Charcot Foot / Ankle

Charcot is a condition causing weakening/loosening of the bones in the foot/ankle. This can occur in patients that have neuropathy (significant nerve damage) as well as other diabetic complications. The bones are weakened enough to fracture and at times dislocate with minimal to no traumatic event.

With continued neuropathy (inability to feel pain) patients continue walking on the foot which leads to drastic changes in the foot/ankle as well as possible ulceration/infection. As the pathology progresses, the joints collapse completely and the foot takes on a rocker-bottom appearance. Additionally, this can lead to severe deformity, ulceration, and possibly amputation.

Causes

Charcot develops because of neuropathy, this can cause a decrease in sensation and the inability to feel normal responses such as temperature, pain, and injury. Because of the diminished sensation, patients continue to walk on their foot without knowing there is a problem and/or pain (making the injury worse). Patients with neuropathy are at risk for developing Charcot. If you’d like to learn more about how Charcot develops, check out this helpful video.

Symptoms

• Increased warmth to the touch (feels warmer than the other foot)
• Redness in the foot
• Swelling
• Worsening deformity and possible collapse of the foot
• Possible pain or discomfort

Diagnosis

Early diagnosis is imperative for success of the outcome. Your surgeon will examine the foot/ankle and ask about a history prior to the injury/changes. X-rays and possible advanced imaging studies (CT or MRI) may be ordered. Further additional X-rays will be obtained to evaluate continued changes.

Non Surgical Treatment

Treatment approaches for charcot foot/ankle are based on the injury and the pathology of the event. At times surgery may not be a viable option. Surgery is dependent on the extent of injury, medical/cardiac clearance typically needed for surgery and the patient’s ability to recover.

Non-surgical treatment consists of:

• Rest/Immobilization. The foot/ankle can be fragile during the early stage of Charcot healing. These bones but be protected in order to heal. Non-weightbearing is needed to prevent further collapse. Weight bearing will be determined when it is safe to proceed and the bones have healed. Casting or a removable boot may be necessary as well as crutches, knee scooter, or a wheelchair. Timing is dependent on healing and may require several weeks to months.
• Custom shoes/Custom bracing. Shoes and braces with inserts may be needed after healing has occurred to prevent further complications of collapse and/or ulceration.
• Modification of Activities. Activity level may be needed to prevent repetitive trauma. Charcot can occur in the other foot as well and caution is needed to protect each foot/ankle.

Surgery

If non-surgical approaches fail to help/assist with the Charcot deformity surgery may be necessary. Your surgeon will select the best procedure to address the pathology and the extent of the pathology. Several treatment protocols may be necessary to prevent further issues/collapse.

Surgery can be either an outpatient procedure (day surgery) or inpatient procedure (stay in the hospital) pending the pathology.