Diabetic (charcot) foot, also known as charcot arthropathy, is a degenerative condition that affects the bones, joints and soft tissues of the foot and ankle.
As charcot foot is typically accompanied by nerve damage (neuropathy), it is not always associated with painful sensation. Swelling and inflammation are common symptoms, as is instability or weakness as the bones of the foot weaken and facture. In more advanced stages, charcot foot can result in significant deformity.
Charcot foot is caused by a combination of nerve damage and trauma. While nerve damage occurs most commonly as a complication of diabetes, other conditions that affect nerve function can also result in charcot foot. These include spina bifida, leprosy and syringomyelia, as well as spinal cord injuries and alcoholism.
Non-surgical options for charcot foot aim to prevent additional damage, promote healing and minimise the risk of complications like deformity, ulceration and infection. These include:
Casting: casts or customised boots protect the foot and allow bones and joints to heal in a normal position. Typically, the patient should refrain from weightbearing on the affected foot during casting.
Custom shoes, braces, and orthotics: specialised shoes can provide protection and support for the damaged foot, while orthotics can help to redirect stress and pressure away from the foot, reducing the risk of deformity and ulceration.
Physiotherapy: can be used to restore mobility, muscle strength and stability once weightbearing is resumed.
Surgery is typically considered where charcot has resulted in severe deformity and instability, or where the patients is experiencing repeated ulceration and infection. Surgical treatment options include:
Arthrodesis (fusion): a common treatment option for advanced charcot foot, it involves the permanent joining of the joints of the foot and ankle to reduce pain and improve stability, typically secured using plates and screws.
Osteotomy: involves the cutting and reshaping of the bones of the feet to correct the deformities caused by charcot foot, and to restore natural alignment and load-bearing.
Amputation: in cases of irreperable damage or severe infection, it may be neccessary to amputate the affected foot. The level of amputation (partial foot, below knee or above knee) will be dependent on the extent of damage. It may be possible to complete osseointegration following amputation to restore stability and mobility. For more information, please visit our Amputation and Osseointegration pages.
Other procedures, including exostectomy and debridement can be employed to help relieve pain and reduce the risk of ulceration and infection.
For further inquiries or to arrange a consultation, please contact Professor Al Muderis’ office at +61 2 88829011 or book an appointment online.
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Professor Dr Munjed Al Muderis is an orthopaedic surgeon specialising in osseointegration, hip, knee and trauma surgery. He is a clinical professor at Macquarie University and The Australian School Of Advanced Medicine, a fellow of the Royal Australasian College of Surgeons and Chairman of the Osseointegration Group.