Charcot Arthropathy

When someone is first diagnosed with this disease their first response is “charcot, like a shark”. Charcot Arthropathy, is pronounced “shark-O” and has a French/German derivative.

What exactly is Charcot and who does it affect?

Charcot is a degenerative process of joints in the foot and ankle and can present in many different ways. It is a slow progressive process and usually presents itself with bones in the foot appearing to have fractures and dislocations. Charcot is a disease process where the joints of the foot and ankle have bony destruction. Charcot is caused by neuropathy, or a lack of sensation, which is primarily caused by Diabetes Mellitus. Other causes can be caused by Alcoholism, syphilis and other causes of neuropathy.

Charcot begins slowly but as the disease progresses it can appear similar to an infection. The joints of the foot that can are affected appear to be red, hot, swollen, deformed and perhaps have an ulceration. There are 4 different stages of Charcot. The first being Stage 0, this is a pre Charcot stage with minimal symptoms. Stage 1 is an acute stage, when a patient will present with the above mentioned symptoms including a red, hot, swollen foot. Stage 2 is the step down from Stage 1 and there is less redness, swelling during this stage. Stage 3 is a dormant stage and happens in between attacks/ Stage 1.

How is this diagnosed?

Diagnosis can be difficult because Stage 1 can represent other pathologies such as infection, gout or septic arthritis. Having neuropathy with Diabetes puts a patient with symptoms at high suspicion for Charcot. Diagnosis can be difficult because when someone presents to their physician with these symptoms the disease has usually been going on for a while. Diagnosis is usually by clinical exam but x-rays, MRIs and CT scans can be taken to aid in the diagnosis.

How is it treated?

Treatment is broken down into surgical or non-surgical options. During the Acute Phase/Stage 1 non-surgical options are the way to proceed. This includes a total contact cast, which is a non-weight bearing cast and doesn’t allow the foot to touch the ground. By using an offloading device it allows the joints to heal.  This phase of the disease can take many months and even up to a year to heal. Surgical treatment is recommended for Stage 3, which includes foot and ankle fusions and reconstruction. Not all patients are candidates for surgical treatment, since there are a lot of complications and a long recovery time from these surgeries.

What are the long term complications from this disease?

Even with early treatment and compliance this disease has flare ups. Flare ups cannot be predicted and as the disease goes on there can be increase bony destruction. As the disease progresses there can be a collapse of the foot with prominent bones that appear to be “sticking out of the bottom of the foot”.  This type of foot is known as a rocker bottom foot. At this stage certain shoes and orthotics can be custom made to help with support of this foot.

In conclusion, Diabetic neuropathy with Charcot can have devastating consequences for a patient. If you are a diabetic it is recommended to see a Podiatrist every few weeks to do a diabetic foot exam. Seeing a Podiatrist regularly can prevent some of these complications.

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