What is diabetic Charcot foot disease and how can it be prevented?

Over the many years in my Indiana podiatry practice, I have seen numerous diabetics who have shown up in my office with a mildly swollen, warm foot, who have had no obvious wound or other source of infection. These individuals have had normal x-rays, but I became suspicious that they were developing an early form of Charcot joint disease that somehow had not fully developed in its initial stage. My concerns were confirmed with MRI scans. Fortunately, these individuals received quick offloading of their affected foot, and the process died down long before the foot had a chance to fracture.

Charcot foot disease, also called Charcot neuroarthropathy, is a serious disease most commonly associated with diabetes. In this condition, the foot suddenly becomes red, hot, and swollen, and multiple bones begin to fracture, due to several different reasons that are tied into diabetic nerve disease. This fracture process continues for several months, as the foot begins to severely deform. After the process stops on its own, the bones harden again, stuck in their deformed position. People with these deformities tend to develop serious foot wounds due to the newly prominent bones, which often lead to infection and even amputation.

The key to controlling this disease is early recognition of its presence, and immediate reduction of weightbearing to reduce the deformity seen during the fracturing phase.

In the above cases, the Charcot process was about to kick off, but had not done so yet. The early intervention prevented the longer lasting acute fracturing phase from developing, and saved a month or two of recovery time, as well as prevented bone fracturing and deformity. While most cases do no present themselves to doctors so early, the early changes associated with subtle swelling and warmth of the foot can be noticed by a diabetic at home during a daily inspection. If you are a diabetic and notice that your foot or ankle is becoming more swollen or warm than usual, it is probably a good idea to see your podiatrist for an assessment. Most of the time, these symptoms are due to reasons other than Charcot foot disease or even an infection, but if a true problem can be caught early on the benefit to the health of the foot can be enormous.


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