Charcot Foot

Charcot Foot | Singapore Diabetic Foot Centre

 

Charcot foot is a limb-threatening foot complication of diabetes. Considered an inflammatory disease, the osteoarthropathy is categorized by varying degrees of bone, joint and soft tissue disorganization. This condition develops when there are underlying neuropathy, trauma and abnormal bone metabolism. The result is bone destruction, complex fractures, and a relentless deformation of the foot and ankle; the hallmark rocker-bottom foot deformity of a diabetic patient.

 

What exactly is Charcot foot?

  • Inflammation leading to osteolysis.
  • Abnormal vascular reflex increasing peripheral blood flow and active bone resorption.
  • Spontaneous bone fractures prompting the body to release of pro-inflammatory cytokines.  Pain may be felt, for a short period.
  • Lack of sensation means the diabetic patient will continue to ambulate, causing further irreversible trauma to the foot.

What does Charcot foot look like?

Typically the foot presents as swollen, warm, with bounding pulses and inflammation.  To the patient, there may be only mild to moderate pain/discomfort. Charcot foot may be mistaken for cellulitis, deep vein thrombosis, acute gout or a musculoskeletal issue such as ‘flatfoot’. Very often there is a marked temperature difference between the two feet, due to the increased blood flow to the affected side.

 

What happens if Charcot foot is left untreated?

Leaving a Charcot foot untreated can lead to open sores on the base of the deformed foot, which progress and worsen to bone infection resulting in the foot or leg amputation. Even without foot ulcers, patients will quickly lose mobility with the dysfunctional foot shape and be more prone to falls.  Patients become at higher risk for subsequent complications, from infection and limb-threatening ischaemia (tissue death from a lack of blood flow).

 

Podiatrists are trained to understand the subtle differences of a normal diabetic foot and one undergoing destructive Charcot changes. Early intervention is key to avoiding severe debilitating deformity.