The condition develops in some people with diabetes from peripheral neuropathy, where high blood glucose levels affect the nerves in your feet. It causes fractures and joints to dislocate and the foot can collapse. It is very serious and can lead to severe complications like foot ulcers and amputation.
Early recognition and immediate immobilization can prevent severe complications from developing. Proactive management, including routine foot care and glycemic control, can significantly improve outcomes.
Risk factors
The condition is a result of nerve damage from high blood sugar levels that causes peripheral neuropathy, which can lead to weakened bones in the foot. This causes fractures, dislocations and deformities. It can also cause a person to develop ulcers, which may require surgery to heal. Without treatment, these wounds may not heal and the person’s foot could deteriorate to a point where an amputation is needed.
The most extensive study of charcot foot to date found that people with diabetes who develop the condition have higher risks for developing ulcers or needing an amputation if they have long-standing diabetes and specific risk factors, such as micro- and macroalbuminuria, retinopathy and atherosclerosis. People with type 1 and type 2 diabetes who have these risk factors have a greater chance of developing the condition than those who do not have them.
Fortunately, there are ways to prevent Charcot foot from occurring in the first place. This includes checking your feet daily and keeping your blood glucose and lipid levels within their target ranges. You can also reduce the risk of complications by following your doctor’s instructions about when it is safe to put weight on your feet. Those who have been diagnosed with the condition should also be sure to see their podiatrist regularly. This will ensure that any problems are detected and treated early, reducing the risk of major deformities and ulcers.
Symptoms
If a person with diabetes has nerve damage (neuropathy) in their feet, it can affect how the bones and joints in their foot feel. As a result, the bones can weaken, and joints may dislocate. This can cause the foot to collapse. It can also lead to open sores, called ulcers, which are at risk of infection due to poor blood flow.
If the problem is caught early, it’s easier to treat. So it’s important for people with diabetes to visit a healthcare provider or foot specialist (called a podiatrist) regularly and inspect their feet every day. In addition, keeping blood sugar levels under control can help reduce the onset of neuropathy and Charcot foot.
The earliest symptoms are pain, swelling, and warmth in the foot or ankle. X-rays may show signs of fractures, joint dislocations, or deformities. The foot may also start to change shape, and the toes might curl or curve under as a result.
As the disease progresses, it can take a long time for the foot to heal. The foot might stay in a cast for months. During that time, you must keep all of your weight off the foot, and you’ll need to use crutches, a knee-walker device, or a wheelchair. Once the foot has healed, you’ll need to get custom shoes that fit well and provide proper support.
Diagnosis
People with diabetes have a higher risk of developing Charcot foot. But early diagnosis and treatment can help prevent deformity, foot ulcers, and amputation.
This condition happens when multiple fractures, and sometimes joint dislocations, change the shape of your foot and ankle. Over time, this can lead to an abnormal rocker-bottom foot, in which the middle part of your arch collapses. It can also cause the bones of your feet to become misaligned and change the way you walk, causing the heel bone to sink down into the front of your foot.
If you have diabetes, it’s important to check your feet every day for redness, warmth, and swelling. If you notice any of these symptoms, contact your doctor right away. The sooner your doctor diagnoses Charcot foot, the less likely you are to experience serious complications.
Your doctor will take a careful history of your symptoms and examine your foot. They may take radiographic images of your feet, including anteroposterior and lateral weight-bearing views, to diagnose the condition. If the condition is afoot, your doctor may recommend that you use a removable total contact cast. Other treatments include specialized dressings that reduce infection, electrical or ultrasonic bone stimulators to increase circulation and promote healing, and growth factors that can enhance wound closure in diabetic foot ulcers.
Treatment
If you have Charcot foot, you must see a doctor right away for treatment. He or she will evaluate your feet for redness, warmth, swelling, and deformities. He or she may also order X-rays to check for fractures, dislocations, and joint collapse.
Doctors can use casts to protect your feet while the bones heal. The most common cast is a “total contact” cast that covers the whole foot and ankle. It is important that you not put any weight on the foot while it is in the cast. Your doctor may recommend crutches or a knee scooter to help you get around.
Surgery may be necessary if the injuries are severe and the foot can’t be stabilized with shoes or braces. During surgery, your doctor might realign or fuse bones to make the foot more stable. He or she might also smooth sharp bones that could cut into the skin and cause sores.
Getting early treatment can minimize deformities and the risk of ulcers that lead to amputation. The best way to prevent this complication is to keep your blood sugar level under control and see a doctor who specializes in foot and ankle problems for regular checkups. You should also carefully inspect your feet every day and report any changes to your healthcare provider. If you have diabetes, check your feet for redness, warmth, and swelling every day.