Charcot Foot

What causes Charcot Foot?
Peripheral diabetic neuropathy is the root cause for charcot foot.

Why does in many patients  diagnosis of Charcot Foot delayed?
Its diagnosis is often missed or delayed, resulting in more complications ,
The patient may present late because of the absence of pain perception due to  peripheral neuropathy. Early radiographic changes may be limited to soft tissue swelling before bone and joint changes occur.

What is Charcot Foot?
Charcot foot consists of fractures and dislocations in foot  with peripheral neuropathy

How does Charcot Foot present?
Charcot foot  presents  with  swelling foot of unknown cause. There may or may not be a history of trauma. Despite the presence of severe bone and joint destruction, pain may be absent or less than expected.so patients continue to walk with foot swelling ending up in rocker bottom deformity or hindfoot collapse dislocation and nonwalkable foot and diabetic foot  ulcers later leading to infections and amputations

How to diagnose Charcot Foot?
Charcot foot presents as foot swelling with erythema and increased warmth over foot associated with peripheral neuropathy,radiographically shows xray fractures and dislocations in late stages,
In early stages there may not be x ray changes where clinical examination with  MRI or nuclear bone scan may help

Can Charcot Foot be misdiagnosed?
Charcot foot is often  misdiagnosed as cellulitis, deep venous thrombosis,or osteomyelitis,
In the late stage, where bone destruction can be seen in x ray, it is misdiagnosed as osteomyelitis. This can lead to progression of bone fractures in early stages ending up with deformity and diabetic foot ulcers,and  some doctors  place patients on long-term antibiotics unnecessarily or recommend amputation as a treatment misdiagnosing them as osteomyelitis/cellulitis.

What complications can occur in Charcot Foot?
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 hindfoot charcot collapse with complete dislocation of ankle joint leading to nonwalkable foot

How is Charcot Foot treated?
Acute charcot foot is treated with immobilization with total contact cast or bivalve TCC,with bisphospanates helping to heal bones faster,
Chronic charcot foot is treated with custom moulded orthotic insoles to prevent further bone collapse and other foot wear modifications according to individual presentation
Podiatric surgery might be option in case of recurrent ulceration/failure of conservative management,it should be kept as last option since recurrence is possible with failure of surgery

How does Charcot Foot end up in amputation?
Patients with midfoot collapse or hindfoot collapse diabetic foot ulcers which if not properly offloaded always has risk of getting infected and if properly not attended by treating doctor can end up in amputation.