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Charcot's foot: what it is and how to treat it

Charcot's foot: what it is and how to treat it


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The foot of Charcot it is a progressive condition that involves the gradual weakening of the bones, joints and soft tissues of the foot and ankle.

With such features, Charcot's foot is often one of the most serious complications of the diabetes, and is caused by peripheral neuropathy (that is, nerve damage) that causes the person's foot or ankle to become numb to pain. The condition is thought to be caused by repetitive injuries, typically represented by a series of microtraumas that a person may be only minimally or even completely unaware of.

As the foot of Charcot, the bones can become so weakened by break. The joints can dislocate in the foot or ankle, and with repetitive trauma and degeneration, the joints can eventually collapse, causing the deformation of the foot and assuming an abnormal shape, such as a particular "rocking appearance". The deformity can lead to foot sores and ulcers, bone infections (osteomyelitis) and, if not treated aggressively, amputation.

Although Charcot's foot tends to be a rare condition, its true prevalence may be underestimated due to misdiagnosis or delay.

But what are the Causes of Charcot's Foot? What is its clinical evolution? And what can be done?

Causes of Charcot's Foot

The foot of Charcot it can typically develop when a person sprains or breaks a bone in the foot or ankle, and the injury goes untreated due to the lack of sensation caused by peripheral neuropathy.

The person ends up walking on the broken foot, causing further trauma to the bone. As part of the body's natural reaction to trauma, bone begins to lose calcium and other materials that are supposed to keep bones strong.

Eventually, the bone loss causes changes in the structure of the foot and in the areas of collapse of the foot. When collapse occurs in the middle of the foot, it rounds the bottom of the foot. Depending on the location of the broken bone, the toes can begin to curve underneath like claws and the ankle can become deformed and unstable. In turn, the sharp edges of the bone can exert pressure on the skin, creating the risk of chronic skin sores. The end result - a combination of bone disintegration and trauma - is Charcot's foot.

Please note that theCharcot's arthropathy it can affect any part of the foot and ankle, including the midfoot, hindfoot, ankle, heel and forefoot. In addition, more regions may be involved. Fractures and dislocations often involve several bones and joints, with extensive fragmentation and deformity.

Read also: Pain in the sole of the foot, causes and treatments

Charcot's Foot Symptoms

THE Charcot's foot symptoms may include:

  • foot "warm" to the touch compared to the opposite one;
  • redness;
  • swelling;
  • pain or soreness.

Some Charcot joints, such as the ankle, can heal with fibrous tissue and this can lead to severe instability that can predispose the person to foot ulcers and can be difficult to support with the appliance.

Charcot's Foot Diagnosis

There early diagnosis of Charcot's foot it is important to stop the deterioration of the structure of the foot itself.

For this reason, the doctor will build a detailed history of the patient, examining the foot and ankle for "traditional" signs of the condition. X-rays and other imaging studies may also be required, as well as laboratory tests.

Charcot's Foot Treatment

A first attempt to properly treat Charcot's foot is the non-surgical treatment, which first of all provides forimmobilization. Because the foot and ankle are so fragile during Charcot's initial stage, they need to be protected so that the weakened bones can repair themselves.

In fact, at this stage it is important to prevent the foot from collapsing further. The patient will not be able to walk on the affected foot until the surgeon deems it safe. During this period, the patient may be equipped with a cast, a removable boot or a brace, and the use of crutches or a wheelchair may be required. Bone healing can take several months, although in some patients it can take much longer.

Another support can be guaranteed with the use of custom shoes and brace. After the bones have healed, shoes with special inserts may be necessary to allow the patient to return to daily activities, as well as helping to prevent the recurrence of Charcot's foot, the development of ulcers and possible amputation. In cases with significant deformities, bracing is also needed.

Finally, we can recommend one change in activity level generally performed, to avoid repeated trauma to both feet. A patient with Charcot in one foot is more likely to develop Charcot in the other foot, so it is necessary to take measures to protect both feet.

If non-surgical treatments do not enjoy the desired effects, we proceed with the surgery. In some cases, in fact, Charcot's deformity can become severe enough to require surgery of this type, with various alternatives that may include realignment osteotomy and fusion (correction of the deformity), or ostectomy (removal of the bony prominence that could cause an ulcer).

Prevention

The patient can play a vital role in preventing Charcot's foot and its complications by following some essential measures, such as keeping blood sugar levels under control to help reduce the progression of nerve damage in the foot, frequent visits from the doctor, being careful to avoid injury, such as bumping your foot or overdoing an exercise program.


Video: Midfoot Charcot Reconstruction Strategy (June 2022).


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