Charcot foot is a devastating complication of neuropathy in the diabetic foot. Those most at risk to acquire this condition are diabetics with a combination of nephropathy (kidney), retinopathy (eye) and peripheral (leg and arms) neuropathy. The condition can come on spontaneously but often follows a minor fracture or soft tissue injury. The foot becomes red, swollen with taut skin and very warm to the touch. Contrasted with an infection, the foot is not tender to light touch.
The amount of pain experienced is dependent on the degree of neuropathy. Some will be completely pain free. For those with less pain, they will continue walking on the foot in the acute phase, accelerating the destructive process. Early recognition of the acute Charcot joint is key to avoiding long-term problems as non-weight bearing therapy is necessary to prevent further damage. Where the condition progresses, the foot literally collapses and assumes a deformed shape. The bottom of the foot becomes a “rocker bottom” and is very susceptible to foot ulcers because of the changes it makes in gait.
Other names or similar foot conditions:
- Charcot arthoropathy
Symptoms:
- Red, swollen with taut skin
- Warm to the touch
- Some have pain and others do not but most continue weight bearing in the acuter phase
- Reduced pinprick and vibratory sense in both feet
Signs to look for:
- Diabetic diagnosis with history of nephropathy, retinopathy and peripheral neuropathy
- Red, swollen foot with taut skin, warm to the touch
- A rocker bottom foot
- A fallen, deformed appearing foot
Possible Causes:
- Diabetes with history of nephropathy, retinopathy and peripheral neuropathy
- For some, a minor fracture of soft tissue injury in the foot immediately precedes the development of a Charcot foot
Goals:
- Medical treatment
- Accommodation and protection of foot to prevent foot ulcers
How We Help:
Arch Supports:
Custom plastazote cushion with viscoelastic polymer excavations where there are bony prominences
Shoes:
- Custom molded shoe is usually all they can wear
- Stretchable uppers as necessary
- Some over-the-counter diabetic shoes can work if they are triple depth with soft, accommodating uppers and fitted by those trained in diabetic fitting
- Rocker soles
- Don’t wear pumps or heels
- Don’t go barefoot
Other:
- Copper, bamboo or silver socks that wick moisture away from the skin and prevent infection
- Toe cushioning and straightening devices, such as toe separators, toe straighteners, gel toe caps, gel toe crests, etc.
Activities:
- Medical treatment
- Non-weight bearing exercising, such as swimming and arm ergometer
- Regular callus filing with pumice device (leaving cutting of calluses to a physician only)
- Regular skin care program to include exfoliating and moisturizing, however, no moisturizing between the toes
This information has been compiled from sources available to the general public and referenced below. Copyright 2005-2010 Carole Romig
Sources Image: Weil4feet.com Text: I. Alexander, The Foot: Exam & Diagnosis, D. Janisse, CPed, Editor, Introduction to Pedorthics