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One of the main indicators of Charcot Foot is impaired pain sensitivity. Patients with this condition do not experience pain as they normally would, which can lead to undetected injuries. Other symptoms of Charcot Foot include:
These symptoms can sometimes lead people to think that an infection is present, but if there are no open wounds, it’s likely that Charcot Foot is the cause. A simple way to distinguish between these two conditions is to gently elevate the affected foot for a few minutes. Any reduction in swelling, heat, or change in colour should indicate that it is Charcot foot. Conversely, if no improvement is observed, there is a strong likelihood that an infection is responsible for these symptoms.
Charcot Foot is a consequence of diabetes-related neuropathy, where nerve damage prevents the patient from feeling injuries. Diabetes, which affects millions worldwide, can also damage small blood vessels in the feet, resulting in frequent complications that often require hospitalisation. This damage impairs sensation and healing capabilities, making diabetic patients more prone to open wounds and bacterial infections due to their inability to detect and recover from such wounds. Unnoticed injuries of this nature can result in notable deformities and disabilities linked to Charcot Foot.
Non-surgical options for Charcot Foot management include:
Casting
In the initial stages of Charcot’s, casts or customised boots are used to protect the foot and ankle, allowing bones to heal in a proper position and preventing further deformities. Casting has proven effective in reducing swelling and maintaining bone integrity. A total contact cast is the preferred choice for addressing Charcot’s condition, as it is designed to cover the whole foot.
To ensure a successful recovery, it is crucial that the patient refrains from putting weight on their foot until the bone has undergone sufficient healing. The most common methods of providing support include crutches, knee scooters, or wheelchairs. The complete healing process may take up to three months.
Custom shoes, braces, and orthotics
Diabetes can make it difficult to wear standard shoes, so specialised diabetic shoes or custom orders tailored to the foot’s needs can provide the necessary support and prevent injury or worsening deformities. Inserts and braces may also be needed to ensure proper support for feet and ankles, aiding in preventing injuries and the worsening of deformities.
Surgery might be recommended to address deformities that hinder normal gait or increase the risk of developing ulcers. Additionally, surgical intervention is often advised for unstable fractures and dislocations that are difficult to heal naturally. Various surgical procedures have been developed to effectively treat complications arising from Charcot Foot. The choice of surgical procedures depends on the severity of the condition and individual circumstances.
Ulcer Debridement
The process of debridement involves removing any dead or unhealthy skin cells that cannot regenerate. Following this, a cast is applied to alleviate pressure on the ulcer while it heals.
Lengthening the Calf Muscle or Achilles Tendon
Tension in the calf muscle or Achilles tendon, even if not caused by an injury, can create painful pressure points on the sole of the foot, often leading to ulcers. By stretching out the calf and the Achilles tendon, you can effectively reduce this strain and alleviate discomfort.
Removal of Bony Prominences (Exostectomy)
Deformities can often cause abnormal bone growth under the skin, creating pressure on the surface and ultimately leading to ulcers. To address this issue, the removal of the affected bone fragment proves to be an effective approach. Prominences situated at the base and inner areas of the foot are particularly prone to causing these issues.
Charcot Deformity Correction
When fractures and dislocations have shifted significantly out of alignment or lack stability, the use of plates, screws, and rods may be necessary to realign the bones for proper healing. Diabetic patients often face more complex fractures due to poor bone quality. Consequently, surgeries addressing these fractures usually require a greater amount of hardware compared to cases without diabetes. Bone grafting is another technique used in surgery to aid in the bone repair process.
Arthrodesis (Joint Fusion)
Arthrodesis, also referred to as joint fusion, is a surgical technique that effectively fuses two misaligned bones together into a single, stable unit. This surgical method is commonly employed in treating conditions like Charcot arthropathy, where it corrects deformities and offers essential stability.
Open Reduction and Internal Fixation
In cases of acute fractures without joint dislocation, surgical intervention involving open reduction and internal fixation may suffice to mend the fractured bones.
Surgical Intervention for Extreme Abnormality Cases
Particularly in instances of extreme abnormalities, especially involving the ankle or heel, a large rod may need to be surgically inserted into the ankle to ensure structural integrity.
Amputation
In severe cases of Charcot arthropathy, where there is a significant deformity, a potentially life-threatening bone infection, or a disruption in blood supply to the foot, it may become difficult to save any part of the affected limb. In such situations, your healthcare provider might recommend amputation above the affected area, followed by the fitting of a prosthesis. This prosthesis could be the traditional socket-mounted type or involve a procedure called osseointegration. For more information, please visit our Amputations and Osseointegration pages.
For further inquiries or to arrange a consultation, please contact Professor Al Muderis’ office at +61 2 88829011 or book an appointment online.
X-ray facilities at all locations | Urgent appointments available if necessary.
Professor Munjed Al Muderis is an orthopaedic surgeon and a clinical professor at Macquarie University and The Australian School Of Advanced Medicine. He specialises in hip, knee, trauma and osseointegration surgery. He is a fellow of the Royal Australasian College of Surgeons and Chairman of the Osseointegration Group of Australia.