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What is Charcot foot?
What causes Charcot foot?
Symptoms
Risk factors
Diagnosis
Complications
How can you live with Charcot foot?
Treatment
FAQs

Charcot foot is a serious complication of diabetes that leads to the bones in the feet weakening and fracturing - often painlessly, hence why its severity is often overlooked or left unnoticed. 

What Is Charcot Foot?

Being diagnosed with Charcot foot, which is medically known as Charcot arthropathy, means that your foot or feet are undergoing notable weakening in the bones that is causing them to fracture (even without tremendous force) and dislocate. The result is notable changes in foot shape over time, often leading to a foot and arch collapse that produces a ‘rocker bottom’ style foot and sole. This can greatly impair your ability to walk, be active, and continue to enjoy the activities you love. 

What Causes Charcot Foot?

Charcot foot is most often a severe complication of diabetes that is caused by nerve damage (medically called peripheral neuropathy) in which the foot or ankle can no longer detect pain - and so there’s no reaction or care taken to support the foot when an initial foot or ankle injury occurs, triggering the problem to start. As a result, people continue to walk on their feet and exercise, worsening the injury and leading to further fractures, dislocations and damage. Other conditions that cause neuropathy to the feet can also lead to a charcot foot, so if you’ve been diagnosed with diminished or absent sensation to the feet from any source, you should take great care.

What Are The Symptoms Of Charcot Foot?

As the foot weakens and breaks down, clinically we will notice symptoms of infection such as the foot or feet feeling warm or hot, being swollen, appearing red, and producing some pain or tenderness for those that still have some sensation in some areas of their feet, although for many the ability to detect any sensations (including pain) is already lost. We may also notice changes to the appearance of their feet depending on how long the condition has been going on, and their feet may feel less stable when walking. 

If the foot has had changes that have led to more prominent bones or joints, or areas of high pressure, then over time other problems such as ulcers, calluses or corns may also arise. In most cases we see, only one foot is affected.

What Risk Factors Make People More Susceptible To Charcot Foot?

While the biggest risk factor is having diabetic neuropathy arising from poorly managed blood sugar levels in those with diabetes, other risk factors include:

• Obesity, as excess body weight places additional stress on the feet which leads to greater damage when you cannot sense and detect pain
  
• Trauma or repetitive stresses on the feet
  
• Foot infections, which can lead to inflammation and joint damage
  
• Alcohol abuse, as it can contribute to the development of neuropathy
  
• Ageing, with a greater likelihood of developing a Charcot foot as you grow older
  

How Can You Diagnose Charcot Foot?

Accurately diagnosing Charcot foot requires a combination of a clinical assessment where we check for signs of inflammation of one or both feet as well as any changes in the foot structure, a review of your medical history to understand if neuropathy is or could be present (and testing for this in the clinic if needed), and medical imaging, often x-ray, to look for bone abnormalities, fractures, dislocations, and joint destruction, which are characteristic of this condition.

As a podiatrist, it is not uncommon for a Charcot foot to be a coincidental at a routine visit with us - as the damage in the foot remains undetected due to the lack of sensation, a person may know their foot is a bit swollen, but not thinking anything more of it, presuming it’s only temporarily and will shortly settle on its own. This is where we’ve been able to suspect Charcot foot and send for imaging to confirm a diagnosis, allowing for the right care to be started promptly to support our patients health and quality of life.

The Importance Of Early Diagnosis For Effective Treatment

Early diagnosis is paramount in the case of Charcot foot as when left untreated, it can quickly cause significant permanent structural changes in the affected foot, which in turn affect foot function and hence a person’s mobility and quality of life. An early diagnosis enables us as podiatrists to implement appropriate treatment strategies to manage the condition's progression and get the best outcomes, while making timely referrals to other appropriate health professionals to help do the same. 

By starting treatment early, we are able to help mitigate the risk of fractures and dislocations that frequently occur in advanced stages of Charcot foot, as well as reduce their severity. Early intervention may also eliminate the need for surgery in cases where the structural foot changes would otherwise be so severe that surgery would be needed to help a person continue to stay mobile and active.

What Complications Can Charcot Foot Cause?

Charcot foot can have significant complications, including:

• Significant structural changes to the feet (such as a midfoot collapse and a rocker bottom foot) that lead to foot instability and hinder normal foot function, which can impair even simple tasks like walking
  
• Difficulty finding shoes that fit or support the feet, so often requiring custom footwear
  
• Areas of bony prominences at the bottom of the foot that are prone to wounds or ulcers. Due to the nature of Charcot foot that involves neuropathy and often diabetes, this means that any wounds or ulcers have a notable risk of developing an infection and it being difficult to treat due to poor blood flow to the area. Hence, one in two diabetics with Charcot foot that develop an ulcer require an amputation.
  

How Can You Live With Charcot Foot?

When the right care is taken early, many people can reduce their risks of complications and continue to live comfortably and safely with an active Charcot foot (as well as beyond it once the inflammation has subsided), often maintaining their ability to walk relatively normally and stay active on their feet. If your Charcot foot has created considerable bone and joint damage and changes to your foot structure and function (which is irreversible), the goal shifts to helping you stay as comfortable and active as possible given the challenges and prevent further problems from arising.

What Are The Treatment Options For Charcot Foot?

Treating a Charcot foot involves putting the right measures in place to help prevent (or reduce the impact of) further damage so your foot can stay in a more optimal position that best supports its function and your movement. We will initially start by completely offloading your foot, often by a specialised boot, which will help prevent further bone damage and foot collapse as well as other structural changes.

After the ‘active’ stage has passed, we’ll help support your feet and your gait in the ways you need - which may include custom footwear or footwear modifications, custom foot orthotics or custom braces. An in-shoe pressure analysis can also be extremely useful here to understand the new areas of pressure being placed on your feet so we know how to best support them and offload that pressure, reducing your risk of ulceration.

 

It is likely that you may need ongoing care and monitoring in the form of routine visits, where we will also care for any corns and calluses that now arise due to your altered foot posture. These visits are extremely useful in that they also allow us to monitor for any ulcers, as well as any signs of inflammation, infection or further damage. Similarly, if you have diabetes, we highly recommend attending your routine diabetic foot health checks with us for these same reasons.

We’ll also work closely with your GP and any other practitioners involved in the management of your Charcot foot to help you in getting the best outcomes.

Why Is It Important To Get A Personalised Treatment Plan?

No two feet are the same when it comes to exactly how the changes associated with a Charcot foot will affect them and the complications it will lead to, which is why getting a personalised treatment plan is a 100% necessity for anyone with Charcot foot.

What Are The Chances Of Full Recovery From Charcot Foot?

As the bony changes associated with a Charcot foot are typically permanent, and the severity of changes you experience are largely dependent on how early your Charcot foot was detected and your management approach to offloading your foot, in most situations a “full recovery” to the foot's original state is not possible. Instead, the goal is to keep you at the best level of mobility and function possible, which we achieve with early care and offloading. 

How Can You Prevent Charcot Foot?

While you may not be able to prevent Charcot foot altogether, the best things you can be doing is keeping your diabetes and blood sugar well managed (if you have diabetes), attend your regular podiatric diabetes screening and routine foot care appointments (as we always check over your feet extensively at these appointments), and monitor your feet daily for any changes, alerting your podiatrist to any problems as early as possible.

Final Thoughts On Charcot Foot

While Charcot foot can lead to debilitating changes that can affect a person’s mobility and quality of life, we see very good outcomes when the condition is detected early and management is started promptly. Charcot foot is a condition that all diabetics should be aware of, as well as those with foot neuropathy for non-diabetes causes. If you’re concerned or suspect you may have Charcot foot, our podiatrists are here to help.