How is Charcot foot treated?
Early diagnosis and treatment can prevent more damage and avoid deformity and other complications. Treatment has three goals: take the weight off the foot, treat bone disease (usually with cast; bisphosphonates and other supplements are sometimes used), and prevent new foot fractures.
The first and most important treatment is rest or to take the weight off of the affected foot (also called “offloading”). In the early stage of Charcot foot, offloading helps prevent inflammation and stops the condition from getting worse and prevents deformity. Protected weight-bearing (walking in a walking boot) in later stages can prevent complications from the existing deformity and avoid new deformities.
Offloading may involve putting the foot into a cast, which protects it and keeps it from moving. The patient usually wears a series of casts or a removable cast walker over a total of 8 to 12 weeks. Crutches, knee walker, or a wheelchair are used to avoid putting any weight on the affected foot. The cast is changed several times as the swelling in the foot goes down. A cast stays on the foot until the redness, swelling, and heat are resolved.
After the cast is removed, the patient is given a prescription for footwear. Prescription orthopaedic footwear properly fits the foot and relieves pressure points to prevent a repeat injury and ulcers. A common device used is a Charcot Restraint Orthotic Walker (CROW). The doctor may also recommend changes in the patient’s activity to avoid further trauma to the feet.
Surgery is recommended for those patients who have severe ankle and foot deformities that are unstable and at high risk of developing a foot ulcer. In addition, if the deformity makes braces and orthotics difficult to use, surgery may be indicated. After surgery, the patient will have to avoid putting full weight on the Charcot foot for an extended period of time.
All people with Charcot foot must be dedicated to wearing protective footwear and taking extra care of their feet for the rest of their lives. Education of the patient and family members about preventive foot care and signs to watch for is an important part of preventing future problems.
What are the complications of Charcot foot?
Deformity in any part of the foot or ankle can cause skin ulcers from the bone pressing against the shoe or the ground. When Charcot foot affects the ankle, the joint may become unstable or “floppy” because tissue has replaced the bone in the joint. This so-called “floppy foot” also can cause ulcers.
Ulcers are often difficult to heal due to complications of diabetes, poor circulation in the feet, being on your feet for long periods of time, and the development of infections. An infected ulcer that does not heal can be limb-threatening and even result in amputation of the foot or even the leg.