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Charcot Neuroarthropathy

What is Charcot Neuroarthropathy?

Charcot neuroarthropathy, often referred to as Charcot foot, is a serious condition that affects the bones, joints, and soft tissues of the foot and ankle. It occurs when peripheral neuropathy leads to a loss of sensation, causing patients to continue walking on an injured foot without realizing the extent of the damage. Over time, this can lead to fractures, dislocations, and severe deformities, significantly altering the biomechanics of the foot.
Causes of Charcot Neuroarthropathy
  • Peripheral Neuropathy: Most commonly associated with diabetes, neuropathy reduces the ability to feel pain, pressure, or temperature, allowing injuries to go unnoticed.
  • Repeated Microtrauma: Without the protective sensation of pain, minor injuries such as sprains or fractures may accumulate and worsen over time.
  • Medical Conditions: In addition to diabetes, conditions such as chronic alcohol use, syphilis, and other diseases affecting nerve function may also lead to Charcot neuroarthropathy.
Symptoms of Charcot Neuroarthropathy
  • Redness, swelling, and warmth in the affected foot or ankle, often mistaken for infection
  • Pain or discomfort (though often mild due to neuropathy)
  • Instability or difficulty walking
  • Noticeable foot deformities, such as a rocker-bottom appearance or significant flattening of the foot arch
  • Changes in the shape or structure of the foot, as the bones collapse or shift
Effects on Foot Biomechanics

Charcot foot can drastically alter the structure and function of the foot, leading to significant changes in biomechanics. The loss of normal arch support and the development of deformities, such as a flattened midfoot or a protruding bone, can shift weight-bearing areas to abnormal points. This increases the risk of pressure ulcers, further infections, and difficulty with mobility. Left untreated, these changes can result in severe complications, including amputation.

Treatment Options for Charcot Neuroarthropathy

1. Non-Surgical Treatments:

  • Immobilization: The primary goal of early treatment is to prevent further damage. This may involve using a total contact cast or removable walking boot to offload pressure from the foot and allow the bones to heal.
  • Custom Orthotics or Bracing: Once healing has occurred, custom-molded orthotics or braces can help improve foot stability and prevent further deformities.
  • Activity Modification: Limiting weight-bearing activities and using mobility aids like crutches or a wheelchair can reduce stress on the affected foot.

2. Surgical Treatments:

  • In severe or advanced cases, surgery may be necessary to correct deformities, stabilize the foot, or address complications such as ulcers or infections. Surgical options may include joint fusion, bone realignment, or removal of bone fragments.