Charcot foot, or neuropathic osteopathy, is a degenerative disorder of the feet that is progressive and debilitating. According to the Podiatry Channel, it occurs as a result of nerve damage, or neuropathy, and is characterized by decreased sensation, fractures and joint dislocations. The bones of the foot suffer from repeated stress and microtrauma, which leads to softening, fracture and eventual breakdown. The arch collapses and the foot becomes convex in shape, called rocker-bottom foot. Charcot foot can affect those with neurological disorders, but is more prevalent in diabetics.
X-ray Examination
The early signs of a Charcot foot include an increase in temperature of the affected foot, along with redness and swelling. According to ePodiatry, there is an absence of pain due to decreased sensation, and circulation may be more than adequate. An X-ray will show the characteristic changes seen in a Charcot foot, such as micro-fractures and joint dislocations.
Immobilization
The main goal of treatment of a Charcot foot is to stabilize the joints and prevent further damage. Diagnosis typically comes later in the process when fractures and breakdown begin to occur. According to the American College of Foot and Ankle Surgeons, the bones must be protected because they become fragile and soft. It is necessary to keep the foot and ankle completely non-weight bearing. A total contact cast or removable boot may be applied to the affected foot, depending on severity. Any moving around must be done on crutches or in a wheelchair. Healing needs at least eight weeks to occur, but it can take six to nine months.
Medication And Bone Stimulation
Along with immobilization, some medication may be prescribed. Pamindronate, a bisphosphonate, is an intravenous drug used to treat Charcot foot. According to Drugs.com, pamidronate alters the cycle of bone formation and breakdown. This aids in bone healing. In some cases, bone-stimulating devices help stimulate new bone growth, but this treatment is still in the experimental stage.
Custom Shoes And Bracing
After immobilization, the next step is to provide support for the foot and decrease the chance for further breakdowns. According to the American College of Foot and Ankle Surgeons, special custom-made molded shoes with cushioning inserts can be constructed by an orthotist that will fit the affected foot exactly, relieving any pressure points. There is the danger of developing ulcerations and infections from pressure and they can lead to amputation, especially in diabetics. The custom-made made shoes may be worn with braces to prevent further deformity.
Surgery
Surgery may be considered when there is chronic ulcer formation or when all other conservative treatments have failed. According to Podiatry Today, in the event of bone infection, osteomyelitis, an incision and drainage is required, along with the removal of infected bone. Following bone removal, a procedure called an arthrodesis is performed, which fuses two bones together to improve function and prevent further deformity. A newer treatment, an external fixator that fits around the foot from the outside and holds the bones together via pins and screws while they heal, is showing some promise as a treatment that allows more mobility.
