Charcot Foot

We are all aware that diabetes is a very serious condition. If you are in any doubt about the effects it can have, then look no further than Charcot foot.  

Diabetes, along with other conditions, can cause neuropathy which is a loss of the ability to feel temperature, pain and trauma. People with neuropathy, especially those who have had it for a long time, are at risk of developing Charcot foot. It is named after Jean-Martin Charcot, a French neurologist who in 1868 first associated neuropathy with bone and joint destruction in the foot.

The problem is due to the inability to ‘feel’ the ground as you walk, a lack of 'proprioception'. A good example of this is when walking on uneven ground. As the foot hits the ground, proprioceptors in the foot and leg recognise the position of the ground and adjustments are made in order to keep walking forward. When sensation in the feet is lost, the connection is not made between the feet and the brain; the feet do not adjust properly, causing excessive strain on the joints and bones. Over time these joints and bones begin to break down. The bones are weakened enough to fracture and with continued walking, the joints collapse and the foot takes on an abnormal shape.

The damage to the joints results in a foot that no longer functions properly. There are pressure points on the foot which may ulcerate and become infected which may in turn lead to osteomyelitis.

Nobody wants this to happen, so it is very important to understand the process and be able to recognise the symptoms.

The first stage is very destructive and the foot displays signs of inflammation; redness, swelling and increased heat. Under the surface the bones may be fractured, even though there is probably still no pain. Next, the body attempts to heal the fractured bones to restore normal joint function, but they are already damaged and with continued pressure from walking, they are deformed.

If Charcot's is treated early, the damage can be limited. Usually, a total contact cast is applied to the affected foot to evenly distribute the weight, although non-weightbearing is best. This prevents further damage and helps the bones to heal properly. If damage has occurred, then specialist footwear will help to minimise pressures on the foot and prevent ulcerations. Severely deformed feet may require surgery to remove bony prominences and to fuse weakened joints in order to prevent further damage.

SO VERY IMPORTANTLY:

• With diabetes, keep blood sugar levels under control to help reduce the progression of nerve damage in the feet.
• Check both feet every day. Charcot usually occurs in one foot, so if there is a difference between your feet, such as one is warmer and more swollen than the other, then contact your podiatrist or GP IMMEDIATELY
• Be careful to avoid injury, such as bumping the foot or overdoing an exercise program.
• Visit a podiatrist regularly.