Neuropathic Joints

Charcot is a condition in patients who have neuropathy or loss of sensation. Charcot can lead to fractures and dislocations in the foot and ankle. As the disease progresses the joints collapse and the foot can take an abnormal shape known as a rocker-bottom foot. Diabetes is the most common cause of Charcot because diabetes is associated with poor blood flow, causing weakening of bones, and neuropathy, which is the main cause of Charcot. Other causes and risk factors include repetitive microtrauma and patients with peripheral neuropathy secondary to:

– Chronic alcoholism

– Leprosy

– Syphilis

– Poliomyelitis

Symptoms

There are various stages of Charcot and symptoms will vary depending on the stage of the deformity.

Stage 1: Red, hot, swollen foot/ankle.

X-rays show soft tissue edema and bony fragments

Stage 2: Decreased local edema foot/ankle

X-rays reveal coalesence of bony fragments

Stage 3: No local edema

X-rays show consolidation and remodeling of the bone

Imaging

In addition to reviewing your overall health, symptoms and discussing your medical history, our physicians at Foot& Ankle Doctors, Inc may order various imaging tests for further detailed pictures of your foot or ankle.

X-rays:

In early stages of Charcot, x-rays may appear normal. As the disease progresses the bones may fracture or dislocate. As a result repeat x-rays may be taken several weeks later.

MRI:

Ordered to evaluate soft tissue and when a bone infection is suspected

Bone Scans:

Helpful to differentiate between Charcot and infection. Charcot and an infection are positive on a technetium bone scan, however infection will only produce a hot spot on an indium bone scan and Charcot will not.

Non-Surgical Treatment

– Immobilization is important in the early stages of Charcot to protect the bones

from stress and shear forces that can further damage the bones

– Total contact cast changed every 1-2 weeks for 2-4 months

– Charcot restraint orthotic walker (CROW) boot

Custom Shoes designed to decrease the risk of ulcers

– Rocker bottom shoes will help reduce the risk of ulceration

Surgical Treatment

Depending on the type and extent of the deformity surgery may be recommended

Dr. Dardashti