Charcot Neuroarthropathy

Charcot Neuroarthropathy or Charcot Foot is a traumatic joint arthritis which occurs due to loss of sensation and proprioception in the affected limb. It is most commonly presents in patients with diabetes and typically involves the tarsometatarsal joints. Other joints that may be affected include mid-tarsal, ankle or phalanx joints. Charcot is typically identified in clinic by noticeable swelling and warmth of the affected area. Radiographic imaging is used to formally diagnose the condition which will display destruction of the affected joint, dislocation, bony debris, deformity and dense sclerotic subchondral bone.

Due to the nature of sensory loss associated with diabetes, Charcot foot often goes unnoticed until major joint destruction has already occurred. Therefore, regular podiatry appointments are paramount for diabetes patients to ensure Charcot symptomology and other neurovascular changes are noticed at the earliest opportunity.

Charcot foot, whilst commonly occurs with diabetes, can also be associated with the following conditions:

• Spinal Chord Injury
• Syphilis
• Syringomyelia
• Chronic Alcoholism
• Renal Dialysis
• Leprosy
• Congenital insensitivity to pain
• Meningomyelocele

Risk factors for Charcot Neuroarthropathy include:

• Diabetic Peripheral Neuropathy
• History of Trauma
• Elevation in skin temperature of 3-7 degrees
• Excessive alcohol consumption
• Osteopenia
• Poor diabetic control
• Long duration of diabetes
• Retinopathy
• Nephropathy
• History of ulceration
• Obesity
• History of previous Charcot Neuroarthropathy

Other differential diagnoses for Charcot Neuroarthropathy include:

• Gout
• Pseudo gout
• Severe ligament sprain
• Rheumatoid Arthritis
• Septic arthritis
• Osteomyelitis

If you are concerned that you or a loved one has Charcot Foot it is important to see your podiatrist or GP. Once the acute phase has passed your podiatrist will work to offload high pressure areas with footwear and customised orthotics. An orthopaedic opinion may be indicated if deformity post Charcot is severe. Your podiatrist will also review your feet regularly to assist with further pathology prevention, general podiatric care & continuing diabetes related foot health education.