What causes Charcot Foot Deformity?
Neuropathy or loss of sensation plays a vital role in causing Charcot Foot Deformity.
Poor control of blood vessels due to nerve damage results in washing out of bones. Blood flow through the blood vessels is controlled by small nerves supplying the blood vessel wall. These nerves are called Vasa-Vasorum. In diabetics, these nerves are damaged. As a result, control is lost and blood flow into the bones becomes excessive. This causes minerals to leach out of the bone and ultimately the bones begin to fracture.
Repeated unrecognized microtrauma- Due to daily activities in which the foot is mildly injured (injury is often unrecognized), but such injuries accumulate over time and become much more significant.
Abrupt trauma – about half of the patients with Charcot Foot can recall a precipitating event such as a slip.
Most Commonly Affected Bones by Charcot:
- Most common location for Charcot Arthropathy is the bones of middle of the foot called the tarsal bones. The collapse of bones causes the middle of the foot to drop down through bottom and can cause calluses, ulcer, infections and significant deformity.
- It can also occur in ankle bones causing extreme deformity where the ankle can turn in one or the other direction. This causes ulcers to occur on the sides of the ankle.
What are the signs and symptoms?
Initial symptoms resemble infection (cellulitis). Most often, the systemic signs such as fever and chills seen in infection, will be absent in Charcot foot. One of the first sign you may see in your foot on daily inspection is that your foot may become warmer or more swollen without any visible wound present throughout the foot. When this occurs, it could be cellulitis, but you should always keep in back of your mind that it can be Charcot foot. IMMEDIATELY take off weight on the affected foot and see your health care provider. Your healthcare provider will perform some tests to differentiate between the two.
Typically, this condition evolves through three stages:
STAGE – 1: This is the most critical stage because the foot bones are dissolving. This stage will progress if not recognized and treated and will cause bone break down into small pieces in your foot which will ultimately cause collapse of significant portion of your foot. This stage can last for about 3 months. Every single step that you take during this stage, will further breakdown the bone. So I can’t emphasize how important it is that if unexplained swelling occurs in your foot, see your healthcare provide immediately, THAT SAME DAY!
Charcot foot usually shows up with the following signs in this stage:
STAGE -2: In this stage, the fracture begins to heal and the bones start to fuse back together. This stage can also last for about 3 months.
STAGE – 3: Bones begin to remodel and start changing shape, being affected by the way one walks. If there is significant deformity, you’ll need special custom made shoes and inserts to prevent your foot from sores and ulcers.
What to expect in terms of treatment?
Your healthcare provider will take X-rays which will show the fracturing process, and perform tests to rule out infection. MRI and Bone scans may also be done. Once the infection is ruled out, treatment for Charcot foot is started.
STAGE – 1: It requires an initial period of strict immobilization using a device that holds your foot in a neutral position. Usually a total contact cast is used. The cast will redistribute weight and relieve pressure. Your healthcare provider will replace the cast every one to two weeks to make sure it continues to fit as the swelling goes down. It is important to keep on the cast until this acute stage is over. This can take somewhere between 3-6months.
STAGE – 2: After the acute stage is over, your healthcare provider will replace the cast with some sort of brace to protect the feet. It can be a walking boot or C.R.O.W Boot. C.R.O.W, which stands for Charcot Restraint Orthotic Walker, is a custom made brace for Charcot Foot which will help immobilize as well as provide support to off-load any sore spots on your foot.
STAGE – 3: Treatment at this stage mainly focuses on preventing sores and ulcers in a Charcot foot. Using custom foot wear to protect and support the foot is absolutely essential.
SURGERY: Most of the times, this condition can be treated using appropriate orthotics. But if the condition progresses despite that, there’s a reasonable chance that you might need surgery to reconstruct the foot. Surgery will realign the foot bones to redistribute pressure more favorably.
Early diagnosis, immediate immobilization and a lifelong program of preventive care are the key to preventing complications associated with Charcot Arthropathy!