Charcot Foot - Information and Specialists

Charcot foot is a specific form of diabetic foot syndrome. This condition occurs when polyneuropathy reduces pain sensitivity in the foot. Polyneuropathy refers to a disorder (-pathy) affecting a large number (poly-) of nerves (neuro), which is very often caused by diabetes mellitus. This condition is also known as diabetic polyneuropathy.

Since all the nerves in the leg—from the top down to the tips of the toes, so to speak—are affected, patients experience less and less sensation in their feet. However, most patients do not notice this loss of pain sensation until late in the course of the disease—or not at all—since this process is gradual and unfolds over many years. As a result, minor injuries or fractures can go unnoticed and worsen.

The term “Charcot foot” is named after the French neurologist Jean-Martin Charcot, who first described this condition.

Charcot foot is a rare long-term complication of diabetes mellitus that leads to bone fractures in the foot @ Pepermpron /AdobeStock

The symptoms of Charcot foot can vary widely and often develop gradually. Typical signs include:

Redness and swelling of the foot:

This is primarily caused by inflammation and chronic overuse of the foot. The joints become irritated, so to speak, because the joint surfaces no longer align properly and are gradually shifting out of place.

Increased skin temperature:

This is also a sign of chronic inflammation and is frequently observed. However, this typical sign is sometimes not recognized—or recognized too late—due to the prominent deformity (malalignment) of the foot.

Deformities and instability of the foot:

The misalignment of the foot and its reduced stability are certainly among the main characteristics of Charcot foot. Due to the chronic inflammatory process and the nerve disease, the joints of the foot undergo progressive remodeling and restructuring, so that in advanced cases of Charcot foot, a misalignment of the foot that is easily recognizable even from the outside can be observed.

Fractures also frequently occur, which are often unnoticed by the patient due to the polyneuropathy described above. These unnoticed—and therefore untreated—fractures are another cause of the malalignment of the foot often observed in advanced Charcot foot.

Pain:

Despite the almost universal presence of polyneuropathy and the resulting reduced sensitivity to pain, some patients also report chronic pain in the foot or ankle, and in some cases, in the lower leg as well. In addition, patients describe a dull pain when walking, although these symptoms are often reported early in the course of the disease. Since a diagnosis of polyneuropathy has usually not yet been made at this stage, this pain is often unrecognized or misinterpreted. Therefore, it is all the more important—especially for people with diabetes—to see a doctor immediately if they notice any unusual changes in their feet.

Charcot foot is primarily caused by a combination of diabetes mellitus and polyneuropathy. This nerve damage leads to a reduced sensation of pain, so that injuries and pressure points go unnoticed. Other risk factors include:

• Poorly controlled blood sugar
• Long-standing diabetes
• Obesity
• Previous foot injuries
• Alcohol dependence

Charcot foot is diagnosed through a thorough physical examination and imaging tests such as X-rays or MRI. Important diagnostic steps include:

Medical history:

This involves taking a detailed medical history. Particular attention is paid to pre-existing conditions, not just diabetes mellitus. Medication use is also of interest, as are previous foot surgeries.

Clinical examination

This involves examining the foot for visible signs of Charcot disease. Particular attention is paid to deformities, as well as wounds and other abnormalities. Sensitivity to pain and sensory disturbances are also assessed. Attention is also paid to pressure points as a potential risk for wound development and to scars as an indication of chronic wounds and impaired wound healing.

Blood Tests

Reviewing laboratory values is particularly helpful when inflammation is present and the extent of pus accumulation and inflammatory tissue changes needs to be examined more closely. Specific inflammatory markers are measured for this purpose and should also be used to monitor the patient’s progress.

Imaging Techniques

Imaging procedures are always necessary and useful when a diagnosis cannot be sufficiently established through clinical examination alone. In addition, imaging procedures are indicated in most cases for monitoring progress or prior to surgical interventions.

X-ray examination is one of the primary imaging techniques. It can provide a preliminary assessment of injuries to the bones and joints, including misalignments (medically referred to as dislocations). 

However, since X-rays can only visualize bone and calcified structures, an MRI scan may be necessary in some cases. This allows for a more detailed examination of soft tissue structures, which is particularly necessary when inflammation, abscesses, or deep wounds are suspected.

To reach a diagnosis, the doctor examines the foot and the ankle joint @ memorisz /AdobeStock

The treatment of Charcot foot is complex and requires an interdisciplinary approach. Key therapies include:

• Immobilization of the foot using special orthoses or casts. This measure is certainly the most important for halting the disease process and preventing severe long-term damage. In many cases, prolonged immobilization is necessary, which can last for many weeks or even months. On the one hand, it is understandable that many patients question the value of this strict immobilization. Nevertheless, this is where the greatest potential lies in terms of treatment options for preventing serious consequences and a possible leg amputation. Therefore, the recommendation for strict immobilization should be strictly followed.
• Blood Sugar Control to Prevent Further Nerve Damage
• Physical therapy to stabilize and improve foot function
• Surgical procedures to correct deformities, though these are only necessary in advanced stages of the disease or in cases of pus accumulation

Physical therapy and foot exercises are particularly important for Charcot foot, as there is an increased risk of falling due to reduced sensorimotor control @ Olga Miltsova /AdobeStock

Specialists in the treatment of Charcot foot include diabetologists, orthopedic surgeons, and podiatrists. These specialists often work together in specialized foot centers to ensure the best possible care.

The course of Charcot foot can vary greatly and depends heavily on early diagnosis and consistent treatment. With the right therapy, the course of the disease can often be positively influenced. It is important to:

• Regular clinical and, if necessary, imaging follow-ups
• Consistent foot care and monitoring by the patient and, if necessary, a podiatrist (commonly known as a foot care specialist)
• Lifestyle adjustments to control blood sugar and prevent obesity

In most cases, amputation can be avoided through consistent treatment and follow-up care. However, in severe cases, surgery may become necessary despite all efforts.

In summary, Charcot foot is a serious complication of diabetic foot syndrome that requires early diagnosis and intensive treatment. Through close collaboration with specialists and consistent blood sugar monitoring, affected patients can positively influence the course of the disease and maintain their quality of life. Therefore, be alert to the first signs and seek medical advice immediately if you suspect you have this condition to avoid serious consequences.