By Aletha Tippett MD
Many have never heard of Charcot foot, or at least don't know what it is. If you care for individuals with diabetes who have neuropathy, you almost certainly will see Charcot foot. My patients with Charcot have told me they have a disease of the foot "with crumbling bones." This is actually fairly accurate. Charcot is a neuropathic bone disease that causes osteoporosis-type destruction of the bones in the foot. As a result of this, the bones shift and move and break.
One day the patient will step off a curb and suddenly one foot is swollen, red and tender. When he goes to the ER, the doctor says "you have an infection" and treats him with antibiotics. This doesn't help, even if he is on IV antibiotics for weeks. Often then, the patient is offered an amputation. The problem he has is an "acute Charcot foot," with disruption of the bones. He does not need antibiotics; he needs intense offloading, preferably with a contact cast. He must not bear weight on that foot. A simple x-ray can show the problem.
With contact casting and offloading, that acute Charcot foot can be converted to a chronic Charcot foot. He will still need special shoes, but the foot is not swollen, red or painful, and certainly does not need amputation.
Complicating Factors in Patient's with Charcot Foot
Of course, the deformity of a Charcot foot predisposes the patient to the development of ulcers, and this is a nightmare of treating with an ever-changing environment. Just when you think things are going well, the foot changes/shifts again. There is surgery to correct Charcot foot and this can be very successful but can also be difficult, expensive and time consuming. The other option is orthotics to offload, but this can also be difficult. Finding an orthotist who knows how to treat Charcot is a must. A helpful medication is bisphosphonates, prescribed for several months. These help to stabilize the foot and reduce pain.
A patient who has a Charcot foot may not appreciate the problem. They have neuropathy and according to a study by Paul Brand, they often do not even consider their feet or legs as part of their body. So getting ownership and buy-in from these patients is often very difficult. Controlling the patient's diabetes is one way to help the condition — it won't correct it, but can prevent worsening and slow the progression.
What is the message for us, those taking care of wounds? Always be vigilant with your patients with diabetes for Charcot foot. Look for deformities of the foot, especially medial protrusion and flat foot. If you are treating a diabetic foot wound and have Charcot you need to offload that foot in order to successfully treat the wound. Total contact casting is a real boon, a gold standard of treatment. Derma Sciences offers a kit that can be stocked and applied in just a few minutes. Having this available leaves no excuse for not using gold standard of treatment.
Learn what you can about Charcot foot and how to treat it. You may save a limb or a life.
About The Author
Aletha Tippett MD is a family medicine and wound care expert, founder and president of the Hope of Healing Foundation®, family physician, and international speaker on wound care.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.