Charcot foot: treatment and when surgery is considered

A warm, red, swollen foot that does not hurt much? With numb feet, it can be Charcot foot, and prompt protection can prevent the bones from collapsing. In Charcot foot, the bones and joints of a numb foot weaken, and can fracture and dislocate, usually without the pain that would normally make you stop walking. Because sensation is reduced, people keep walking on the injured foot, and the damage progresses. Over time, the arch can collapse into a rocker-bottom shape. The early, active stage is often a warm, red, swollen foot that may not be very painful, and it is easily mistaken for infection or a sprain. In the active stage, the foot must be protected from weight and impact, so the bones can heal. It occurs in people with neuropathy, most commonly from long-standing diabetes, and a tight Achilles tendon may add to the risk. International guidelines separate the active stage, when the bones are inflamed and fragile, from later stages, when the foot has healed in whatever shape it ended up. The early sign is a foot that is warm to the touch, red and swollen, often with only mild soreness, or no pain at all. Charcot foot should be suspected whenever a foot with diabetes is warm, swollen and red without an obvious cause. It can look like an infection or a sprain, and it can coexist with an ulcer, so an experienced evaluation is important. The examination compares the temperature and swelling of the two feet, and checks sensation, circulation, the shape of the foot and any ulcer. X-rays are the first imaging test, and MRI or other imaging may be needed when X-rays are normal early on, or to tell Charcot from infection. In the active stage, the foot needs complete non-weight-bearing protection, in a cast, boot or brace, with crutches or a wheelchair, for a period of months. After that, custom footwear with inserts and bracing help people return to daily activities. Both feet need protection, because increased load on the other foot puts it at risk too. Long-term care, with regular checkups, daily foot inspection and blood sugar control, helps prevent ulcers and further collapse. Surgery is considered when the deformity is severe or unstable, can’t be braced, or causes ulcers or infection that won’t heal. Reconstruction removes infected or damaged bone if needed, corrects the deformity, and fuses the unstable joints with screws, plates, a rod or an external frame. In a systematic review of one thousand one hundred and sixteen reconstructed feet, about eighty-six percent achieved bone fusion, and about ninety-one percent returned to walking. But complications of the technique occurred in about thirty-six percent, and the amputation rate after reconstruction was about five point five percent. Surgery carries a high risk of infection and other complications, so careful preparation and close follow-up are essential. Seek care the same day for a warm, red, swollen foot with diabetes or numbness. Especially with an open sore, fever, drainage or a change in the shape of the foot. Go to an emergency department if you feel very unwell or redness is spreading up the leg. If you have neuropathy or diabetes and a foot becomes warm, red or swollen, even without pain, have it evaluated within a day. To learn more, visit our website, or call the office to arrange a visit.

General education only; not a substitute for individual medical advice.