Charcot Foot

What is Charcot foot?

Charcot foot is a rare complication of diabetes-related neuropathy. It can make injuries or infections much more serious.

Diabetes-related neuropathy is nerve damage that makes you lose feeling in your lower legs and feet. This makes it hard (or impossible) to feel pain or notice other signs that something is hurting your foot. Charcot foot happens when a small injury or an infection causes severe complications because you can’t feel or notice the symptoms.

If it’s not treated soon enough, Charcot foot can make the joints in your foot collapse and permanently affect your ability to use your foot. It can also make it more likely that an infection in your foot gets much worse or spreads to the rest of your body. In severe cases, this can lead to needing your foot amputated or cause life-threatening complications.

Talk to a healthcare provider about managing diabetes and your blood sugar (blood glucose) levels. The best way to prevent Charcot foot is to have regular checkups with a provider and examine your feet for any loss or change in your ability to feel touch, pain or pressure.

Some other names healthcare providers use instead of Charcot foot include:

• Diabetes-related foot.
• Charcot arthropathy.
• Charcot neuropathy.

How common is Charcot foot?

Charcot foot is rare. It affects less than 1% of all people with diabetes.

What are Charcot foot symptoms?

Early symptoms of Charcot foot include:

• Foot pain.
• Discoloration or redness.
• Swelling.
• A feeling of heat or warmth (especially one foot feeling noticeably warmer than the other).

Visit a healthcare provider as soon as you notice any changes in your feet. The sooner your provider can diagnose Charcot foot, the less likely you’ll experience severe complications.

More advanced Charcot foot can cause changes to your foot’s shape (Charcot foot deformity), including:

• Rocker-bottom foot: Rocker-bottom foot happens when the bones in the middle of your foot break down and collapse. This makes the arch of your foot collapse. Instead of having its natural upward curve, a rocker-bottom foot is rounded out. You might have a bulge in the middle of your foot where the arch used to be.
• Toe shape changes: Your toes may curl or curve under. If bones and other tissue in your foot collapse or break, your toes compensate by gripping like a claw shape to keep you stable.
• Ankle shape changes: Your ankle might bend or curve to one side and look noticeably less straight and stable than your other ankle.
• Foot ulcers: If Charcot foot causes your foot or ankle to change shape, you might put too much pressure on areas of your foot. This can lead to open ulcers or sores that increase your risk of infections.

What causes Charcot foot?

Charcot foot happens when you injure your foot or get an infection but can’t feel symptoms like pain. It’s usually a diabetes-related foot condition:

• People with diabetes who have a hard time managing their blood sugar (blood glucose) levels are more likely to have high blood sugar (hyperglycemia) more often.
• Having hyperglycemia frequently for a long time can cause neuropathy (nerve damage), especially in your lower legs and feet.
• That nerve damage causes you to have reduced sensation and feeling in your affected foot.
• If you can’t notice pain or other signs something is wrong with your foot or ankle, you’re more likely to miss signs you need medical treatment. Easily treatable issues can become more severe before you realize something is hurting you.

For example, people with Charcot foot might not be able to feel the pain signaling that their bones, tendons or ligaments are damaged and keep walking on an injured foot. A usually minor ankle injury or a bone fracture can become much worse if you keep walking on your foot without feeling pain or knowing it’s hurt. Over time, that extra stress can cause permanent damage to the shape of your foot and ankle.

Similarly, if you have Charcot foot and can’t notice symptoms like pain or a feeling of warmth, you might miss symptoms of an infection until after it’s caused severe complications.

What are Charcot foot risk factors?

Charcot foot almost always affects people with diabetes. People who’ve had diabetes for more than seven years who smoke and regularly drink alcohol have an increased risk of developing neuropathy.

You’re also more likely to develop neuropathy if you have diabetes and have other health conditions, including:

• High blood pressure (hypertension).
• Obesity or overweight.
• High cholesterol.
• Kidney disease.

What are Charcot foot complications?

Charcot foot itself is a complication of diabetes-related neuropathy. If your foot is damaged enough or you have a serious infection you might experience other severe complications, including:

• Your foot’s physical shape may permanently change. This can make it hard to fit into most shoes.
• You may need your affected foot amputated (surgically removed) if the physical changes are severe. You may need an amputation if an ulcer or wound on your foot or ankle gets infected.
• Charcot foot can be fatal if an infection spreads to the rest of your body or you experience other life-threatening diabetes-related complications.

How is Charcot foot diagnosed?

A healthcare provider will diagnose Charcot foot with a physical exam and some imaging tests. Tell your provider if you’ve noticed any symptoms like pain, swelling, a feeling of warmth or if you’ve lost some feeling in your ankles, feet or toes.

Your provider will examine your ankles and feet. They’ll check both your feet and compare them to look for changes or differences. Your provider will also check how much feeling you have in your feet by touching your ankles, feet and toes.

What tests do providers use to diagnose Charcot foot?

Your provider might use a few tests to diagnose Charcot foot, including:

• Foot X-rays.
• Magnetic resonance imaging (MRI).
• Blood tests to check for signs of infection.

How is Charcot foot treated?

Preventing severe complications is the most important part of treating Charcot foot. You need to stop walking on your foot before any injuries or issues get worse (progress). Your healthcare provider will suggest treatments to relieve your symptoms and reduce how much Charcot foot permanently affects your ability to use your foot.

The most common treatments for Charcot foot include:

Taking weight off your foot

Putting less weight and pressure on your affected foot reduces swelling and prevents injuries like bone fractures from getting worse. You might need:

• A cast or brace.
• Crutches.
• A walker.
• A wheelchair.

Orthotics and footwear changes

Orthotics are shoe inserts that support your feet and keep your toes in the correct position. You might need custom-made inserts or an ankle brace. Your provider will recommend orthotics or special shoes with extra depth to help relieve extra pressure on your feet and support you when you walk.

Physical therapy

A physical therapist is a healthcare provider who helps you improve how your body performs physical movements. They’ll help you manage symptoms like pain, stiffness and discomfort that make it hard to move. They’ll also develop a customized set of exercises and movements to help you move your body.

Charcot foot surgery

You might need Charcot foot surgery if you’re experiencing severe symptoms (including collapsed bones and joints or ulcers) or have an infection that might spread.

Your surgeon will repair damage inside your foot and ankle joint and will stabilize your foot. It’s rare, but people with severe Charcot foot may need their foot amputated.

Your surgeon will tell you which procedure you’ll need and what to expect while you’re recovering.

How can I prevent Charcot foot?

The best way to prevent Charcot foot is to manage diabetes and your overall health. Managing your blood sugar will prevent hyperglycemia and reduce your risk for neuropathy.

Ask your healthcare provider how often you should have your feet checked. Ask them if you should see a foot care specialist like a podiatrist or a foot and ankle orthopedist.

You can also reduce the risk of Charcot foot and other diabetes-related foot problems by:

• Checking your feet every day for any changes. Don’t forget to look between your toes. Ask someone for help or use a mirror if needed.
• Getting your feet checked at every visit with a healthcare provider.
• Keeping your toenails trimmed and filed. Cut them straight across to prevent ingrown toenails.
• Maintaining blood flow to your feet. Keep your feet elevated when you sit, and wiggle your toes often.
• Wearing socks and shoes (or slippers) all day. Make sure your socks aren’t too tight and that your shoes fit properly.
• Washing your feet every day. Dry them thoroughly, including between your toes. Apply lotion to the tops and bottoms of your feet, but not between your toes.

What can I expect if I have Charcot foot?

If a healthcare provider diagnoses Charcot foot early, you should be able to avoid serious complications.

You’ll need regular follow-up appointments with your provider. They’ll take more X-rays to check your feet for any changes or new symptoms.

If Charcot foot causes severe symptoms or complications, you might need to learn to walk and move differently, or use mobility aids. Your provider will help you understand what to expect. They’ll guide you on your recovery journey and will be there to answer all your questions.

When should I see my healthcare provider?

Visit a healthcare provider as soon as you notice any new or worsening symptoms in your feet.

If you have diabetes, tell your healthcare provider right away if you notice:

• Changes in your feet’s shape.
• Changes to the skin on your feet, including a wound, discoloration, a feeling of warmth or a funny smell.
• Hair loss on your toes, feet or legs.
• Loss of feeling in your legs, ankles, feet or toes.
• Pain, tingling, burning or cramping in your legs or feet (especially overnight).

What questions should I ask my healthcare provider?

• Do I have Charcot foot or another diabetes-related foot condition?
• Which treatments will I need?
• Will I need surgery?
• How often should I have my feet checked?

Can you still walk with Charcot foot?

You should be able to walk and move with early Charcot foot. But don’t force yourself to use your foot, especially if you notice swelling or discoloration. They can be signs that your foot is injured, even if you can’t feel it.

Stay active, but choose activities that are gentler on your feet, like swimming or biking. Ask your provider which activities are safest for you.

A note from Cleveland Clinic

Charcot foot is a rare complication that happens when diabetes damages nerves in your lower legs and feet. The best way to prevent serious complications from Charcot foot is to get it diagnosed as soon as possible. Visit a healthcare provider for regular checkups and foot exams if you have diabetes. Your provider will monitor your feet for any changes that could mean you’re at risk.

Talk to your provider about managing diabetes. They’ll help suggest resources that help you manage your blood sugar to reduce the chances you experience diabetes-related neuropathy and Charcot foot.