What is Charcot Foot ?
Charcot Foot is a very serious disease which causes significant damage to the nerves present in the foot. The disease was first described by Jean- Martin Charcot in 1868, after whom it is named. It is most commonly occurs in patients who have been suffering from acute diabetes for several years. Due to the damage to nerves, the bones in the foot weaken and over time, with continuous walking and running, more and more pressure is put on the already weakened bones because of which they move from their original positions, giving an abnormal shape to the foot. Mostly, the shape of the foot changes so badly that it becomes impossible to even stand on that foot, let alone walk or run.
Causes Of Charcot Foot :
The basic cause of this disease is a weakening or damaging of the nervous system which can be a result of many factors. The most common cause for damaging of nervous system is diabetes, but it can also be caused due to syphilis, leprosy, cerebral palsy and many other diseases. The Neurotraumatic theory states that Charcot Foot is caused when the foot suffers an extreme external injury, but due to weak nervous system, the person does not feel the pain in his foot, such that the injury is not treated on time and ultimately results in distortion of bones. Another theory called the Nervovascular theory states that due to damage to nerves, there is extreme blood flow to the feet which is not in proportion to bone density and synthesis, which ultimately also leads to Charcot Foot.
Symptoms of Charcot Foot :
- Mild or severe swelling of the foot which does not recede for days.
- Noticeable deformity.
- Increased skin temperature around the joint (3-4 degree Celsius)
- Soreness or pain, especially while walking.
Charcot Foot is a disease which is not exactly visible to the naked eye and is therefore ignored many a times as just a mild ache in the foot. But patients of Charcot Foot will notice that the pain, though not severe, would be persistent and would not go away permanently even through analgesic ointments or pain killers. Swelling of foot is another sign to watch out for, especially if you cannot recall when or if you hurt your foot. The area around the bone joint which is cracking from under pressure also feels warmer to the touch than any other body part.
Following a visual examination of the foot and questions about medical history, the following tests can be done :
- Imaging Test – Charcot Foot can be identified with an X-Ray test which is sufficient to see bone dislocation, fractures or joint effusions. An MRI scan can also be done which is a more advanced imaging test and will differentiate between Charcot Foot and bone infection.
- Laboratory Test – In some cases, laboratory tests are also done on the fluid drawn from the joint to scan for cartilage and blood.
Diagnosis of Charcot Foot is generally based only on the results of imaging tests. An X-Ray test is an absolute essential to be conducted and the doctor may also ask you to get an MRI scan or a bone scan done to be sure that it is not a bone infection. The doctor may also recommend tests to count the White Blood Cells in the blood and to check for deficiency of Vitamin B-12 or folate. If you are a heavy drinker, you may also have to go through a liver test before the final diagnosis can be given.
If the symptoms of Charcot foot are detected early before the disease has had a chance to do much damage, the way forward for curing the disease may be quite easy. Generally, a total cast is put upon the foot and mobility of the patient is restricted as much as possible. The cast stays on for 12-18 weeks, during which time the patient is also advised to not go to work and take a kind of vacation to relieve the stress which is also a contributor to Charcot Foot. After the cast is taken off, professional foot care and specially made shoes with deep soles are recommended to be worn as much as possible.
The best way to prevent Charcot Foot is to keep an eye out for the symptoms and signs mentioned above, along with keeping your sugar levels under control. If you are diabetic, you must take special care of your feet and examine them on a regular basis for any swelling or strange pain even when you did not hurt your foot anywhere. Early treatment is the best way to prevent the foot from getting deformed.
Types of Charcot Foot :
Although Charcot Foot does not really have any distinguished types, the causes for it may be different. The most common cause is when due to loss of sensation because of damage to nerves; a foot injury is not noticed on time and which gets converted to Charcot Foot over time. The second cause is when blood flow to the foot increases, increasing the resorption of bone which can bend or break due to increased mechanical stress over a period of time.
The worst part of Charcot Foot is that the patient can often not even feel the pain in the foot. Because of this, a fracture or bone dislocation goes unnoticed by him, resulting in a big injury when it could have been avoided by simply fixing the fracture. Sometimes, a neuropathic ulcer or a soft tissue infection also occur which just makes things worse. In some cases, delay in diagnosis and treatment of Charcot Foot led to such a great deformity that the foot had to be amputated.
Home Remedies :
If you have been diagnosed with Charcot Foot, the best you can do is to keep your mind relaxed since stress and anxiety delay the healing process. Try taking a vacation or indulging in a hobby. You should also be extra careful in your movements and follow all the instructions of the doctor.
In most cases of Charcot Foot, a Total Contact Casting is used which is a tubular casting and covers the entire leg. Regular x-ray scans are taken to observe the healing of the bones. The cast generally stays on for a minimum of 12 weeks but the time duration can extend according to the severity of the condition. After the cast is taken off, custom made braces are used to support the foot which may look normal but is not strong enough to take the weight of the body yet. In cases where the patient develops a neuropathic ulcer which causes infection, a surgery is conducted to remove the ulcer.
Innovations In Treatment Of Charcot Foot :
Some experiments have been conducted to treat this disease with the help of pulsed low-intensity ultrasound which can accelerate the healing process and also strengthen the bone. Use of electrical stimulation and magnetic field also promote bone formation which can bring a revolution in treatment procedure. However, these theories are still under research and therefore, cannot be used by general public.