Charcot foot disease


charcot foot disease

Acute Charcot foot deformity

Charcot foot disease has many causes and typically involves the joints of the foot and ankle.

Charcot arthropathy, or neuropathic arthropathy, is a condition that affects some diabetic patients with peripheral neuropathy (loss of sensation).  Patients with this disease, I describe it like termites circulating in the blood and accumulate around the foot bones, specifically the mid-foot bones.  The termites (osteoclasts) basically, eat away the hard bone and turn the bone soft and cause a collapse in the foot.  The “falling arch” causes a rocker-bottom foot shape and higher potential for foot ulcers and infections.  There are 3 phases of charcot foot disease: Phase 1 is the acute phase characterized by swelling, redness, and increased warmth. Stage 2 is defined as the sub-acute phase (coalescence) that shows signs of healing, decreased swelling, elevated foot temperature, and radiographic indications of osteoclastic activity. Stage 3 is the remodeling phase that is marked by the consolidation and resolution of inflammation.

Causes

Diabetic neuropathy, poor glucose control, hyperglycemia, syphilis (tabes dorsalis), meningomyelocele / spina bifida, nerve injury: spinal cord or peripheral nerves, leprosy , Charcot-Marie-Tooth syndrome

Symptoms

unilateral swelling, red skin discoloration, warm temperature to affected extremity

Prevention

Control glucose levels or blood sugar and avoid trauma to the foot and ankle.

Treatment

Aredia IV given in hospital infused over 4-6 hours to slow down acute phase of charcot foot disease, non-weightbearing for up to 2 months or cast.  Bisphosphonates in acute Charcot patients can decrease pathological fractures and permanent deformity.  After acute phase of disease is over patient may require surgical correction with external fixation to realign joints together. External fixation may allow patient to walk sooner.  If surgery is needed recovery time may take up to 1-2 years.  Sometimes a simple tendon achilles lengthening can help charcot foot disease.  It is important to see a doctor experienced in diabetic foot and charcot foot disease immediately if you can recognize any of the above symptoms.