Charcot Foot is a neuropathic
disorder, which presents as fractures and dislocations in the foot, generally
identified and observed with diabetes. Dr. P.N. Someshwara Rao. M.S. MRCS, FPS,
Consultant Podiatric Surgeon and Diabetic Foot Specialist, elaborates to
Medindia on the medical condition and the treatments available to correct
Q. Diabetes is usually associated
with Charcot Foot, what are the other reasons contributing to the medical
A. Any condition associated with peripheral
neuropathy can lead to Charcot Foot and the most common cause is diabetes. Other
causes apart from diabetes are neurosyphilis, leprosy, spinal cord injury,
nerve injuries and disorders.
Q. Should the treatment of Charcot Foot be
periodical? Would it need regular monitoring of the condition by a medical
practitioner? If yes, at what intervals?
A. When a person develops Charcot Foot, regular
monitoring of at least once in 2 to 3 months is imperative. The chances of
recurrence are highly likely because the treatment is symptomatic. In some
cases such as in chronic diabetic complications when the nerves are already
dead, the nerves cannot be revived hence the root cause of the pathology
remains untreated. Only the symptom gets medical attention. Whereas in cases of
nerve injuries (e.g. Compression), there are better chances to treat the source
of the pathology.
Q. What are some of the other
complications, in other parts of the body, arising from Charcot Foot?
A. Its diagnosis is often missed or delayed,
resulting in more complications. Charcot Foot in late stages presents with
rocker bottom deformity and subsequent ulceration, or hind foot Charcot
collapse with complete dislocation of ankle joint which in turn leads to a
non-walkable foot. Mid-foot, Charcot Foot with non-healing ulcers can sometimes
lead to secondary infection and in certain cases amputation may be necessary.
At which part of the acute stage can a foot still be saved from
A. Acute Charcot Foot is treated with
immobilization with Total Contact Cast or bivalved TCC (Total Contact Cast),
with bisphospanates helping to heal bones faster. Chronic Charcot Foot is
treated with custom moulded orthotic insoles to prevent further bone collapse
and other footwear modifications according to individual presentation.
Podiatric surgery might be an option in case of recurrent ulceration or failure
of conservative management; hence it should be kept as a last option since
recurrence is possible with the failure of the surgery.
Q. How are the customised shoes
prescribed for people with Charcot Foot different from the ones prescribed for
people with diabetes without Charcot Foot?
A. Footwear for a person with a neuropathic
condition does not have a cosmetic appeal. It is custom designed to avoid
future bone collapse so it should basically have custom moulded accommodative
insoles with rocker outsoles and stabilization of hind foot done with high heel
counter or ankle foot orthosis. The
addition, other required footwear modifications are done according to
individual presentation. It is better to consult a podiatrist for footwear advice
in any patient with Charcot Foot or any chronic non-healing plantar callus
Q. What age group of people and with
what kind of lifestyle are likely to be affected by Charcot Foot?
A. It is usually a condition prevalent among the
elderly. People with 5 to 10 years of diabetes with neuropathy are prone to be
affected by Charcot Foot.
Vulnerable to misdiagnoses Charcot Foot is
presumed to be general swelling and is usually treated with regular
antibiotics. If foot ulcers do not show any sign of improvement or healing for
more than 4 to 8 weeks, it is advisable especially for people with diabetes to
consult a podiatrist to avoid further complications. Medindia thanks Dr. P.N.
Someshwara Rao for his valuable insights.