Charcot Foot Brace

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 less than 1% 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.

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.

Your provider may also recommend specialized footwear with extra depth and an ankle brace to support and stabilize the foot.

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.

CROW Boot Orthotic for Charcot Foot

The Charcot Restraint Orthotic Walker (CROW) is a custom ankle-foot orthosis (AFO) designed for patients with Charcot neuroarthropathy (CN). The CROW boot provides critical support to the bones and joints of the foot and ankle during the remodeling stage of CN to help prevent further structural damage.

This orthotic device consists of a fully enclosed, rigid shell with a rocker-bottom sole, which ensures even weight distribution across the foot. A custom-made design of ankle foot orthoses includes a removable foam insole tailored to the patient's foot, offering enhanced support and stability.

The CROW boot is especially effective for patients with mild to moderate CN deformities, reducing pain, preventing further deformity, and minimizing the risk of ulcers. Its robust construction allows patients to continue walking and standing with minimal pressure on the affected foot which promotes healing while maintaining mobility.