What is Charcot foot and how is it managed?

From the Guidelines

Charcot foot is a serious complication of diabetes that requires immediate non-weight bearing, typically with a non-removable knee-high device, to prevent deformity and promote remission. This condition occurs when weakened bones fracture and the foot loses its normal architecture, often triggered by minor trauma that goes unnoticed due to lack of pain sensation 1. The management of Charcot foot involves immobilizing and offloading the foot to promote remission of the disease and prevent progression of deformity.

Key Management Strategies

• Use of a non-removable knee-high device is strongly recommended to immobilize and offload the foot, promoting remission of the disease and preventing deformity 1.
• A total contact cast can be considered as a first choice in the treatment of active Charcot neuro-osteoarthropathy with intact skin in a person with diabetes mellitus 1.
• Assistive devices, such as crutches or walkers, should be used to reduce weight-bearing on the affected limb and prevent musculoskeletal complications 1.
• Below the ankle offloading devices should not be used in the treatment of active Charcot neuro-osteoarthropathy and intact skin, given their inadequate immobilization of the diseased bone and joints, and limited off-loading capacity 1.

Treatment Initiation and Duration

• Treatment with a knee-high offloading device should be initiated as soon as possible once the diagnosis of active Charcot neuro-osteoarthropathy is considered, even while further diagnostic studies are being performed to confirm the diagnosis 1.
• The duration of treatment with a knee-high offloading device should be continued until the disease goes into remission, which can take several months, and offloading should be continued for 4-6 weeks after the clinical signs of active Charcot neuro-osteoarthropathy have resolved 1.

Importance of Multidisciplinary Care

• Regular follow-up with a multidisciplinary team, including endocrinology, podiatry, and orthopedics, is essential for optimal management of Charcot foot 1.
• Prevention through daily foot inspection, blood glucose control, and prompt attention to any foot changes is crucial, as early intervention significantly improves outcomes 1.

From the Research

Definition and Description of Charcot Foot

• Charcot foot, also known as Charcot arthropathy or neuroosteoarthropathy, is a condition characterized by extensive bone loss, complex instability, and deformity of the feet 2.
• It is often associated with diabetes mellitus and peripheral sensory neuropathy, which can lead to trauma and further destruction of the foot architecture 3.
• The condition can cause chronic plantar ulcerations, infections, and other complications, making it a challenge for orthopedic surgeons to manage 2.

Management and Treatment of Charcot Foot

• The treatment of Charcot foot is varied, with some studies recommending nonoperative treatment with cast/orthosis immobilization, while others suggest surgical intervention to improve long-term outcomes 4, 5.
• Surgical treatment options include tibio-calcaneal arthrodesis, midfoot fusion bolts, and corrective osteotomy with or without arthrodesis 2, 6.
• The use of accommodative footwear, such as depth-inlay shoes and custom-fabricated accommodative foot orthoses, is also an important aspect of managing Charcot foot 4, 6.
• The goal of treatment is to reduce the number of ulcerations and infections, minimize the risk of amputation, and improve the patient's quality of life 2, 3.

Complications and Outcomes

• Complications of Charcot foot can include infections, nonunions, talus necrosis, and wound healing disorders, which can lead to amputation in severe cases 2, 5.
• Studies have shown that early detection and treatment of Charcot foot can help reduce morbidity and further complications 2, 3.
• The outcome of treatment can vary depending on the severity of the condition, the presence of comorbidities, and the effectiveness of the treatment plan 5, 6.