacing the expertise of a health professional. We recommend seeking professional advice for all foot problems (especially Charcot foot), before embarking on any form of self treatment or management. Neither the content or any other service provided through ePodiatry is intended to be relied on for medical diagnosis or treatment. Do not delay in seeking health professional advice because of something seen on ePodiatry.
©2003. The information contained on this page about Charcot foot is subject to copyright. No part of the information about Charcot's joint contained on this page can be reproduced in any form without the permission of ePodiatry.

Charcot's Foot (Charcot's arthropathy or neuroarthropathy)

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