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Charcot foot

Charcot joint; Neuropathic arthropathy; Charcot neuropathic osteoarthropathy; Charcot arthropathy; Charcot osteoarthropathy; Diabetic Charcot foot

Charcot foot is a condition that affects the bones, joints, and soft tissue in the feet and ankles. It can develop as a result of nerve damage in the feet due to diabetes or other nerve injuries.

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Nerve conduction test
Diabetes and nerve damage
Diabetic foot care

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Causes

Charcot foot is a rare and disabling disorder. It is a result of nerve damage to the feet. A common cause is peripheral neuropathy.

Diabetes is the most common cause of this type of nerve damage. This damage is more common in people with type 1 diabetes. When blood sugar levels are high over a long time, both nerve and blood vessel damage occurs in the arms and legs.

Nerve damage makes it harder to notice the amount of pressure on the foot or if it is being stressed. The result is ongoing small injuries to the bones and ligaments that support the foot.

Other factors leading to foot damage include:

Symptoms

Early foot symptoms may include:

At later stages, bones in the foot break and move out of place, causing the foot or ankle to become deformed.

Bones that stick out at odd angles can lead to pressure sores and foot ulcers.

Exams and Tests

Charcot foot is not always easy to diagnose early on. It can be mistaken for sprains, bone infection, arthritis or joint swelling. Your health care provider will take your medical history and examine your foot and ankle.

Blood tests and other lab work may be done to help rule out other causes.

Your provider may check for nerve damage with these tests:

The following tests may be done to check for bone and joint damage:

Foot x-rays may look normal at early stages of the condition. Diagnosis often comes down to recognizing early symptoms of Charcot foot: swelling, redness, and warmth of the affected foot.

Treatment

The goal of treatment is to stop bone loss, allow bones to heal, and prevent bones from moving out of place (deformity).

Immobilization. Your provider will have you wear a total contact cast. This will help limit movement of your foot and ankle. You will likely be asked to keep your weight off your foot entirely, so you will need to use crutches, a knee-walker device, or wheelchair.

You will have new casts placed on your foot as the swelling comes down. Healing can take a couple of months or more.

Protective footwear. Once your foot has healed, your provider may suggest footwear to help support your foot and prevent re-injury. These may include:

Activity changes. You will always be at risk for Charcot foot coming back or developing in your other foot. So your provider may recommend activity changes, such as limiting your standing or walking, to protect your feet.

Surgery. You may need surgery if you have foot ulcers that keep coming back or severe foot or ankle deformity. Surgery can help stabilize your foot and ankle joints and remove bony areas to prevent foot ulcers.

Ongoing monitoring. You will need to see your provider for checkups and take steps to protect your feet for the rest of your life.

Outlook (Prognosis)

The prognosis depends on the severity of foot deformity and how well you heal without infection. Many people do well with braces, activity changes, and ongoing monitoring.

Possible Complications

Severe deformity of the foot increases the risk of foot ulcers. If ulcers or the underlying bone becomes infected and hard to treat, it may require amputation.

When to Contact a Medical Professional

Contact your provider of you have diabetes and your foot is warm, red, or swollen.

Prevention

Healthy habits can help prevent or delay Charcot foot:

References

American Diabetes Association. 11. Microvascular complications and foot care: Standards of Medical Care in Diabetes-2021.Diabetes Care. 2021;44(Suppl 1):S151-S167. PMID: 33298422. pubmed.ncbi.nlm.nih.gov/33298422/.

Baxi O, Yeranosian M, Lin A, Munoz M, Lin S. Orthotic management of neuropathic and dysvascular feet. In: Webster JB, Murphy DP, eds. Atlas of Orthoses and Assistive Devices. 5th ed. Philadelphia, PA: Elsevier; 2019:chap 26.

Brownlee M, Aiello LP, Sun JK, et al. Complications of diabetes mellitus. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 37.

Kutschke M, Blankenhorn B. Charcot joint. In: Ferri FF, ed. Ferri's Clinical Advisor 2022. Philadelphia, PA: Elsevier; 2022:356.

Rogers LC, Armstrong DG. Podiatric care. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 9th ed. Philadelphia, PA: Elsevier; 2019:chap 116.

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Review Date: 11/12/2020  

Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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