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Charcot's Arthropathy

Infection of the Foot Diabetic Neuropathy Charcot's Arthropathy Peripheral Vascular Disease Foot Examination Foot Care What sort of help is needed

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Charcot's Arthropathy - The swollen foot

What is it and why is it important ?

Charcot's arthropathy is a complication of diabetic neuropathy. Due to the neuropathy, the bones in the foot become weakened and fractured without major trauma. As the patient notices little pain (a result of the neuropathy), he/she continues to walk on it. This leads to severe deformities of the foot, intractable ulceration, culminating in the need for amputation. It is therefore most important to make the diagnosis early at the acute phase of Charcot's arthropathy because appropriate treatment at this stage can minimize deformities and reduce associated morbidity.

Typical clinical history

Charcot's arthropathy Charcot's arthropathy can affect both people with Type 1 or Type 2 diabetes. In the majority of cases only one foot is affected, however both feet can be affected over a period of years. Diabetes is usually long standing and diabetic neuropathy is always present and quite severe.

Typically, the foot suddenly becomes very swollen and warm to touch . The patient can recall no history of trauma or only a very minor episode (eg. twisted the ankle a few weeks ago). The first clue to the diagnosis is the disproportionate lack of pain. The second clue is the slowness of recovery. (i.e. the swelling does not go away). X-ray at this stage may be normal or show a minor fracture but may already show quite gross bone destruction.

 

Charcot's Arthropathy - Management

Management of acute Charcot's arthropathy

Prevention of further destruction and deformity of the foot at the acute phase is the primary goal of treatment. It is therefore essential to prevent the patient walking on the fragile bones until they have a chance to heal. The mainstay of current treatment is placing the foot in a well moulded contact cast to relieve pressure and to preserve foot shape. Patients remain in the contact cast until there is no major difference in the temperature and swelling between the affected and unaffected feet. This usually takes between 6-9 months.

Application of a contact cast

If treated early, the foot is not grossly deformed. Patients can avoid the need for specialist footwear and have a good chance of avoiding ulceration.

If not treated early, the foot affected by Charcot's arthropathy becomes very deformed and ulcer prone. Treatment at this stage is palliative and relies on special foot wear, regular podiatry treatment and limitation of activities. Amputation is sometimes required because of intractable ulceration. Therefore diagnosing Charcot's arthropathy at the acute stage of a "swollen foot" is essential and limb saving.

 

A grossly deformed Charcot's

 

A grossly deformed Charcot's
joint with neuropathic ulcer.

 

 

 

 

 

Specific treatment

There is no proven specific pharmacological treatment for Charcot's arthropathy. There has been a report that a group of drugs known as the biphosphonates may be useful. These are currently undergoing clinical trials.

 

 

 

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Last modified: 04/22/18