Charcot Foot Deformity
What Is Charcot Foot?
Also known as Charcot arthropathy or Charcot neuroarthropathy, this condition may arise when injuries to the bones of the foot or ankle are undetected and untreated. This combination of bone disintegration and trauma can result in significant deformity and severe disability.
Nerves carry pain sensations to the brain. But in certain patients, like diabetics, peripheral neuropathy may lead to a lack of or reduced nerve sensations, thus leading to this trauma being ignored and hence untreated. This is because neurons
Diabetic patients are highly prone to neuropathy. When a person with diabetic neuropathy, sustains an injury in their foot or ankle that leads to a dislocation or fracture of the bones in this area, their risk of developing Charcot Foot significantly increases.
As a person with neuropathy doesn’t quite experience pain like a regular person, they continue to walk and perform activities that can worsen the injury, which may lead to significant deformity. Only some diabetic patients with Charcot foot report a specific foot injury that they can even recall.
Risk Factors of Charcot Foot
Apart from diabetic neuropathy, obesity is one of the significant risk factors for this condition to develop. The extra weight on the feet makes it difficult to sense pain in the feet, which can give way for Charcot foot to develop. Furthermore, the elderly are at an elevated risk of developing Charcot foot as the risk of the falls, injuries, and neuropathy increases with age.
Complications Associated with Charcot Foot
Deformities caused as a result of Charcot foot may also lead to the following problems.
● Difficult or impossible to wear footwear.
● Foot and ankle may become unstable and as a result of this, walking normally could be difficult.
● Deformities caused by the Charcot foot can create areas of prominent bone below the skin. Due to this, the patient may suffer from ulcers or wounds that are caused due to excess pressure on the skin. Once the skin of the feet breaks and is damaged, the risk of contracting an infection is alarmingly high.
● People with diabetes may also experience poor blood flow, which may become a challenge for the wounds to heal and fight infection. Diabetics with Charcot foot could be recommended for amputation if they develop foot ulcers!
Why Do Diabetics Often Get Charcot Foot Disease?
Diabetes spikes the blood sugar level, and it is one of the significant health concerns globally. The CDC reports that in the US alone, it affects 1 in 10 Americans, amounting to 37.3 million diabetics in the US alone. A person with diabetes can also face foot problems that may be caused when the small blood vessels are damaged. The damage to small blood vessels can also result in two primary issues, which are.
● As a result of poor blood supply to the nerves impairs sensation in both the feet, those who have diabetes-related peripheral neuropathy are less likely to feel cuts and other injuries.
● Additionally, poor blood supply to the skin and feet could take more than the average time for wounds on the feet to heal. Thus, those with diabetes could experience both conditions. They could be highly prone to experiencing injuries and cuts on the feet that take time to heal, or wounds may not recover in worse situations. Bacteria may enter the foot when wounds do not heal, resulting in diabetic foot infections.
Symptoms
Charcot foot patients may not experience pain. However, they may display other symptoms, which include:
● Early signs of the condition may include swelling in the feet that may be caused as a result of an injury. One of the earliest signs of Charcot foot may be difficulty in wearing footwear.
● The feet may become red and warm, an inflammatory reaction to the injuries caused to the feet. The swelling, redness, and warmth must not be mistaken for an infection.
● The doctor may ask the patient to elevate the foot to differentiate between Charcot foot and infection. If the swelling, warmth, and redness improve, the patient could be suffering from Charcot foot. If it doesn’t, the doctor may declare it as an infection.
● Furthermore, the diabetic with a swollen foot without any wound could be diagnosed with a Charcot foot if confirmed through radiographical and other similar tests.
Medical History and Physical Examination of the Patient
The doctor will examine the patient, during which the medical practitioner may probe the cause of injury in the feet. The doctor could also ask the patient about the wounds and infections that the patient may have suffered in the past in the feet.
Next, the medical practitioner may want to examine the feet and check for warmth, redness, and swelling. The doctor will also take a closer look for ulcers and the bones below the skin surface that could cause an ulcer. The blood flow to the feet will be assessed. Deformities in the feet will be checked. If diagnosed, the doctor will determine if they are correctible or rigid.
Diagnosing Charcot Foot
Charcot foot can be diagnosed with:
X-ray: When the Charcot foot is just setting, in its early days, the X-ray could look normal. Fractures and bone fragments may be present in severe cases. However, the X-ray can bring to light aspects like the destruction of various joints and new bone formation, if any, that can be formed as and when the condition progresses.
Computed Tomography (CT) scan: A 3-dimensional x-ray is the CT scan that can present a detailed picture of the bones. The doctor could recommend a CT scan for patients undergoing surgery, which helps determine what type of surgery must be performed.
Magnetic Resonance Imaging (MRI) and Ultrasound: An MRI scan gives better images of the soft tissues of the ankle and foot when compared to an x-ray. The doctor could suggest MRI if an infection is suspected.
Bone Scan: The bone scan can be recommended to determine and confirm if the bone is infected. The doctor is more likely to recommend a particular bone scan based on the specific problem. Despite being slightly superior in distinguishing Charcot foot from a bone infection, the bone scan results can sometimes be inconclusive.
Indium Scan: As part of the indium scan, a marker is placed on a section of the white blood cells. The cells are tracked to determine if they are making their way to the bone to battle the infection.
It may be noted that both Charcot foot and bone infection may reflect positively in the bone scan. However, on the indium scan, the condition is more likely to display increased activity.
Treating Charcot Foot
The goal of treating Charcot foot is to ensure that the patient can walk wearing a diabetic shoe that is commercially available. To achieve this, treatment provides that the foot is stable, that the foot can rest on the floor, and that it is free of ulcers.
● Non-surgical treatments of Charcot foot may include casting. When in the initial stages, Charcot foot can be treated using a cast or a special boot that can protect the foot and ankle. With the cast, the bones will be in a stable position, which can help the bones heal and prevent future deformities. A cast may also be recommended to bring down the swelling.
● Total contact cast is the most common cast used to treat Charcot foot. The doctor may advise the patient who uses a cast not to put pressure on the foot until the bones start healing. Healing of the bones may take three months or more. The cast may be replaced weekly or fortnightly, until the swelling subsides.
● Once the swelling subsidizes, the patient may be recommended to use removable special heavy-duty boots covering the foot. The advantage of letting go of the cast and using the boot is that it allows that patient to walk, and unlike the cast, the booth can be removed when the doctor is examining the foot. The treatment methods aim to make sure that the patient begins to wear regular footwear.
● Custom shoes, braces, and orthotics are recommended for patients who cannot wear regular footwear. Custom shoe inserts or braces may also be recommended to support the foot and ankle, which can help prevent further injuries and deformities.
Surgical Treatment of Charcot Foot
The doctor may recommend surgery for patients experiencing unstable and severe ankle and foot deformities as such patients may be prone to developing a foot ulcer. Additionally, surgery could be suggested if the deformity is severe, making it challenging to use braces and orthotics. As part of post-surgery care, doctors may advise the patient to not put pressure on the foot.
