Charcot Feet is a bone and joint disease involving the foot and ankle region causing fragmentation and destruction of the bones leading to permanent deformity, limb loss along with other morbidities. Today the most common cause is Diabetes complicated by Neuropathy. 

It starts innocuously as simple swelling with warmth and usually gets mistreated and misdiagnosed as cellulitis or infection. The limb slowly changes its shape but the patient is unaware of changes till it is in bad shape or unstable with difficulty walking. The main issue is that it is painless all the time and hence care and seriousness in the early stage are not taken. The incidence of the Charcot foot problem in India is up to 5%to 9%. In India, adult diabetic patients are expected to increase to 73 million by 2025. This volume of Charcot disease patients itself would be exceeding the whole population of a country like Denmark. Charcot joint destruction is a devastating and possibly limb-threatening effect of diabetes.

The calamitous deformity can be treated today with a better understanding of the disease process. In the early stages, simple plaster techniques with offloading save the limb from deformity progression. Once the deformity has set in, customized foot wears, boots especially Charcot Restraining Orthotic walker (CROW) help save the feet from further issues. 

In those feet where the deformity has become severe with a non-healing wound, a major surgical repair would be needed to salvage the limb from amputation. The most important aim is to prevent the limb from amputation. Though surgery for Charcot disease is mired with complications, today with a better understanding, many limbs have been salvaged and saved. 

Treatment of Charcot foot disease has come a long way from total disaster to limb salvage. However, it needs loads of understanding and a meticulous multidisciplinary approach to save the feet and thereby the life of the patient. Today in India we have been fortunate to have multidisciplinary team effort taking place in many places and we have saved a sizeable no of feet from tragic amputations and thereby improving morbidity and decreasing mortality.  

Why does this disease happen to a diabetic patient?

The exact reason for what triggers the bone destruction is unknown but it usually happens to the feet that have neuropathy (nerve damage) with some blood flow alteration. The bone starts fragmentation with some trivial injury but there is no pain felt in what we call a Loss of Protective Sensation (LOPS) 

Is Charcot disease treatable?

 The disease can not be reversed into normal but the devastating deformity can be prevented by just offloading with a proper total contact cast. However, it may need prolonged therapy of offloading and proper sugar management. In case of already developed deformity or ulcer with deformity, today we can manage in a staged surgical way to save the limb to walk back in a near-normal way. 

What will happen if I do not take any treatment as it is not painful?

The Charcot foot without deformity does not need surgery but customised footwear. However, the ones with deformity or instability need surgery to prevent ulcerations and further destruction and instability to prevent calamitous amputation. 

Is there any medication for this Disease? 

No. Unfortunately, no specific medications help prevent or treat this.

Mind Your Foot!

Check your feet every day for cuts, redness, swelling, sores, blisters, corns, calluses, or any other change to the skin or nails. 

Use a mirror if you can’t see the bottom of your feet, or ask a family member to help.

Wash your feet every day  in warm (not hot) water. Don’t soak your feet. Dry your feet completely and apply lotion to the top and bottom—but not between your toes, which could lead to infection.

Never go barefoot.  Always wear shoes and socks or slippers, even inside to avoid injury. 

Wear shoes that fit well. For the best fit, try on new shoes at the end of the day when your feet tend to be the largest. Break in your new shoes slowly—wear them for an hour or two a day at first until they’re completely comfortable. Always wear socks with your shoes.

Get your feet checked at every healthcare visit.

  •  Also, visit your foot doctor every year (more often if you have nerve damage) for a complete exam.
  • Trim your toenails straight across and gently smooth any sharp edges with a nail file. Have your foot doctor (podiatrist) trim your toenails if you can’t see or reach your feet.
  • Keep the blood flowing. Put your feet up when you’re sitting, and wiggle your toes for a few minutes several times throughout the day.
  • Choose feet-friendly activities like walking, riding a bike, or swimming. Check with your doctor about which activities are best for you and any you should avoid
    (Source: Centres For Disease Control and Prevention )

Dr Rajesh Simon, Senior foot and ankle surgeon, is the national President of Indian Foot and Ankle Society (IFAS)