Charcot Arthropathy (Charcot Foot)

What is Charcot Foot?

Red, hot, and swollen

Charcot Foot is a term used for the degeneration of bones and joints. Charcot Foot occurs in people who have lost protective sensation due to nerve damage. The loss of sensation in the feet and hands is called peripheral neuropathy. People who have diseases such as diabetes mellitus may be at risk of developing peripheral neuropathy

What does Charcot Foot look like?

A Charcot Foot will appear red, hot, and swollen. Pain, deformities, and ulcers may also occur, but because of the lack of sensation, you might not feel anything.

What happens in Charcot Foot?

For people who have nerve damage, the bones in the foot may become weakened and fracture easily. Due to the lack of protective sensation, the person does not feel pain that is normally associated with an injury and may continue to walk on the foot. Further damage and deformity may occur. The deformities of the foot may result in extra pressure on the skin causing ulcers.

Two Factors Related to Charcot Joint

The exact cause of a Charcot Joint is not clear. Two factors may work together:

  1. Change in blood flow causes loss of bone strength making the bones brittle and susceptible to fractures
  2. Loss of protective sensation. Diseases such as diabetes mellitus can cause damage to nerves resulting in loss of feeling in the feet. Injuries such as ankle sprains or small fractures in the bones can go unnoticed. The person will continue to walk on the foot instead of protecting or treating it.

The Stages of Charcot Foot

The only sign of a Stage 0 Charcot Foot is the loss of protective sensation. A person may be identified as “at risk” if they have had an injury such twisting of the ankle. An acute injury or several small injuries may trigger inflammation that is the beginning of the Charcot Foot.

The foot appears red, hot, and swollen, often with no pain. X-rays may show fractures and dislocations of the bones in the foot and ankle. There is a possibility of active destruction and deformity of the bones and joints. If the bones are held in a proper position, less destruction will occur.

The redness, heat, and swelling start to subside. The bones start to heal and form new bone. If the bones are held in a proper position while healing, less deformity will occur.

The redness, heat, and swelling are gone. There may be evidence of boney deformity as the bones continue to heal.

The entire process may last six to twelve months and if a patient is not careful to protect the healing foot, it will take longer.

Protection and Offloading

The foot and ankle that has Charcot changes needs to be treated to protect the bones that are fractured and fragile. The bones must be kept immobilized and protected so that they heal and heal in proper alignment.

If they are not immobilized, the whole boney structure of the foot can collapse. For most fractures, a cast would be put on but since the person who has a Charcot foot usually does not have good feeling/sensation, then they do not know if a cast is rubbing.

The Charcot Restraint Orthotic Walker or CROW provides the same support as the cast but it can be removed to check the skin and for hygiene purposes. Also many people with Charcot feet also have ulcers so with the CROW, dressings can be changed and pressure offloaded or reduced from the ulcer area.

Other options are listed below.  Each person is assessed to determine the best options for them.

Charcot Foot

Our Treatment Options

A Charcot foot is treated according to the individual needs of the person.  Information such as past medical history, complications, balance, sensation, support systems and extent of damage to the foot are reviewed in order for us to determine the most appropriate course of action for the person.  Some of the options are listed below. Once the Charcot joint stabilizes, some people return to an orthopaedic shoes with a foot orthosis to provide ongoing protection. 

Non-Weight Bearing

Non-weight bearing basically means you do not put your foot on the ground.  Is is very effective at protecting the foot and allowing it to heal.  The drawback is that it is very hard for most people to keep theri foot off of the ground all of the time.  There are many options to help out with keeping the pressure off of the foot such as a wheel chair, crutches and a wheeled knee scooter.

Removable Cast Walker

Removeable cast walkers (RCW) are commercially available from many companies such as Ossur and Air Cast.  They work like a cast but can be removed in order to change dressings and sometimes to sleep.  They work well for people who have regularly shaped feet and ankle as long as it is worn all of the time.

Sometimes the RCW is modified or adjusted to customize it for the individual.

Total contact cast (TCC)

A TCC is a type of cast that is made from fiberglass or plaster. The Certified Orthotist or casting technician applies the cast to your foot and leg to immobilize the joints. The TCC provides excellent protection to the Charcot Foot. Since there is no way to check the skin without removing the cast, there is a risk of developing ulcers.

Charcot Restraint Orthotic Walker

The CROW walker is a custom made ankle foot orthosis or brace that is made from a plaster mold of the foot and ankle. It is used to immobilize the foot and ankle for patients who have severe deformities or ulcers.

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