Charcot foot also referred to as neuropathic osteoarthropathy can cause gradual weakening of your foot or ankle. It can result in mobility issues. The problem leads to the weakening of soft tissues, joints, and bones of the ankle or foot. So, it can result in limiting your mobility. In the majority of the cases, the problem occurs as a side-effect of diabetes. Severe complication can occur due to nerve damage (peripheral neuropathy). Affected people become insensitive to pain. The inflammatory process occurs due to a repetitive injury or a series of microtraumas that you have some or no knowledge of. You can prevent the condition in some cases. With proper assistance and steps, you can prevent the severe complications associated with it.
If you fail to address the condition, it can result in bone weakening. So, you become susceptible to fractures or dislocation in the foot and ankle region. The repetitive trauma, as well as degeneration, can result in the collapsing of the foot joints. Therefore, the problem can lead to foot deformity. Your affected foot can take on an abnormal shape (for example, like rocker-bottom appearance). Ultimately, the deformity can cause foot sores and ulcers, in some cases, the problem results in bone infection (osteomyelitis). Without proper treatment, you can face the risk of amputation. Read ahead to understand the risks associated with neuropathic osteoarthropathy and the proactive behavior to prevent the condition or stop its progress.
What Is Charcot Foot?
The condition results from complete or near-complete numbness of one or both of your feet or ankles. It can result in the weakening of the bones in your foot. So, you can become prone to damages like dislocation and fractures. The nerve damage causes the numbness. It results in complete failure to detect the pain from fractures or other traumas. So, you can put your foot at risk of additional trauma when you walk or stand. The continuing weakening of bone in the joints can cause dislocation or collapse of foot joints. It will ultimately result in the changing of your foot shape.
In most cases, the affected person can experience rocker-bottom foot. The problem causes the foot of the arch to extend down and out. So, it gives your foot a rocker like an appearance. Charcot foot can also lead to the development of sores. It becomes hard to heal. So, you need to get treatment as early as possible. Without treatment, the condition can lead to severe deformity or disability. In extreme cases, the problem can cause amputation.
Symptoms Of Charcot Foot
The condition develops in stages. Each stage has different symptoms. Do you wish to know the complete detail of the signs associated with the problem? Then, read ahead.
Stage One: Fragmentation And Destruction
The initial stage may cause severe symptoms. But, most people ignore the issue. Never overlook the following symptoms:
- Redness in the foot or ankle
- Significant swelling of your ankle and foot
- The affected area feels warm or hot to touch compared to the other foot
- Soft tissue swelling can start to occur
- Experience small bone fracture
The above-mentioned problems can lead to the destruction of your joint around the surrounding bone. So, you can experience the following:
- Lose joint stability
- Dislocation of joints
- Jellification or complete softening of bones
- Flat or rocker-bottomed foot appearance
- Plantar prominences (bony protrusions) on bottom of the foot
You need treatment for the condition. Without any medical treatment, you can experience the signs associated with the problem for up to a year.
Stage Two: Coalescence
When you ignore the first stage, your body attempts to heal the damage occurred during the first stage. So, the condition can result in the slowing of the bone and joint destruction. It can result in:
- Experiencing less swelling
- Reduction of redness
- Less warmth
Stage Three: Reconstruction
It is the final stage during which your body tries to heal the problems with the joints and bones. Unfortunately, the problems do not solve on its own. So, the shape of your foot does not go back to its normal shape or condition naturally. While your body prevents further damage, it often fails to restore your foot to normal condition. The deformed state of your foot can result in an unstable condition. The unstable state of your foot leaves you prone to the formation of ulcers and sores. So, it can cause further deformity. In severe cases, you require amputation to deal with the deformity.
Causes Of Charcot Foot
The problem is common among people who experience peripheral neuropathy. It refers to the nerve damage that can trigger numbness in affected person’s feet and legs. Some problems can lead to peripheral neuropathy. The conditions that trigger the problem includes:
- Diabetes
- Drug Abuse
- Alcohol use disorder
- Leprosy
- Polio
- Syringomyelia
- Trauma or damage to peripheral nerves
- HIV
- Parkinson’s disease
- Inflammatory conditions (for example, psoriasis or sarcoidosis)
Complications of Charcot Foot
Charcot foot is a severe complication causing problems with mobility. The issue can make your bones weaker. So, you can experience the breaking of bones or moving of the bones from its actual place. When such problems occur, it can cause complications like:
Loss Of Foot Shape
Your foot can lose its shape due to the condition. It is a common complication associated with the problem. Charcot foot can lead to the dropping of the arch found in the middle of the foot. So, it causes the bones to drop to go lower than your toes or heel. The condition is referred by the doctor as rocker bottom.
Curling Of Toes
Another complication is the curling of toes. In most cases, it signifies spasticity in the feet and toes. The miscommunication between the brain and your muscles can result in the condition.
Ankle Twisting
The condition can cause twisting of your ankle. It makes you unsteady while walking.
Open Sores
The untreated Charcot foot can cause the bones to press against your shoes. So, excess friction can cause open sores on the skin. It can result in infection. Peripheral neuropathy is a common problem in people with diabetes. But, diabetic people can suffer from poor blood flow. It can lead to a problem with the healing of infection. Unhealed infection can trigger other problems, which needs immediate removal of the foot. It is a severe issue that can lead to amputation.
Diagnosing Charcot Foot
In most cases, the problem goes undiagnosed as the imaging tests like X-rays fail to pick up the damage starting to occur on your feet. So, the issue remains undetected during stage one. It is important for the patients with increased risk of developing the problem to inform their doctor about the medical condition resulting in Charcot foot. So, people with conditions like diabetes, leprosy or other causes leading to the issue need to talk to their doctor about the issue.
Physical Examination
In most cases, you start to notice the issue when you see changes in the physical appearance of your foot and ankle. Once you see the issue, your doctor can analyze your symptoms closely. The physical examination can help detect the signs of neuropathy. Your doctor can also ask you about your medical history. It gives an idea about the health concerns that lead to neuropathy.
Sophisticated Imaging Tests
As the problem progresses, sophisticated imaging techniques can pick up the problem. So, X-ray and MRI can reveal the intensity of the problem in detail. Your doctor can see the images to detect the problem.
Other Tests
Apart from the tests suggested above, your doctor can also use several other diagnostic techniques to analyze the sensitivity to pain. It can help detect problems like neuropathy with ease.
Semmes-Weinstein 5.07/10 gram Monofilament Test
It is a test that can analyze the sensitivity to pressure as well as touch in the large nerve fibers. Based on the test, your doctor can detect neuropathy and its severity.
Pinprick Test
The invasive test checks for your ability to feel a pinprick. It also determines your ability to tell the difference between sharp and dull pain. So, based on the assessment of your ability to feel pain, the doctor can come to a definite conclusion.
Neurometer Test
It is a unique neurodiagnostic device that helps identify peripheral nerve dysfunction. So, your doctor can make a diagnosis of diabetic neuropathy using the tool. The diagnostic device can help in the painless evaluation of sensory nerve fibers can help detect any problem with ease.
Apart from the above-mentioned tests, your doctor can test the tendon reflexes. The muscle tone and strength in your legs and foot need thorough analysis. It will provide information about any issues that can affect the region.
Charcot Foot Treatment Options
The treatment options available to alleviate the problem depend on its stage. So, based on the stage of the issue, your doctor can determine the best treatment option.
Stage One Treatment Methods
The stage one refers to the early stage of the problem. So, you may start developing only small signs. Therefore, your doctor can suggest treatment that offers relief from swelling and warmth in the area. The methods suggested also aims to keep the foot stabilized. In most cases, you need to limit mobility to avoid further complication. Your doctor can ask you to put off the pressure or weight from the affected foot to prevent additional damage. The method is known as off-loading, which keeps your foot safe from further damage.
Stage Two Treatment Methods
During the second stage, you can experience problems with the joints of your foot and ankle. The destruction can trigger several inconveniences. So, your doctor suggests several low-tech, non-surgical options to deal with the problem and stop its progression. Therefore, the various options available are:
- You can wear a protective splint, customized walking boot or walking brace to prevent further damage to your feet or ankle.
- You need to keep the weight off your affected foot. So, minimize or completely off load the weight on your foot suffering from the issue. Use assistive devices like crutches, wheelchair or walking scooter to get from one place to another.
- To correct the alignment of your foot, the doctor can suggest using an orthotic brace. It can help manage the complications and prevent further damage to the bones.
- Wear a contact cast as per your doctor’s suggestion. You can wear the customized cast that fits your leg and foot specifically to avoid problems.
It is important to wear the supports for several months or a longer duration until the doctor suggests. Your doctor can monitor the progress regularly to check for any issues or complications. When the problem affects only one foot, your doctor monitors the foot to check for symptoms. Once your affected foot heals, your doctor can suggest the following to eliminate the possibility of recurrence of Charcot foot in the future:
- Wear a well-fitted diabetic footwear or therapeutic shoes to reduce the chances of getting foot issues again.
- Your doctor can suggest modification in your regular activity. The reduction in activity levels can avoid repetitive trauma to both your feet.
Since you have high chances of developing the condition in the other foot when you suffer from Charcot in one foot, you need to maintain caution. The preventive measures can protect both feet and avoid any complications.
Stage Three Treatment Option
Stage of the problem means you have extensive damage to your foot and ankle. The foot and ankle have an abnormal shape due to the issue. It can cause instability and problems with movement. Your doctor first tries to manage the condition with support devices or braces. When it fails to see the effect, then invasive surgery can fix the issue. Surgery is also an option when you have an ulcer or sore that does not heal properly. Based on the issue you suffer, your doctor can suggest the following surgical techniques:
Reconstructive Osteotomy
The surgical procedure is also known as realignment bone surgery. Using the procedure, your doctor can lengthen or shorten a bone in the foot or ankle region. So, it can positively alter the alignment. Therefore, the surgery can restore the ability of the foot and ankle to support the joints. For lengthening the bone, the surgeon adds a wedge of bone to the affected area. While surgeons can shorten the bone by cutting it.
Ankle Fusion
The procedure can enable the motion of the ankle joint. It uses screws, plated or rods to lock the ankle joint, which causes problems with leg motion. After the surgery, you can restore the mobility of the ankle joint.
Exostectomy
It is the procedure to remove the plantar prominences that cause you discomfort. The removal can prevent ulcer formation.
 Amputation And Prosthetic Fitting
Amputation means the complete removal of the foot or portion of the foot affected by Charcot disease. It is the final step adopted when other methods cannot offer desired relief. After the removal surgery, a prosthetic device is fitted. It will aid with walking. A well-fitted prosthetic device can offer support with your mobility.
Preventing Charcot Foot Development
It is possible to prevent Charcot foot by taking good care. You need to monitor your health closely. If you suspect any problem, then take steps to avoid the condition from developing.
Diabetes
People with high blood sugar need to keep it under control. Abnormal sugar levels can lead to nerve damage and other problems. So, if your doctor diagnoses diabetes, then take your medications as prescribed. It keeps the sugar levels in your blood within control and helps reduce nerve damage.
Avoid Trauma
People with high blood sugar levels or have a high risk of developing peripheral neuropathy must avoid trauma to the feet. If possible, you need to prevent getting injured. Injuries or trauma to the feet can put you at risk of Charcot foot. So, avoid the following activities that increase your risk of foot problems:
- Sports like soccer or kickball
- Exercises impacting your feet
Self-Examination
You can perform self-assessment to detect the changes on your foot. The self-examination can help you detect the early symptoms associated with the problem. It will help you get the required medical assistance. With early assessment, you can get relief and prevent further complications.
Stop Substance Abuse
People with substance abuse problem need to get professional assistance to overcome the addiction. Misusing alcohol or other substances can put you at risk of developing a Charcot foot. Therefore, you need your doctor or other professionals to take steps to avoid using the substances. Enroll in a 12-step program, rehabilitation setting or other interventions to stop the behavior completely. So, it reduces the risk of developing the problem.
Regular Check-Ups
You need to consult your doctor and get professional checkups on a regular basis. The checkups can help detect the problems early. So, you can get medical assistance before the problem becomes worse.
Conclusion
Charcot foot is a devastating condition that you can avoid to an extent. With early detection, it is possible to prevent severe damage and subsequent complications. So, you can avoid severe problems like amputation by seeking treatment early. The condition is common among diabetic patients. Earlier, its prevalence was underestimated due to the delayed or misdiagnosis. People with health conditions that put them at risk of the problem need to maintain caution. By adopting ample preventive measures and seeking immediate care, you can manage the symptoms. Early diagnosis and management can offer excellent results as it avoids progression towards permanent foot deformity and other complications. So, with early medical intervention, you can manage the problem and prevent lasting side-effects. Go to your doctor immediately when you suspect the problem, medical assistance can help you deal with the issue properly.
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