Charcot foot, or Charcot neuroarthropathy, is a rare, and potentially disabling condition that can impact the quality of life negatively of the people that it affects. Charcot foot can be seen in people with different diseases, but it's most commonly found in diabetics. Hallmarks of Charcot foot include joint destruction, bone breakdown, and foot deformities. One key question that comes up with a Charcot diagnosis is whether Charcot foot in diabetics is reversible.
Due to the destructive and progressive nature of Charcot foot, it is not reversible. But there are treatment options available to slow or stop the progression of Charcot, and further damage or destruction to the foot.
Table of Contents: 1. Understanding Charcot Foot In The Diabetic
3. Factors That Influence How Severe Charcot Foot Will Be
Understanding Charcot Foot in The Diabetic
Charcot foot is seen in 0.1 - 7.5% of all people with diabetes. For those people with diabetes + peripheral neuropathy, the incidence of Charcot goes up to 35%. [1]. There are two reasons why Charcot foot develops, and unfortunately, people with diabetes that isn't well controlled, or controlled at all, have both of these factors that increase their risk of developing Charcot foot.
1. Neurotraumatic Theory:
The neurotraumatic theory says that the main cause of Charcot foot is continued trauma due to peripheral neuropathy. Diabetic peripheral neuropathy affects the nerves responsible for a person having feeling in the feet. If someone has peripheral neuropathy, it would be harder for them to know if their feet are getting too much pressure, stress, or strain, because they wouldn't feel pain. Over time, repeated microtrauma can start an inflammatory response, leading to bone dissolving, joint destruction, and foot deformities.
2. Neurovascular Theory:
The neurovascular theory says that Charcot foot starts because of a combination of peripheral neuropathy and increased blood flow. Diabetic peripheral neuropathy also affects the blood vessels, specifically the arteries to the feet. Usually, diabetics will have poor blood flow to their feet, but in Charcot, with this theory, they are actually getting too much blow flow, leading to weak bones, fractures, joint destruction, bones dissolving, and foot deformities, including complete foot collapse.
Warning Signs of Charcot Foot in The Diabetic Include:
1. Foot pain in a foot that is usually numb
In my experience as a foot doctor that has managed many Charcot patients, this is the #1 seen in Charcot foot. A diabetic with neuropathy suddenly feeling foot pain is an alarm for a serious underlying problem. Often time in Charcot foot in the diabetic, someone will start having foot pain, in a foot where they previously had no sensation.
2. Sudden swelling:
Charcot foot usually will usually start with sudden swelling in one foot or ankle. The amount of swelling may be much more in relation to any prior injury, or many times the swelling comes out of nowhere.
2. Redness and warmth:
The affected foot can be warm and red. This can be a sign of inflammation and increased blood flow due to bone and joint damage from Charcot.
3. Changes to your foot shape
As Charcot foot gets worse, the shape or position of your foot or ankle will change. The arch of the foot usually will collapse in end-stage Charcot, leading to a rocker-bottom appearance. This is also known as a rocker bottom foot.
Factors That Influence How Severe Charcot Foot Will Be In The Diabetic:
1. Amount of time it takes for a diagnosis:
Early detection of Charcot foot in the diabetic means that proper treatment isn't delayed, and this can slow down or stop the progression of Charcot. The issue with Charcot foot is, because it's so rare, especially for doctors that don't see it every day, Charcot is misdiagnosed as other things, most commonly infection. Early detection and diagnosis of Charcot can spare people from getting the most severe foot deformities from Charcot, chronic ulcers, infections, and amputations.
2. Treatment approach from multiple doctors:
Slowing down or stopping the progression of Charcot foot in the diabetic takes a team approach from several doctors. These include the foot doctor or podiatrist, an endocrinologist, and a primary care doctor. We have to be sure that the patient is overall healthy, and that their diabetes is under control in order to tackle fighting Charcot foot.
Treatment Options for Charcot Foot In The Diabetic:
Treatment options for Charcot foot in diabetics depend on the stage of this disease progression and the patient's overall health. While complete reversal is more likely is not possible, the following treatment options can help in managing the effects of Charcot foot:
1. Non-surgical Treatments:
Non-surgical treatment of Charcot foot includes:
casts
braces
orthotic devices.
staying off of the affected foot
Note: Patients must be diligent about sticking to the treatment plan in order for this to be successful. Otherwise, the foot will continue to break down.
2. Surgical Treatments:
In cases where conservative treatments fail or when foot deformities are too severe, surgery may be necessary. Screws, wires, plates, and other hardware, placed inside or outside of the foot can be used to help stabilize the foot during recovery, and after healing.
Prevention of Charcot Foot in The Diabetic:
1. Regular foot exams:
People with diabetes should be seeing a podiatrist or foot doctor regularly. At these visits, your foot doctor will examine you for signs of neuropathy, foot deformities, or skin breakdown. Again, early detection is key to lowering your risk of developing the foot deformities seen with Charcot.
2. Controlling your blood sugar:
Maintaining good blood sugar control is vital for preventing and managing complications like Charcot foot. Consistently monitoring and managing blood glucose levels can reduce the risk of peripheral neuropathy and slow the progression of the condition.
3. Wearing the right shoes:
Wearing the right shoes for diabetic feet will give your feet the support, padding, and protection they need to lower your risk of developing Charcot foot. To learn more about the differences between diabetic shoes, and regular shoes, click here for a blog post from me. And to see some options for diabetic shoes that actually look good, also click here.
4. At-home foot exams and self-care:
Daily foot exams are crucial for diabetics preventing ulcers and amputations. On your daily foot checks, if you notice any changes to your feet, call your foot doctor to make an appointment immediately. We can address and treat any changes before they become disabling, like end stage Charcot foot is. To view my pics for products to make your daily at-home foot checks much easier, click here.
Charcot foot unfortunately is not reversible, but there are treatment options available to slow down or stop its progress in the diabetic foot. Early detection is the key to preventing the disabling foot deformities that Charcot can bring.