1st Edition-August 2005
Complications
There are many Complications of Diabetes. Knowing about them and how to treat it
properly is the key. This article is a complication from Neuropathy.
properly is the key. This article is a complication from Neuropathy.
Charcot Foot is the term given to neurogenic arthropathy that affects the joints in the
foot. Neurogenic arthropathy is a rapidly progressive degenerative arthritis that results
from damaged nerves (neuropathy). With Charcot foot, pain perception and the ability to
sense the position of the joints in the foot are severely impaired or lost, and muscles lose
their ability to support the joint(s) properly. Loss of these motor and sensory nerve
functions allow minor traumas such as sprains and stress fractures to go undetected and
untreated, leading to ligament laxity (slackness), joint dislocation, bone erosion, cartilage
damage, and deformity of the foot. The bones most often affected are the metatarsals
and the tarsals, located in the forefoot and midfoot, respectively.
Signs and Symptoms
While peripheral neuropathy develops over decades, the progression of Charcot foot
(ligament tears, small fractures, subluxation, dislocation, deformity) can occur in a matter
of weeks or months. A minor trauma, such as twisting the foot, can initiate the process.
Increased bone resorption makes the joints in the foot susceptible to small fractures.
Because of the loss of pain perception and the loss of the sense of position of the foot,
joints receive repeated injuries, such as torn ligaments and bone fractures.
Early signs that may present soon after injury include the following:
Heat
Insensitivity in the foot
Redness
Strong pulse
Swelling of the foot and ankle
foot. Neurogenic arthropathy is a rapidly progressive degenerative arthritis that results
from damaged nerves (neuropathy). With Charcot foot, pain perception and the ability to
sense the position of the joints in the foot are severely impaired or lost, and muscles lose
their ability to support the joint(s) properly. Loss of these motor and sensory nerve
functions allow minor traumas such as sprains and stress fractures to go undetected and
untreated, leading to ligament laxity (slackness), joint dislocation, bone erosion, cartilage
damage, and deformity of the foot. The bones most often affected are the metatarsals
and the tarsals, located in the forefoot and midfoot, respectively.
Signs and Symptoms
While peripheral neuropathy develops over decades, the progression of Charcot foot
(ligament tears, small fractures, subluxation, dislocation, deformity) can occur in a matter
of weeks or months. A minor trauma, such as twisting the foot, can initiate the process.
Increased bone resorption makes the joints in the foot susceptible to small fractures.
Because of the loss of pain perception and the loss of the sense of position of the foot,
joints receive repeated injuries, such as torn ligaments and bone fractures.
Early signs that may present soon after injury include the following:
Heat
Insensitivity in the foot
Redness
Strong pulse
Swelling of the foot and ankle
The prevention of further joint destruction and foot deformity is the primary initial aim in
treatment of Charcot's foot. Rest and stabilization of the area are a key. Most cases
should be put in a plaster or fiberglass cast ('total contact cast') to relieve pressure and
to prevent further deformity. These need to be replaced periodically until there is no
temperature difference between the two feet. This can take up to 6-9 months. Care
needs to be taken of the other foot to prevent problems developing.
A drug have been shown to be useful as an adjunct in the
management of Charcot's foot.
After the Charcot foot has healed specialized footwear and foot orthoses may be
needed to prevent it happening again (this may depend on the extent of deformity). If
treatment was not started early enough and/or the foot is deformed, the possibility of an
ulcer developing is high. Prevention with footwear and foot orthoses is then very
important.
If the deformity is severe or ulcer recurrence is a problem, surgery can be used to
reshape the deformity. This may vary from a simple removal of a bony prominence to a
fusion of joints to realign the foot.
What can you do to help Charcot Foot:
If you have a Charcot foot, following medical advice is important. Charcot foot can be
very disabling if not managed early and properly. Avoid bearing weight as much as
possible.
If you do not have Charcot foot but have diabetes and neuropathy (loss of sensation),
the risk of developing it increases. Avoid putting yourself in situations that may lead to
trauma. Check your feet frequently for any swelling. Do not wait, seek professional help
urgently if you notice any. The 'wait a couple of days to see what happens' could mean
the difference between a good and poor outcome.
treatment of Charcot's foot. Rest and stabilization of the area are a key. Most cases
should be put in a plaster or fiberglass cast ('total contact cast') to relieve pressure and
to prevent further deformity. These need to be replaced periodically until there is no
temperature difference between the two feet. This can take up to 6-9 months. Care
needs to be taken of the other foot to prevent problems developing.
A drug have been shown to be useful as an adjunct in the
management of Charcot's foot.
After the Charcot foot has healed specialized footwear and foot orthoses may be
needed to prevent it happening again (this may depend on the extent of deformity). If
treatment was not started early enough and/or the foot is deformed, the possibility of an
ulcer developing is high. Prevention with footwear and foot orthoses is then very
important.
If the deformity is severe or ulcer recurrence is a problem, surgery can be used to
reshape the deformity. This may vary from a simple removal of a bony prominence to a
fusion of joints to realign the foot.
What can you do to help Charcot Foot:
If you have a Charcot foot, following medical advice is important. Charcot foot can be
very disabling if not managed early and properly. Avoid bearing weight as much as
possible.
If you do not have Charcot foot but have diabetes and neuropathy (loss of sensation),
the risk of developing it increases. Avoid putting yourself in situations that may lead to
trauma. Check your feet frequently for any swelling. Do not wait, seek professional help
urgently if you notice any. The 'wait a couple of days to see what happens' could mean
the difference between a good and poor outcome.
Charcot Foot Images
By Denise
Treatment: