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CHARCOT FOOT

Charcot foot is a devastating complication of neuropathy in the diabetic foot.  Those most at risk to acquire this condition are diabetics with a combination of nephropathy, retinopathy and peripheral neuropathy.  The condition can come on spontaneously but often follows a minor fracture or soft tissue injury. 

The amount of pain experienced is dependent on the degree of neuropathy.  Some will be completely pain free.  For those with less pain, they will continue walking on the foot in the acute phase, accelerating the destructive process.

The foot becomes red, swollen with taut skin and very warm to the touch.  Contrasted with an infection, the foot is not tender to light touch.  Early recognition of the acute Charcot joint is key to avoiding long-term problems as non-weight bearing therapy can be instituted.

Where the condition progresses, the foot literally collapses and assumes a deformed shape. The bottom of the foot becomes a “rocker bottom” and is very susceptible to ulcers because of the changes it makes in gait. 

Other names or similar foot conditions:

• Charcot arthoropathy

Symptoms:

• Red, swollen with taut skin
• Warm to the touch
• Some have pain and others do not but most continue weight bearing in the acuter phase
• Reduced pinprick and vibratory sense in both feet

Signs to look for:

• Diabetic diagnosis with history of nephropathy, retinopathy and peripheral neuropathy
• Red, swollen foot with taut skin, warm to the touch
• A rocker bottom foot   
• A fallen, deformed appearing foot

Possible Causes:

• Diabetes with history of nephropathy, retinopathy and peripheral neuropathy
• For some, a minor fracture of soft tissue injury in the foot immediately precedes the development of a Charcot foot

Goals:

• Medical treatment
• Accommodation and protection of foot to prevent foot ulcers

Solutions:

Arch Supports:

Full contact Plastazote cushion with viscoelastic polymer excavations where there are bony prominences

• Custom molded shoe is best but over the counter shoes can work if they are

• Extra depth shoe with soft, accommodating upper

• Shoes with stretchable uppers, as necessary

• Double rocker sole

Other: 

• If using a conventional extra depth shoe, spot stretching as necessary

• Toe cushioning and straightening devices, such as toe separators, toe straighteners, toe gel caps, toe crests, etc.

Activities:

• Medical treatment

• Non-weight bearing exercising, such as swimming

• Regular callus filing with pumice device (leaving cutting of calluses to a physician only)

• Regular skin care program to include exfoliating and moisturizing