Charcot Neuroarthropathy, also known as Charcot Arthropathy 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 seen in diabetes and typically involves the tarsometatarsal joints, however can occur in any of the following five locations: toes, tarsometatarsal, mid-tarsal, calcaneus or ankle joint. It can be identified clinically with warmth and swelling to the affected area or with radiographs. With radiographs features will be seen such as destruction of the joint, dislocation, bony debris, deformity and dense sclerotic subchondral bone. Due to the nature of sensory loss associated with diabetes, when a Charcot foot is first occurring, often it goes unnoticed. This is why it is important to have regular reviews of your foot health to assess sensory loss.
Charcot foot, whilst commonly occurs with diabetes, can also be associated with the following conditions:
- Spinal Chord Injury
- Chronic Alcoholism
- Renal Dialysis
- Congenital insensitivity to pain
The actually etiology of what causes Charcot Neuroarthropathy remains unknown and early detection is important as the therapeutic intervention at this stage can help prevent gross deformity and subsequent ulceration.
Risk factors for Charcot Neuroarthropathy include:
- Diabetic Peripheral Neuropathy
- History of Trauma
- Elevation in skin temperature of 3-7 degrees
- Excessive alcohol consumption
- Poor diabetic control
- Long duration of diabetes
- History of ulceration
- History of previous Charcot Neuroarthropathy
Other differential diagnoses for Charcot Neuroarthropathy include:
- Pseudo gout
- Severe ligament sprain
- Rheumatoid Arthritis
- Septic arthritis
If you are concerned that you or a loved one has Charcot Foot it is important to see your podiatrist or GP, especially as it can take months to treat by offloading the affected foot via casting or applying a moonboot to the foot. Once the acute phase has passed your podiatrist will work to offload any areas of high pressure or refer you for orthopedic opinion if they believe surgery may be indicated. They will also review your foot regularly to assist with prevention and provide education for continued foot hygiene such as daily foot checks and correct foot washing.