Description, Causes and Risk Factors:
Charcot foot is a sudden softening of the bones in the foot that can occur in people who have significant nerve damage (neuropathy). The bones are weakened enough to fracture, and with continued walking the foot eventually changes shape. As the disorder progresses, the arch collapses and the foot takes on a convex shape, giving it a rocker-bottom appearance, making it very difficult to walk.
Charcot foot develops as a result of neuropathy, which decreases sensation and the ability to feel temperature, pain, or trauma. When neuropathy is severe, there is a total lack of feeling in the feet. Because of neuropathy, the pain of an injury goes unnoticed and the patient continues to walk — making the injury worse. People with neuropathy (especially those who have had it for a long time) are at risk for developing Charcot foot. In addition, neuropathic patients with a tight Achilles tendon have been shown to have a tendency to develop Charcot foot.
Charcot foot is a very serious condition that can lead to severe deformity, disability, and even amputation. Because of its seriousness, it is important that patients with diabetes — a disease often associated with neuropathy — take preventive measures and seek immediate care if signs or symptoms appear.
Charcot foot occurs most often in people with diabetes mellitus. According to the American Diabetes Association (ADA), 60-70% of people with diabetes develop peripheral nerve damage that can lead to Charcot foot. Onset occurs after the patient has been diabetic for 15-20 years, usually at the age of 50 or older. The disorder occurs at the same rate in men and women.
Charcot foot symptoms may include:
Feels warmer than the other.
Redness in the foot.
Swelling in the foot.
Pain or soreness.
Warmth to the touch of the foot.
Early diagnosis of Charcot foot isextremely important for successfultreatment. To arrive at a diagnosis, thesurgeon will examine the foot andankle and ask about events that mayhave occurred prior to the symptoms.X-rays are also essential for diagnosis. In some cases, other imagingstudies and lab tests may be ordered.
Once treatment begins, x-rays aretaken periodically to aid in evaluatingthe status of the condition.
There are 3 stages to your treatment depending on the stage of the disease process.
Stage 1: During this stage, the bones become inflamed, softened and the foot begins to change its shape. Protection of the foot is required to prevent the foot's shape from changing too much.
Complete non-weight bearing is necessary. This means you will be hopping on your other leg, as to not take weight on your affected foot. You will not be able to walk on the affected foot until your Consultant agrees it is safe to do so. Your plaster will be removed after 1 week and your consultant will re-assess your foot. It may be that you are placed in another plaster and this is continually removed and re-applied every week. This process normally lasts for 6 months to 1 year. During this period, you may be required to use crutches, frame or a wheelchair. This will help you to be safely non weight bearing.
Immobilization in plaster cast and non-weight bearing: Because the foot and ankle are so fragile during the early stage of Charcot foot, they must be protected so the soft bones can repair themselves in a good position.
Stage 2: During this phase, the bones of the foot will set and fuse. It is at this stage when your consultant will allow you to start taking some weight through the foot again. Returning to taking weight on your leg will be a gradual process. This means that you will likely require using crutches and a special boot or shoe to continue to protect your foot.
Stage 3: During this phase the bones are re-modeling and becoming stronger. This is the final phase of healing of your foot, although this phase could many several months. Custom shoes and bracing: Special shoes may be needed after the bones have healed, to allow you to return to daily activities. In addition, this helps prevent developing ulcers on the foot, continued "change in shape" and possibly amputation.
Activity adapting: A change in your level of activity may be needed to avoid trauma to both feet. A patient with Charcot in one foot is more likely to develop it in the other foot, so measures must be taken to protect both feet.
Surgery: At this stage and in some cases, surgery may be required. Your consultant will decide the type of surgery that would be best for your foot. This may include amputation.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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