Diabetic Charcot Foot, also known as neuropathic arthropathy, is a condition that affects some diabetic patients with peripheral neuropathy (loss of sensation) after few years of the disease.
As a result of long standing diabetes, peripheral neuropathy progresses and the joints in the feet are unable to bear the force exerted on them by shear trauma or microtrauma which result in arthropathy in the foot. This occurs in lower extremities because of their weight bearing function.
SYMPTOMS OF CHARCOTS FOOT:
Stage 1or destruction stage:
As the process begins, the joints and surrounding bones are destroyed. In some cases the bones are completely reabsorbed.
Clinical presentation:
• Significant swelling of the foot.
• Redness (erythema).
• Warmth to the area.
• Foot becomes flat as the arch is lost.
As the bones are affected, fractures and instability is common without any history of trauma or accident. This process can last for 6 to 12 months.
It is important to differentiate between the swelling and redness of charcots foot and that of cellulitic foot. Cellulites is commonly associated with ulcer and typical signs of infection. Charcots foot swelling rapidly responds to elevation than infective foot.
Stage 2 or coalescence stage:
Here the acute destructive phase slows down and body tries to heal itself.
Clinical presentation:
• Swelling and redness disappears.
• Flat foot.
Stage 3 or reconstruction stage:
Often the foot is deformed.
Clinical presentation:
• Rocker bottom deformity.
• Residual instability.
• Inability to wear footwear as a result of deformed foot.
As a result of the deformity, the foot becomes vulnerable for ulcers and healing becomes difficult.
TREATMENT OF CHARCOTS FOOT:
• Acute phase has to be controlled.
• Stabilize the foot to minimize the deformity.
1) A total contact cast is applied which is to be changed frequently in initial stage as it will get loose as the swelling subsides.
2) Minimizing weight bearing on the affected foot is very important.
3) Appropriate diabetic footwear.
4) Use of medicines like bisphosphonates is a routine treatment for charcots foot.
5) Some cases would require surgical correction and few may end up with amputation due to repeated trauma on the foot.
6) Counselling and reassurance play an important role in patients with charcots foot.
