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Charcot foot

Charcot foot collapse

What we are about to discuss is pretty rare, even for people with diabetes, but something I think you should still be aware of because it can end up in leg amputation. There is a condition that can happen to people that are active, do not experience foot pain due to neuropathy, and has foot arthritis. The arthritis in a neuropathic foot can get so bad that the bones and joints of the foot breaks down. The medical term is called Charcot neuroarthropathy (pronounced shark-oh). It can happen to any joint of the body, but the most common area is the arch of the foot.

The animation above shows how the arch collapses in Charcot foot. Normally, this occurs slowly and gradually within weeks. However, in rare cases it could happen in a single misstep or slip. Normally, a person that can experience pain will take less steps to allow the foot to recover. A neuropathic foot will continue to walk without realizing it’s breaking down. The first sign is swelling that does not go away.


A collapsed arch puts pressure on a new area of the foot

Most of the weight is being pushed through the skin underneath the collapsed arch and not the toes. This can then cause very large foot ulcers that are difficult to heal.

People suffering from this foot condition often only notice foot swelling that does not go away for days. Because they have neuropathy, they don’t feel pain. So they could not imagine the possibility that multiple foot bones are actually broken. If left untreated, the arch can completely collapse. This collapse happens slowly over time. A collapsed arch puts an extraordinary amount of pressure on an area of the foot that is not designed to bear weight. This can then cause very large foot ulcers that are very difficult to heal.

Total contact cast can be used to treat acute Charcot neuroarthropathy and diabetic foot ulcers.

The best treatment would be to catch it early, before the arch completely collapses. We would then put the foot in a total contact cast that will be changed every few weeks. We take x-rays of the foot regularly to track the bone healing and make sure that the arch does not continue to collapse. This healing process of the fractures could take months, even up to a year. That is because the bones are shredded so bad that there is a large space that must be filled in with bone and allowed time to solidify. Another treatment would be to surgically rebuild the arch, but there is an extremely high risk of infection and failure of the surgical procedure. Unfortunately, with or without surgical reconstruction, collapsed Charcot feet will develop ulcers that may never heal, and eventually get infected. An infection is what leads to foot amputation. Basically, if the arch collapses, the prognosis isn’t good.

We don’t know why some people get Charcot foot while others don’t. I however know that if I had diabetes and a neuropathic foot, I would want to know about this rare possibility and know what signs to watch out for, which is why I’m sharing this information with you. Basically, if there is swelling especially one foot more than the other, this is not normal. See a doctor right away!

What can I do to stop this from happening?

This is a mechanical problem, meaning treatment is mechanically based, and so is prevention. If you have diabetes and neuropathy, most likely you will qualify for custom insoles and diabetic shoes. A secret that some people know about is that you get 3 insoles per year, but your doctor could request the orthotics and prosthetics company to swap out one of those insoles for carbon fiber foot plates or rocker shoe modification. This foot plate or shoe modification will make the foot stiffer, therefore absorbing some of the bending forces that goes through the arch. Lastly, if you know you have some pre-existing arthritis, or if you notice a bit of swelling and your doctor takes an x-ray and discover some arthritis, it might help to get some kind of accomodative brace, such as an Arizona brace or AFO (ankle-foot orthotic) depending on where the arthritis is.

Most people with diabetes and neuropathy know it when they walk more than they should. Your feet can handle only a certain number of steps per day. You could then use a pedometer (which every smartphone has nowadays) and count the number of steps per day. Find the magic number where your foot doesn’t swell that much. That way, you know what your foot can and cannot handle, and can adjust your activity levels based on that.


Dr Haywan Chiu, DPM Haywan Chiu

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