Understanding Charcot arthropathy
Diabetes has the unfortunate consequence of causing nerve damage, or neuropathy. In some cases, as the neuropathy progresses, our Cypress orthopedist sees patients who develop Charcot arthropathy in the foot and ankle. This is a nerve-mediated disorder that results in the abnormal breakdown of bone. It can cause fractures to develop and may result in significant deformities to the foot and ankle. These deformities may cause a number of other problems, including difficulty with shoe wear, ulcer formation and even the need for amputation.
Presentation of Charcot arthropathy
Charcot arthropathy develops in three phases and presents as recurrent flare-ups.
- The initial phase typically presents as severe swelling, redness and warmth of the foot and ankle. These symptoms may develop rather suddenly and there is frequently no obvious inciting event or only minimal trauma. There is often much less pain than might be expected given the appearance of the foot. In many cases, this presentation may initially be misdiagnosed as an infection.
- The second phase occurs when the development of new fractures ceases and healing begins. The swelling, redness and warmth begin to resolve during this phase.
- The third phase is the burn-out phase, in which there is a resolution of the acute flare-up and fracture healing is completed. While symptoms have resolved by the third phase, the multiple fractures that occurred during the flare-up may cause instability of the foot and ankle and lead to the development of significant deformities.
If Charcot arthropathy is allowed to progress without proper treatment from our Cypress orthopedist, complications can quickly develop. Bony destruction may cause collapse of the midfoot, or a fallen arch. Instability of the ankle may also occur, which may have the appearance of the ankle collapsing inward. This can contribute to the appearance of a fallen arch.
As the instability progresses, bony prominences develop which may quickly lead to ulcer formation. Should the ulcer become infected, bone infection, known as osteomyelitis, may quickly follow. If osteomyelitis does occur, amputation is often necessary to eradicate the infection and prevent it from spreading.
Diagnosing Charcot arthropathy
Charcot arthropathy is a potential diagnosis in any diabetic who presents with a swollen, red, warm foot and no obvious source of trauma or infection. X-rays may demonstrate multiple fractures in different phases of healing, as well as foot and ankle deformities, which helps our Cypress orthopedist confirm the diagnosis.
Treating Charcot arthropathy
The goal of treating Charcot arthropathy is to reach the stable, third phase of the disease in which the fractures have healed and no new ones are forming. In doing so, the progression of deformities is limited. This helps prevent the formation of bony prominences that can result in ulcers and subsequent infections.
When a patient presents in the first phase of Charcot arthropathy, our Cypress orthopedist places them in a special cast that is called a total contact cast. The inside of it is lined with foam to cushion any bony prominences and prevent pressure ulcers from forming.
While in the cast, the patient is kept completely non-weight-bearing with the affected foot. The cast is removed every two to three weeks for evaluation of the foot and x-rays. This process is repeated until the swelling, redness and warmth have fully resolved and the fractures appear healed on x-ray. In some cases, this may take six to 12 months. While it is a long and arduous process, casting and remaining non-weight-bearing is vital to prevent complications.
If complications are already present, there are some treatment options to prevent or slow further deterioration. Ulcers and bony prominences may be treated surgically to remove the bony prominence and prevent recurrence of the ulcer.
For inactive Charcot arthropathy that has caused deformities, a custom boot may be ordered to offload any bony prominences and prevent flare-ups. In other cases, surgical reconstruction may be considered to restore a more anatomic position of the foot and ankle. These surgeries are reserved for severe deformities and patients who are not in the active phase and have improved their diabetic control.
Contact us to schedule an appointment with our Cypress orthopedist and learn more about diagnosis and treatment of Charcot arthropathy.
- Diabetic neuropathy
- Bone fractures
- Heel pain
- Congenital problems
- Corns and calluses
- Plantar warts