What type of footwear is recommended for a Charcot (Charcot-Marie-Tooth disease) deformed foot?

Footwear for Charcot Deformed Foot

For patients with Charcot deformity in remission, use custom-made footwear with custom orthoses that accommodate the foot shape, and when significant deformity or joint instability exists, prescribe below-knee customized devices such as a Charcot Restraint Orthotic Walker (CROW) or contoured plastic ankle-foot orthosis. 1

Footwear Requirements Based on Deformity Severity

For Mild to Moderate Deformity (Plantigrade Foot)

• Therapeutic footwear with adequate length, width, and depth is essential to accommodate the altered foot architecture and prevent ulceration 1
• Extra-depth footwear should be prescribed to accommodate custom-made insoles, which redistribute plantar pressure away from high-risk areas 1
• Custom-made orthoses are strongly recommended to optimize plantar pressure distribution and reduce mechanical stress on deformed joints 1
• The footwear must fit, protect, and accommodate the specific shape of the deformed foot to prevent re-activation of the disease 1

For Severe Deformity or Joint Instability (Non-Plantigrade Foot)

• Below-knee customized devices provide superior ankle stability and pressure redistribution compared to ankle-high devices 1
• The Charcot Restraint Orthotic Walker (CROW) is the preferred customized device for long-term management of significant deformity 1
• Contoured plastic ankle-foot orthoses serve as an alternative below-knee option for patients requiring extended ankle support 1
• These devices are built on a positive model of the patient's foot to accommodate deformity and relieve pressure over at-risk sites 1

Critical Footwear Specifications

Custom-Made Medical Grade Footwear Components

• Footwear must be uniquely manufactured when the patient cannot be safely accommodated in prefabricated options 1
• In-depth assessment, multiple measurements, impressions or a mould, and a positive model of the foot and ankle are required for manufacture 1
• The footwear must accommodate deformity and relieve pressure over at-risk sites on both plantar and dorsal surfaces 1
• Custom-made insoles should be built in multi-layer construction using 2D or 3D impressions of the foot 1

Pressure Redistribution Features

• Custom orthoses redistribute plantar pressure to prevent ulceration at high-risk locations created by the deformity 1
• The orthotic device should conform to the shape of the foot while providing cushioning and support 1
• When custom orthoses are prescribed, extra-depth footwear (minimum 5mm additional depth) must be used to accommodate the increased thickness 1

Common Pitfalls and How to Avoid Them

Inadequate Offloading

• Never use below-ankle devices (surgical shoes, postoperative sandals, custom molded shoes) for Charcot feet with significant deformity as they provide inadequate immobilization and limited offloading capacity 1, 2
• Conventional off-the-shelf footwear is insufficient for Charcot deformity and increases risk of ulceration and disease re-activation 1

Insufficient Ankle Support

• Ankle-high offloading is inadequate when joint instability or significant deformity is present 1
• Removable knee-high devices provide superior outcomes compared to ankle-high alternatives for patients requiring long-term ankle stability 1

Premature Transition to Standard Footwear

• Patients with Charcot deformity require lifelong specialized footwear to prevent re-activation and ulceration 1, 2
• The IWGDF Risk Stratification System identifies loss of protective sensation with Charcot deformity as high-risk for ulceration, necessitating permanent therapeutic footwear 1

Evidence Quality and Strength

The 2024 IWGDF guidelines provide strong recommendations (moderate quality evidence) for therapeutic footwear and orthoses in Charcot remission, despite acknowledging no direct comparative studies exist 1. The recommendation strength derives from the high risk of ulceration (6-12 times increased risk of major amputation) and 29% five-year mortality rate associated with Charcot foot complications 2. The guidelines emphasize that therapeutic footwear reduces CNO re-activation and mechanical stress, consistent with established principles of diabetic foot ulcer prevention 1.