The Charcot Foot
Charcot Neuropathic Osteoarthropathy (Charcot Foot) is a condition of the foot that occurs as a complication of Peripheral Neuropathy(loss of function of the nerves in the hands and feet). This can occur with a number of conditions such as Alcohol Abuse but it is most commonly caused by Diabetes.
The Charcot foot is caused by a process of uncontrolled inflammation in the foot that leads to bone fractures and joint dislocation - this in turn leads to deformity that can be complicated by ulcer formation as a result of underlying bony deformity causing pressure on skin. This can lead to osteomyelitis and this can lead to the need for amputation.
The Charcot foot can affect the Hindfoot(ankle), Midfoot(most common and leading to the “Rocker Bottom” Foot deformity) and the Forefoot.
It can present spontaneously or after minor trauma and the redness and swelling that develops is often misdiagnosed as infection. The affected foot is often much warmer than the unaffected side.Deformity subsequently develops and this is because of joint dislocation and bone collapse.
After a variable period of time the inflammation settles and the deformity solidifies and this is where soft tissue complications such as ulcers can lead to limb threatening osteomyelitis(infection of bone)
As the rates of diabetes increases in the community Charcot foot presentations are increasing and this is placing an increasing burden on the health system.
The Charcot Foot is best treated by a Multidisciplinary Team consisting of Endocrinologists, vascular surgeons, Orthopaedic Surgeons and Physiotherapists and early diagnosis and intervention can help reduce the complications and morbidity associated with the Charcot Foot.
The Orthopaedic treatment of the Charcot Foot is Non operative and Operative.
The Non operative treatment consists of casting(Total Contact Casting) to offload the foot.Surgical Treatment can consist of:
- “Bumpectomy”- this is where an underlying bony prominence is removed that is causing pressure or ulceration of the skin.
- Deformity correction and Internal or External Fixation to achieve fusion and prevent recurrence.
In Summary the Charcot Foot should be considered in any patient with diabetes and it is a very challenging and increasingly common problem that is best treated by early referral to a dedicated multidisciplinary clinic and the aim of treatment is to prevent deformity and avoid complications. There is an increasing trend to early surgical intervention with the use of internal or external fixation or a combination thereof.
Dr Tim O’Carrigan
Foot and Ankle Surgeon
Limb Reconstruction Centre at MQ Health