Charcot's
Foot (Charcot's arthropathy or neuroarthropathy) |
Information
for health professionals on
Charcots
neuroarthropathy |
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What is a Charcot Foot
(Charcot's joints; Charcot arthropathy; Neuroarthropathy)?
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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. |
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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. |
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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. |
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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. |
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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.
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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
Peripheral
neuropathy |
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Buy products
here to help foot problems: |
USA & Canada: |
UK & Europe: |
Australia & NZ: |
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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. |
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©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) |