What is Charcot Arthropathy?

Peter Wishnie, D.P.M.
Owner of Family Foot & Ankle Specialists in Piscataway & Hillsborough, NJ

Not to be an alarmist, but the rate of diabetes, both Type I and Type II, in the US  is on the rise. The 2011 National Diabetes Fact sheet published by the Centers for Disease control and the American Diabetes Association estimates that 25.8 million people, or 8.3% of the U.S. population, have diabetes (18.8 million people already diagnosed with Diabetes and at least 7 million people who remain undiagnosed). In addition, there were 1.9 million Americans diagnosed with diabetes 2012 alone! One of the main problems with uncontrolled diabetes is a loss in sensation to the feet and legs, what we physicians called neuropathy.

charcot foot piscataway nj

Now, I know what you are thinking, “If I can’t feel pain in my feet, isn’t that a good thing?” The answer is a resounding NO! Pain is the body’s way of telling you that something is wrong. Imagine if you stepped on a nail or a piece of glass how it would feel; it would hurt right. Now imagine if you as a diabetic who has no feeling and stepped on that nail or piece of glass; there is no way for you to know that you did that unless you looked down at your feet. This is in fact what we podiatrists recommend to our diabetic patients to do every day.

Since we are all busy people and the demands of the day require us to be on our feet, a diabetic may overstress their bones, causing them to break without even realizing it. Walking on a numb, injured foot can cause the numerous bones in the foot to crack, splinter and erode away. Over a period of time then, the affected foot can take on a deformed appearance as joints and change position/shape to adapt the stresses placed on it. Eventually this change becomes permanent as the bones coalesce to their new shape (i.e. become rigid). Sometimes this becomes so severe that the foot takes on a completely new abnormal shape like in the picture shown. This is called a Charcot foot. Although it may look like an infection, with appropriate training and testing, a physician can accurately diagnose this condition for what it is thus allowing us to treat it.

Treatment

Charcot foot can be treated in the early stages with cast immobilization. The reason is that in the early stages of Charcot, the foot and bones are fragile and susceptible to further damage. By placing the affected foot in a case and keeping the patient off the foot, often with the assistance of crutches and/or a wheelchair, we prevent breakdown of the normal foot architecture. If the diagnosis of Charcot is made early and the foot is immobilized, any deformities that may have developed will be prevented.

However, if the diagnosis is not made early or the appropriate treatment was done in time and the bones of the feet have hardened in an abnormal shape, then we have limited options available to us. We can either make custom shoes and braces or accommodate the now malformed foot, or we can surgically fix the foot. However, to reconstruct a Charcot foot is a complex surgery which requires intensive aftercare including weekly visits to your podiatrist’s office and weeks if not month of not being able to walk on the surgical foot.

The Best Medicine

Therefore, the best medicine in dealing with Charcot feet is to prevent them from happening in the first place. Adequate control of your blood sugars as well as daily inspections of your feet and routine visits to your podiatrist’s office is necessary in preventing problems from arising. If Charcot does end up occcurring, for example you have a painless red, hot and swollen foot, then adequate diagnosis followed by rapid treatment by your podiatrist can prevent further issues from arising.

The podiatrists at Family Foot & Ankle Specialists have years of experience in the diagnosis and treatment of not only Charcot but all types of foot and ankle ailments. If you are diabetic with or without neuropathy and think you may be developing a Charcot foot, see one of our podiatrists today to get the very best diagnosis and care of your feet.