Charcot Foot

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Diagnosis

Diagnosis is based on medical history (i.e., history of diabetes), symptoms, imaging tests (e.g., x-rays, MRI), and laboratory tests.

X-rays are used to detect joint effusions, large osteophytes, fractures, bone fragments, and joint misalignment and/or dislocation. Magnetic resonance imaging (MRI) can be used to help differentiate between Charcot foot and osteomyelitis (bone infection). Joint margins, which are clearly defined upon MRI in Charcot foot, appear blurred in osteomyelitis.

Laboratory tests include drawing fluid from the joint (arthrocentesis) to detect bone and cartilage fragments and blood, which may be present in some cases of Charcot foot.

Treatment

The goal of treatment is to stabilize the joint. In patients with diabetes, restraining from placing weight on the foot for at least 8 weeks may help to prevent further damage. During this time, a total contact or walking cast and crutches may be required to protect the foot.

Surgery may be necessary to treat severe deformities or recurring ulcers by reshaping structures within the foot or removing bony protrusions that cause ulcers. After surgery, the foot is monitored for signs of infection (e.g., redness, swelling, warmth).

Osteoctomy is the most common surgical procedure used to treat Charcot foot. It involves making a surgical incision on the bottom of the foot and removing abnormal bone growth and bone and cartilage fragments. In some cases, osteoctomy can be performed on an outpatient basis, but it may require an overnight hospital stay. Local or general anesthesia is used. After the procedure, the patient usually wears a brace of cast for about 4 weeks, or until healing is complete.

Midfoot realignment arthrodesis is performed to remove bony overgrowths and repair the collapsed arch. This procedure requires general anesthesia and an overnight hospital stay. During midfoot realignment arthrodesis, an incision is made in the foot and screws and plates are inserted to stabilize the bones and joints. Bone and cartilage fragments are removed, the wound is flushed, and the incision is sutured.

Following this surgery, a non-weight-bearing cast is required for about 3 months, followed by a weight-bearing cast for another month or so. Custom-made shoes and inserts (orthotics) are then required for walking.

Hindfoot and ankle realignment arthrodesis is performed when the patient is unable to walk and braces are no longer helpful. This procedure requires general anesthesia and at least an overnight stay in the hospital. During hindfoot and ankle realignment arthrodesis, an incision is made in the foot and screws and plates are inserted to stabilize the bones. Bone and cartilage fragments are removed, the wound is flushed, and the incision is sutured.

After this procedure, a non-weight-bearing cast is worn for about 3 months, and then a special brace to protect the arch is worn for 2 or 3 months. Patients often require a custom-made brace to walk following this surgery. With the use of a brace, the foot must be closely monitored because the patient may not feel pressure from a poor fit.

Prognosis

In most cases, patients with Charcot foot can resume regular activities after treatment. In patients with diabetes, blood sugar levels, injuries to the foot, and recurrence of the disease must be strictly monitored.

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