What is the cause of constant foot pain secondary to Charcot (Charcot-Marie-Tooth disease) foot?

From the Guidelines

Constant foot pain due to Charcot foot requires immediate offloading and immobilization to prevent further joint destruction and deformity, and the primary treatment involves non-weight bearing with a total contact cast for 8-12 weeks, as recommended by the International Working Group on the Diabetic Foot (IWGDF) guidelines 1. The management of Charcot foot involves several key components, including:

• Offloading: to reduce pressure on the affected foot and prevent further damage
• Immobilization: to stabilize the foot and prevent further joint destruction
• Pain control: to manage pain and discomfort associated with the condition
• Monitoring: regular X-rays every 4-6 weeks to track bone healing and detect any potential complications

The use of a total contact cast is recommended as the first line of treatment for active Charcot neuro-osteoarthropathy, as it provides optimal immobilization and offloading of the foot 1. A knee-high walker rendered non-removable can be considered as a second choice, while a removable knee-high device worn at all times can be considered as a third treatment choice 1.

It is also important to note that below the ankle offloading devices, such as surgical shoes or postoperative sandals, are not recommended for the treatment of active Charcot neuro-osteoarthropathy, as they do not provide adequate immobilization and offloading of the foot 1.

In addition to offloading and immobilization, pain management is also an important aspect of Charcot foot treatment. This can include the use of acetaminophen, NSAIDs, and neuropathic pain medications such as gabapentin or pregabalin 1.

Regular monitoring and follow-up are also crucial to ensure that the treatment is effective and to detect any potential complications early on. This includes regular X-rays to track bone healing, as well as monitoring for signs of infection or other complications 1.

Overall, the management of Charcot foot requires a comprehensive approach that includes offloading, immobilization, pain control, and regular monitoring. By following the IWGDF guidelines and working closely with a healthcare team, individuals with Charcot foot can receive effective treatment and prevent further complications.

Some key points to consider when treating Charcot foot include:

• The importance of early diagnosis and treatment to prevent further joint destruction and deformity
• The need for regular monitoring and follow-up to detect any potential complications early on
• The use of a total contact cast as the first line of treatment for active Charcot neuro-osteoarthropathy
• The importance of pain management and the use of neuropathic pain medications as needed
• The need for patient education and awareness of the condition and its treatment, as well as the importance of strict blood glucose control to prevent worsening neuropathy 1.

From the Research

Charcot Foot and Constant Foot Pain

• Charcot foot is a highly destructive joint disease of the foot and ankle that can lead to gross deformity, instability, recurrent ulceration, and/or amputation if left untreated or misdiagnosed 2.
• The condition is often misdiagnosed early in its presentation due to a lack of knowledge among members of the medical community, resulting in delayed diagnosis and treatment 2.
• Constant foot pain is a common symptom of Charcot foot, and treatment aims to alleviate this pain and prevent further complications.

Treatment Options for Charcot Foot

• Total contact casting (TCC) is a commonly used treatment to immobilize the foot and ankle, prevent trauma, and preserve foot structure during the inflammatory phase 3.
• The median TCC duration for resolution of acute Charcot foot is approximately 4 months, with an overall complication rate of 5% per cast 3.
• Removable cast walker boots and prefabricated removable walker braces with custom insoles are alternative treatment options that can provide effective off-loading and management of Charcot foot 4, 5.
• Surgical intervention remains controversial, and the gold standard of treatment is non-weight-bearing immobilization in a total contact cast 6.

Management and Outcomes

• Patient education, managing expectations, and improving adherence to treatment are crucial for successful management of Charcot foot 3.
• Osteoarthritis is significantly associated with a longer TCC duration, and clinicians should be aware of this when treating patients with Charcot foot 3.
• The use of rocker sole shoes, insoles, and ankle foot orthoses can help prevent further complications and promote healing in patients with Charcot foot 5.