Diabetic Charcot Foot

By Pradeep Moonot, Orthopaedic & Podiatric Surgeon (Foot & Ankle), Mumbai Knee Foot Ankle Clinic, MumbaiWith more than 15 years of clinical & research experience in orthopaedics in both UK and India, Dr. Pradeep is one of the most privileged and prominent ranked names in this field of Orthopaedics and Podiatry.

In India, the Diabetes capital of the world, the condition of elevated blood sugar affects numerous people who suffer from the diabetic foot or other foot deformities and ailments that is a common cause of their hospitalisation. And, mostly these foot problems arise due to serious complications of nerve damage or poor circulation.

One of the critical but very common foot problems diabetes can cause is Charcot foot, which leads to disability, deformity and even foot amputation in extreme severe cases. The condition causes weakening of the bones in the foot of people who have significant nerve damage also called as neuropathy. The bones get weak to an extent that they fracture easily, and with continued walking the foot eventually changes shape.

Causes and Symptoms
As mentioned Charcot foot among diabetics develop as a result of neuropathy, which decreases sensation and the ability to feel temperature, pain or trauma in or around the foot area. And, because the sensation in the foot is almost negligible, the patient continues to walk, thereby making the injury worse. Thus, its with people who are suffering from neuropathy are at an increased risk for developing Charcot foot. However, some of the common symptoms of Charcot foot may include pain or soreness in the foot, the affected foot may feel warmer, redness/ swelling in the foot, and others.

Diagnosis and Treatment
For the successful treatment of Charcot foot, its early diagnosis is extremely important which includes X-rays and other imaging studies or tests, and others. If diagnosed early and if the condition is not so severe,
it can be well managed with non-surgical treatment. These may include:

Charcot of the ankle sometimes may get difficult to treat non-surgically and therefore it may require surgical fusion of both the ankle and the joint below the ankle to hold the foot straight

Immobilization: It is the first step to treat Charcot foot. As the foot and ankle are fragile during the early stages, therefore, to avoid the foot from further collapsing the patient is advised to restrict his movements or as a precautionary measure the patient is fitted with a cast, removable boot or brace. He may be advised to use crutches or a wheelchair. The bones usually take several months to heal, although it can take considerably longer in some patients.

Custom Shoes with Special Inserts: After the bones have healed, these custom shoes are advised to enable the patient to return to daily activities. Also, these may help in prevention of recurrence of Charcot foot or development of ulcers etc. Besides, bracing may also be required in cases with significant foot deformity.

Surgical Treatment: Surgery is recommended especially to patients where the Charcot deformity may have become severe or where non-surgical treatments failed to show any results. However, foot and ankle surgeon will determine the appropriate procedure after accessing the patient’s condition.

Bony Prominence: Many a times a large bony bump on the bottom of the foot appears. This usually requires surgery but the type of surgery depends on the stability of the bones and joints in the foot. Fractures that occur in the softer bone of diabetics These are typically complex and usually require more plates and screws than would normally be required in people without diabetes.

Ankle Deformity: Charcot of the ankle sometimes may get difficult to treat non-surgically and therefore it may require surgical fusion of both the ankle and the joint below the ankle to hold the foot straight. The risk in this kind of ankle surgery is based on factors such as how much the bone destruction has taken place and the quality of the soft tissue. To ensure the best outcome from treatment, the sooner Charcot arthropathy is diagnosed and treated, the better the final outcome.

Though surgical intervention among diabetics carries a higher risk of wound complications, infections, and amputation as compared to the non-diabetic foot and ankle fracture surgery, yet there’s no other way out. Mostly, patients avoid any kind of medical intervention or surgical treatments fearing they might die as a result of any complication arising due to surgery. But that makes their condition all the more worse because every diabetic foot or foot deformity may not be as serious until the patient ignores it. So, as a precaution, the first thing that every diabetic should do is to understand the seriousness of any kind of foot disease and visit a foot and ankle specialist immediately. Also, they must carefully inspect both feet everyday and keep their blood sugar levels controlled.