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How can Charcot Foot be Treated?

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How can Charcot Foot be Treated?

Treatment of Charcot foot is usually conservative and surgery is performed only if completely necessary.

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Charcot foot should be treated early to maintain the shape and stability of the foot and ankle and to prevent skin ulceration. Patient and family education are necessary for adherence to treatment, especially due to the absence of pain in the condition.

Treatment of stage 0 and 1 involve immediate immobilization of the foot and avoidance of weight bearing. Immobilization is brought about by wearing a total-contact cast till the symptoms of redness, swelling and heat subside. This usually takes 3 to 6 months, during which casts are changed at regular intervals. Elastic stockings or elastic tubular bandage may be used under the cast to reduce swelling. Following this, the patient should use removable braces or a Charcot restraint orthotic walker for the next few months, followed by custom footwear.

Surgery is used during the quiescent stage for cases with severe ankle and foot deformities that result in recurrent skin ulcerations and cannot be prevented using protective footwear. A joint stabilization procedure may be necessary in patient with unstable joints.

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Ulcerations and abscesses should be treated with local medical and sometimes surgical treatment as well as systemic antibiotics.

Complications of Charcot foot can be avoided by early diagnosis of the condition. Charcot foot should be suspected in any patient with diabetes with nerve involvement, and with redness, swelling and an increased temperature of the foot. Any minor injury to the foot in a patient with diabetic neuropathy should be immediately investigated and treated even in the absence of pain. Patient and family education is extremely important in this regard. Regular foot inspections are advised.

References:

  1. Botek G, Anderson MA, Taylor R. Charcot neuroarthropathy: An often overlooked complication of diabetes. Cleveland Clinic Journal of Medicine 2010; 77(9):593-99.
  2. Robert A. Slater DPM, Yoram Ramot MD, Andreas Buchs MD and Micha J. Rapoport MD. The Diabetic Charcot Foot. IMAJ 2004;6:280-283
  3. Sommer TC, Lee TH. Charcot Foot: The Diagnostic Dilemma. Am Fam Physician 2001;64:1591-8.
  4. Caputo GM, Jan U, Cavanagh PR, Juliano P. The Charcot Foot in Diabetes: Six Key Points. Am Fam Physician. 1998;57(11):2705-2710.

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