Charcot arthropathy, also known as Charcot foot and ankle, is a condition that weakens the bones of the foot, causing an eventual fracture or dislocation and collapse of the mid-foot arch.
Causes and Symptoms
This condition often develops from neuropathy. Because of the loss or diminished sensation in the foot, patients do not detect the swelling, warmth and pain caused by Charcot arthropathy, thus continuously bearing weight on it and aggravating the injury. Neuropathic patients with a tight Achilles tendon are at an even greater risk to develop Charcot arthropathy.
Patients with diabetes, leprosy and syphilis are some of those with a higher tendency to develop Charcot arthropathy because of the neuropathy caused by those illnesses. Additionally, their slow rate of healing might not compensate fast enough for the amount of trauma impacted on the weakened joints from their body weight. It is important to check for redness and swelling or the abnormal appearance of the rocker-bottom foot.
These are the different types of scans and tests that may be done on the injury to determine the severity and rule out other conditions.
- Bone Scan
- Doppler Ultrasonography
- Lumbar Puncture
- Bone Probing
- Portable Infrared Dermal Thermometry
- Joint Aspiration
- Synovial Biopsy
Most cases of Charcot arthropathy can be treated without surgery. Immobilization is most effectively done with a cast on for 3-6 months and regularly checked and replaced every 1-2 weeks. A splint, braces or orthoses are other options but the healing period might be longer. A non-weight bearing (NWB) condition is ideal for the injury to heal faster and prevent further damage.
After the initial healing stage is stabilized and the cast is remove, it is recommended to wear custom footwear with special shoe inserts to prevent recurrence and ulcers. Protection to both feet is important as the other foot has a high likelihood to develop Charcot arthropathy as well. As such, physical activity that might bring trauma to the feet has to be minimized.
If the ankle sustains displaced fractures, an open reduction and internal fixation (ORIF) is needed. An even more severe injury would require a correction of deformity or ostectomy. Usually amputation is not necessary unless ulcers are developed. There is a chance of recovery by draining the infection and maintenance of fixation, but if the infection could not be contained, amputation is the last resort.
Typically, it takes up to 1-2 years before the injury is fully recovered. However, a regular lifelong follow-up is required to ensure that symptoms do not recur.