Charcot Foot: Symptoms, Causes, and Treatment

This content originally appeared on diaTribe. Republished with permission.

By John Carr

Charcot foot is an uncommon, but serious diabetes complication. One of the best ways to prevent it is with simple routine foot care, such as wearing well-fitting shoes and keeping feet clean.

Charcot neuropathic arthropathy, more commonly called Charcot foot, is a diabetes-related complication that results from damage to nerve fibers in the ankle and feet.

This complication can occur in people who develop nerve disease from diabetes (diabetic peripheral neuropathy). The loss of sensation in the extremities is caused by long-standing elevated blood sugar from diabetes, which over time damages nerves.

2021 study from Denmark estimates that about 5 out of 1,000 patients being treated for diabetes had Charcot foot. Managing blood sugar and practicing daily foot care are two of the strongest tactics for preventing complications like Charcot foot.

What causes Charcot foot?

Nerves in the feet are particularly susceptible to neuropathy for reasons not well understood. Nerve damage can lead to the progressive destruction of foot and ankle structures in different ways – one being Charcot foot.

Charcot foot often starts with a simple injury or small infection that goes unnoticed and untreated due to the loss of sensation from neuropathy. Without the normal sensation of pain, people will continue an activity and cause further injury, leading to an increasingly larger inflammatory response.

Eventually, the inflammatory response begins to destroy surrounding tissues, including bone, ligaments, tendons, muscles, small blood vessels, and other nerves. Compromise of these structural elements in the foot results in problems over time if left untreated, including foot ulcers.

Dr. Clayton Bettin, an orthopedic and foot surgeon in Memphis, describes how these injuries typically occur.

“In a person with peripheral neuropathy from diabetes, the small corrections that are necessary during walking aren’t there and what that leads to is a lot of little traumas over time. That leads to the destruction of these joints,” Bettin explained.

“These joints become unstable, and just like a straw that breaks the camel’s back, there can be an event, and the whole joint becomes dislocated. Normally that would be extraordinarily painful, but our patients with neuropathy just don’t know,” he said.

How to recognize Charcot foot

It’s important to recognize signs and symptoms of diabetic neuropathy early before chronic injuries and inflammation deform the shape of the feet or toes and lead to Charcot foot.

Signs and symptoms of peripheral neuropathy include:

Numbness or tingling in the toes
A burning sensation in the affected areas, especially at night time
Loss of hair and discoloration of the skin or nails

Routine foot care with a podiatrist (foot specialist) is a critical component of good diabetes care. It’s the single most important thing you can do to identify the small or subtle changes that help with early diagnosis; simple things, like difficulty finding shoes that fit.

Early stages of Charcot foot include:

Discoloration or redness
Swelling
Foot pain
A feeling of heat or warmth (especially one foot noticeably warmer than the other)

By the time foot deformity appears, significant damage to the joint is present. How Charcot foot is treated depends on the severity of the foot deformity. A diagnosis and assessment of Charcot foot starts with a physical exam and lab testing and may include imaging such as X-rays or an MRI.

Recent surveys have reported that the majority of physicians and healthcare providers are unaware of how to diagnose and treat Charcot foot and rely on specialists like orthopedic surgeons and podiatrists to treat this complication. Consequently, rates of late diagnosis and misdiagnosis are high.

Treating Charcot foot

The first step is to stop any ongoing damage, which means treating an infection or ulcer with the appropriate medicine, and pausing any activities exacerbating the problem.

An infection may require antibiotics, additional testing, consultation with other medical specialists, hospitalization, and in severe cases, surgery. Devices like a cast, crutches, walker, or wheelchair may be used to help alleviate and completely offload the foot so healing can take place.

In severe cases that require surgery, the ultimate goal is restoring the ability to walk without assistive devices, said Dr. Dane Wukich, professor and chair of orthopedic surgery at the University of Texas Southwestern Medical Center.

“Because these patients often have an underlying disease, such as cardiovascular disease, walking and activity can really help with reducing mortality,” Wukich said.

How to prevent Charcot foot

In the case of Charcot foot, the best treatment is prevention. Preventing neuropathy is very important; if you don’t have neuropathy, you won’t develop Charcot foot.

If you already have neuropathy, preventing its progression will help prevent Charcot foot. If you have neuropathy that has progressed, Bettin explains why recognizing Charcot foot early is so critical.

“If you have Charcot, you have a 10% chance of amputation in your lifetime. If you add an ulcer to that, your risk goes up to 50%,” Bettin said.

Simple routine foot care is the most powerful way to prevent Charcot foot, which includes:

Inspect your feet and toes every day for red or raw areas of skin
Track and report changes to your feet to a physician or podiatrist
Make sure shoes provide support and fit you properly; make sure there is no rubbing or tight spots (custom shoes or shoe inserts may help)
Keep shoes and feet dry
Care for your skin and nails daily

Learn more about preventing diabetes complications here:

Nerve Damage Beyond the Hands and Feet
The Forgotten Complications – What You Should Know
Treating Painful Diabetic Peripheral Neuropathy

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