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Complications of Diabetes

Charcot Foot

Who should read this?

People at risk of developing Charcot arthropathy are those who have peripheral neuropathy, often as a complication of diabetes. Charcot joints may also occur in those who have neuropathy due to other causes. The condition often requires a high index of suspicion for diagnosis and may be easily missed as a result. As it is often completely painless, people tend to present late with resulting damage to bones and joints.

What is a Charcot Foot?

Charcot footJean-Martin Charcot was a French Physician in the 1800’s and described a disintegration of joints and ligaments in people with peripheral neuropathy. The condition became known as Charcot arthropathy or ‘neuroarthropathy’ and when it involves the foot is often referred to as a ‘Charcot Foot’.

What are the features of Charcot Foot?

  • Bones of the foot become soft and weak. As a result they break or fracture easily.
  • Multiple fractures often leads to complete loss of joint architecture – this causes a lot of disruption particularly in the foot where there are many complex interphases between small bones and ligaments.
  • Continued walking in the presence of ‘painless’ fractures results in further damage to bones and joints and deformity of the foot. For example the ‘arch’ of the foot may be lost as a result followed by development of a ‘rockerbottom’ foot deformity.

What symptoms should I expect?

Swelling and increased warmth are cardinal features. This is easily confused with infection of the bones (osteomyelitis). Once the shape of the foot has changed, ulceration may develop as a consequence of abnormal pressures on the skin. Pain is often absent though ‘neuropathic pain’ may sometimes be severe. For more about neuropathic pain please refer to the page on the subject.

How can I prevent this happening?

If you have diabetes complicated by neuropathy take extra care with your feet. Particularly avoid heavy walking which injures the feet.

If you have peripheral neuropathy you would lose awareness of where your feet are in relation to the ground. As you find it difficult to judge where your feet are, you may tend to slam your feet down with unnecessary force. This can result in the development of cracks and breaks in the bones, known as ‘stress fractures’.

How is this condition treated?

Early diagnosis is most important to avoid disability. The mainstay of treatment is to rest the bones and joints of the foot in order to prevent further damage. Relief of pressure helps prevent further deformity. Doctors may advise you to have a plaster cast in order to achieve this.

It is most important that if you are advised not to bear weight you should comply with this very strictly as you may risk permanent damage and deformity to your feet.

Once deformity occurs corrective surgery may be required. Bespoke footwear is almost always essential to help distribute pressure evenly and to reduce the risk of ulceration.

 

Dr Nishan Wijenaike MD, FRCP
Consultant Physician (Diabetes and Endocrinology)
West Suffolk Hospital NHS Trust
Bury St Edmunds
March 2006