Charcot Foot: Symptoms, Causes & Braces

What Is Charcot Foot?

Charcot Foot is a rare but serious complication of diabetes-related peripheral neuropathy that leads to significant deformities and an increased risk of infection. Neuropathy inhibits the pain sensation, which means minor injuries go unnoticed and worsen over time. This continued use of an injured foot can weaken and fracture bones, potentially causing joints to collapse and resulting in permanent deformities. These structural changes in the foot increase pressure on certain areas, leading to neuropathic ulcers and a higher risk of infections. In severe cases that are left untreated, this can result in amputation.

Also referred to as diabetes-related foot, Charcot arthropathy, or Charcot neuropathy, this condition affects 0.8-8 percent of people with diabetes but requires immediate care to avoid severe outcomes.

Recognizing the Signs and Symptoms of Charcot Foot

Early signs of Charcot Foot include:

• Foot pain
• Redness or discoloration
• Swelling
• A sensation of warmth, particularly if one foot feels noticeably warmer than the other

Advanced Charcot Foot can cause:

• Rocker-bottom foot deformity
• Changes in toe shape
• Ankle deformities
• Diabetic foot ulcers

What Causes Charcot Foot?

People with diabetes often struggle to manage their blood sugar levels, resulting in prolonged periods of high blood sugar (hyperglycemia). Chronic hyperglycemia can damage nerves, particularly in the lower legs and feet. This nerve damage reduces sensation, making it hard to notice signs of injury or infection. Without the ability to feel pain, individuals may continue to walk on an injured foot, exacerbating the damage.

The inability to feel warmth or other symptoms of infection can delay treatment, allowing infections to progress to severe complications. Other factors contributing to Charcot Foot include blood vessel damage from diabetes, which can alter blood flow to the feet and lead to bone loss. Injuries to the foot can also trigger an inflammatory response, causing swelling and further bone degradation.

While diabetes is the most common cause of the nerve damage leading to Charcot Foot, other conditions can also contribute, including:

• Alcohol or drug abuse
• Infections
• Spinal cord disease or injury
• Parkinson’s disease
• HIV
• Syphilis

Charcot Foot Risk Factors

Several factors increase the risk of developing Charcot Foot, including:

• Long-term diabetes
• Poor blood sugar control
• High blood pressure
• Obesity
• High cholesterol
• Kidney disease

Diagnosing Charcot Foot

Diagnosing Charcot Foot involves a thorough physical examination and various imaging tests. During the physical exam, your provider will closely examine your feet and ankles to check for signs of swelling, warmth, and structural changes. They will compare both feet to identify any differences or abnormalities. Additionally, the provider will assess the level of sensation in your feet by gently touching various areas such as the ankles, feet, and toes.

To confirm the diagnosis and evaluate the extent of the damage, imaging tests such as X-rays or MRIs are typically used. X-rays can reveal fractures, dislocations, and bone deformities, while MRIs provide detailed images of the soft tissues, bones, and joints, helping to detect early changes that may not be visible on X-rays.

By combining the physical examination with imaging tests, healthcare providers can accurately diagnose Charcot Foot and determine the best course of treatment to prevent further complications.

What Is the Treatment for Charcot Foot?

Treating Charcot Foot focuses on preventing severe complications and supporting the foot during healing. Early intervention is important to avoid permanent deformities and infections. Here are the key treatments:

Immobilization

To prevent further damage, it’s essential to stop walking on the affected foot. Your healthcare provider will likely recommend complete non-weight bearing, which can involve the use of:

• A cast or brace: A total contact cast can limit movement and reduce pressure on the foot, promoting healing.
• Crutches, walkers, or wheelchairs: These aids help keep weight off the foot and prevent additional injuries.

Over several months, the cast may be changed multiple times as swelling decreases.

Specialized Orthotic Devices

Custom Orthotics

Custom-made shoe inserts play a critical role in treating this condition. They:

• Redistribute weight: A brace for Charcot's foot helps distribute body weight evenly across the foot to avoid pressure points.
• Support structure: Charcot foot orthotics provide essential support to the foot’s structure, maintaining proper alignment and reducing strain on weakened bones.
• Prevent further damage: By cushioning and supporting the foot, orthotics help prevent new injuries and the progression of deformities.

In some cases, your provider may also recommend specialized footwear with extra depth to support and stabilize the foot.

Charcot Restraint Orthotic Walker (CROW)

The CROW boot is a custom ankle-foot orthosis (AFO) specifically designed for patients with Charcot neuroarthropathy. This orthotic device:

• Provides critical support to the bones and joints of the foot and ankle.
• Features a fully enclosed, rigid shell with a rocker-bottom sole for even weight distribution.
• Includes a removable custom-made foam insole tailored to the patient's foot.
• Allows for continued mobility while minimizing pressure on the affected foot.
• Is especially effective for patients with mild to moderate deformities.
• Helps reduce pain, prevent further deformity, and minimize ulcer risk.

Physical Therapy

A physical therapist can help manage symptoms such as pain, stiffness, and discomfort. They will develop a personalized exercise plan to:

• Improve mobility: Exercises aimed at enhancing the range of motion and flexibility.
• Strengthen muscles: Building strength in the surrounding muscles to support the foot and improve stability.

Charcot Foot Surgery

In severe cases, surgery may be needed to correct deformities, stabilize the foot, and prevent further complications. Surgical options include:

• Bone realignment: Correcting the position of bones to restore proper foot structure.
• Fusion: Fusing bones to provide stability and prevent further joint collapse.
• Amputation: In extreme cases, if there’s a severe infection or irreparable damage, amputation may be needed to protect the patient's overall health.

Understanding Orthotic Support for Charcot Foot Management

Ongoing monitoring and lifestyle adjustments are crucial for patients with Charcot foot, as the risk of developing pressure injuries or ulcers remains high throughout their lives. Patients and healthcare providers should work together to manage it effectively. Here’s what patients should know about understanding the condition's progression.

Stage 1: Breakdown and Destabilization

During this initial stage, cumulative nerve damage leads to significant inflammation and structural weakening. The foot typically becomes noticeably red, warm to the touch, and swollen. As this process continues, the joints start deteriorating and shifting out of alignment, causing the foot's arch to collapse.

Early intervention at this point is critical to prevent permanent deformity. Treatment during this acute phase typically involves:

• Strict non-weight-bearing protocols
• Total contact casting (TCC) to immobilize and protect the foot
• Regular monitoring of inflammation markers

Stage 2: Healing Begins

As the body starts its natural healing process, the visible signs of inflammation gradually diminish. During this crucial phase, the bones begin to stabilize in whatever position they've settled into, which highlights why proper positioning and support in the earlier stage were so essential.

Management during this transition phase typically includes:

• Continued use of total contact casting
• Maintaining non-weight-bearing status
• Evaluating readiness for transition to a Charcot Restraint Orthotic Walker (CROW) as inflammation reduces to acceptable levels
• Monitoring for any signs of severe foot and ankle pronation that might require additional intervention

Stage 3: Stabilization and Adaptation

In this final stage, the foot completes its healing process but stays in its altered shape, which may include a flattened arch or other structural changes. Inflammation markers return to normal levels, allowing for more functional mobility.

Management during this chronic phase typically involves:

• Transition to weight-bearing activities while wearing the CROW boot
• Eventually, moving to supportive, accommodating footwear
• Custom pressure-relieving foot orthotics (which most patients will require)
• Ongoing vigilance for potential pressure points that could lead to ulceration

For patients who have developed significant structural changes, particularly those with severe deformity or pronounced pronation of the foot and ankle, more aggressive orthotic intervention or even surgical correction might be needed to prevent complications and maintain mobility.

Regular follow-up appointments are essential throughout all stages to monitor healing progress and make timely adjustments to the treatment plan. This is why it’s so important to work with a provider you trust.