Diabetics experiencing swelling of the foot and ankle with or without pain may have Charcot foot disease
DR. MONIQUE MITCHELL
Published: Jun 04, 2013
Most foot problems seen in people with diabetes arise from two serious complications of the disease — nerve damage and poor circulation. One of the more critical foot problems these complications can cause is Charcot foot (pronounced “Char-co”) which can deform the shape of the foot and lead to disability. If you are a diabetic and have been experiencing swelling to your foot and ankle with or without pain, you may have Charcot foot disease.
What is Charcot foot?
Charcot foot is a condition causing weakening of the bones in the foot that can occur in people who have significant nerve damage (neuropathy). The bones are weakened enough to break (fracture), and with continued walking the foot eventually changes shape. As the disorder progresses, the joints fall (collapse) and the foot takes on an abnormal shape, such as a rocker-bottom appearance with bone protruding at the bottom of the foot.
Charcot foot is a very serious condition that can lead to severe deformity, disability and even amputation. Because of its seriousness, it is important that patients with diabetes take preventive measures and seek immediate care if signs or symptoms appear.
Charcot foot develops as a result of neuropathy, which decreases sensation and the ability to feel temperature, pain or trauma to the foot. Because of diminished sensation, the patient may continue to walk making the injury worse.
People with neuropathy (especially those who have had it for a long time) are at risk for developing Charcot foot. In addition, neuropathic patients with a tight Achilles tendon have been shown to have a tendency to develop Charcot foot more often.
The symptoms of Charcot foot may include the affected foot being warmer than the other foot, redness and swelling in the foot. Sometimes there may be pain or soreness too, but this may be absent.
Early diagnosis of Charcot foot is extremely important for successful treatment. To arrive at a diagnosis, the doctor will examine the foot and ankle and ask about events that may have occurred prior to the symptoms. X-rays and other imaging studies and tests may be ordered. Once treatment begins, x-rays are taken periodically to aid in evaluating the status of the condition.
It is extremely important to follow the doctor’s treatment plan for Charcot foot. Failure to do so can lead to the loss of a toe, foot, leg or life. Non-surgical treatment for Charcot foot consists of:
• Immobilization: Because the foot and ankle are so fragile during the early stage of Charcot, they must be protected so the weakened bones can repair themselves. Complete non-weightbearing is necessary to keep the foot from further collapsing. The patient will not be able to walk on the affected foot until the doctor determines it is safe to do so. During this period, the patient may be fitted with a cast, removable cast boot, or brace, and may be required to use crutches or a wheelchair. It may take the bones several months to heal, although it can take longer in some patients.
• Custom shoes and bracing: Shoes with special inserts will be needed after the bones have healed to enable the patient to return to their daily activities — as well as help prevent recurrence of Charcot foot, ulcers and possibly amputation. In cases with significant deformity, bracing is also required.
• Activity modification: Changing your activity level may be needed to avoid repetitive trauma to both feet. A patient with Charcot in one foot is more likely to develop it in the other foot because of shifting the pressure from one foot to the other, so measures must be taken to protect both feet.
• Wound care: Often times after the bones heal there is a change in the shape of the foot with bones protruding on the bottom. This makes it difficult to walk and also causes pressure and ulcers (wounds) on the bottom of the foot. Oftentimes, these persons will have to see the podiatrist for a while to make sure that the wounds are treated and heal completely before they can walk on the foot.
• Regular foot check-up by a podiatrist is needed to treat Charcot foot. The podiatrist will check the foot to make sure there are no ulcers developing and if there are any other changes in the shape of the foot. The podiatrist will also monitor your shoes and footwear to be sure they fit properly and are not causing ulcers. Sometimes medications will be ordered and a bone stimulator can be used.
When is surgery needed?
In some cases, the Charcot deformity may become severe enough that surgery may be necessary. The foot and ankle surgeon will determine if surgery is needed, the proper timing as well as the appropriate procedure for the individual case.
To prevent Charcot foot, all diabetic patients are encouraged to:
• Keep their blood sugar levels under control which can help reduce the progression of nerve damage in the feet.
• Get regular foot check-ups by a podiatrist.
• Check both feet every day, and see a podiatrist immediately if you notice signs of Charcot foot.
• Be careful to avoid injury, such as bumping the foot or overdoing an exercise or walking program.
• Follow the podiatrist’s instructions for long-term treatment to prevent recurrences and ulcers.
• For more information, visit us at foothealth242@gmail or visit foothealth.org. To see a podiatrist visit Bahamas Foot Centre or call 325-2996 or visit Bahamas Surgical Associates Centre or call 394-5820 for an appointment.