Charcot Osteoarthropathy & Reconstruction

What is Charcot?

Charcot foot is a condition causing weakening of the bones and joints in the foot that can occur in people who have significant nerve damage (neuropathy). The bones are weakened enough to fracture, and with continued walking, the foot eventually changes shape. This occurs from abnormal or repetitive stress to the foot leading to inflammation. This is the same type of stress that the athlete develops. However, the patient with neuropathy is unable to perceive the pain from the stress injury and walking is continued. As the disease progresses, the foot will take on an abnormal shape. This can cause increased pressure pores and sores on the bottom of the feet leading to infection. Charcot foot is a serious condition that can lead to severe deformity, disability and even amputation. Because of its seriousness, it is important that patients living with diabetes—a disease often associated with neuropathy—take preventive measures and seek immediate care if signs or symptoms appear.

Symptoms of Charcot

People may experience very acute symptoms from Charcot at first with other symptoms becoming lasting or chronic in nature.

Acute flare ups involve:

• Redness around the foot
• Swelling around the foot
• If lab work is drawn, the lab work will show increased inflammation without infection
• The foot or ankle appears misshaped
• Chronically deformed foot or ankle
• Increased swelling with activity
• Difficulty with walking or standing with balance
• Wounds
• Pressure sores or calluses

Diagnosis

It is very important to see a Foot & Ankle Surgeon right away if you believe you or a loved one has Charcot. This can be a life-altering and very serious diagnosis. Upon evaluation, the surgeon will have x-rays taken of your foot and a thorough physical examination will be performed. Sometimes, additional testing is needed such as an MRI or CT scan of her leg.

Clinical and X-ray presentation of Charcot. Note the swelling and redness to the leg and foot. 
  

The most important aspect of treatment of Charcot disease is to limit any weight bearing, walking and loading of the foot and ankle until the bone has healed. The goal of treatment is to prevent severe deformities of the foot from occurring and for the patient to be able to wear a shoe without difficulty.

Continued walking with weight bearing can lead to very significant and worsening deformity. The treatment depends on the severity of the bone deformity at the time of diagnosis. Some cases require surgery immediately, some may require surgery later and cases can be treated conservatively. The use of a boot or cast is important and no weight should be put on the foot until healing occurs. It can take up to a year for the bone to heal and the boot may have to be worn during this healing phase.

In some cases, the Charcot deformity may become severe enough that surgery is necessary. The foot and ankle surgeon will determine the proper timing as well as the appropriate procedure for the individual case.

Surgical Treatment

When conservative treatment is unsuccessful or the presentation is too severe, your surgeon may recommend Charcot Reconstruction. The goal of this surgery is to realign the bones and joints of the foot to allow better function including walking and standing. This also includes being able to wear shoe gear and preventing any sores from developing.

Generally, Charcot Reconstruction is a very involved surgery. Making sure you are able to heal from this surgery is very important, therefore you can expect your foot and ankle surgeon to request additional testing before your surgery.

After surgery is completed, you will have to be off of your foot (non-weight bearing) for a number of weeks, generally anywhere from 8-12 weeks. Following this period of non-weightbearing, you can expect needing physical therapy and close-monitoring by your surgeon.

X-ray presentation following Charcot reconstruction.
  

Preventive Care

The patient can play a vital role in preventing Charcot foot and its complications by following these measures:

• Keeping blood sugar levels under control if you are Diabetic.
• Making sure to reduce the progression of nerve damage in the feet by seeing your specialists regularly.
• Get regular checkups from a foot and ankle surgeon.
• Check both feet every day—and see a surgeon immediately if you notice signs of Charcot foot.
• Be careful to avoid injury, such as bumping the foot or overdoing an exercise program.
• Follow the surgeon’s instructions for long-term treatment to prevent recurrences, ulcers and amputation.