The Diabetic CHARCOT FOOT is one of the most dreaded complications of diabetes. It usually happens to patients with a diabetes duration of 10 years or more, but may occur earlier. The peripheral neuropathy associated with diabetes is supposed to be the causal factor.
If you notice any deformity of the foot, especially around the midfoot or the ankle, CHARCOT foot must be ruled out.
Trauma/pressure to the neuropathic(insensitive) foot causes the joints to collapse. This condition may show up initially either as abnormal bone protrusion or then a persistently swollen foot with redness and maybe pain. When such a condition occurs, it is important to stop putting the foot on the ground i.e stop walking on that foot.
CHARCOT FOOT 1
This patient was observed to have foot widening and xray was taken. However the patient was not advised to remain off the foot. Two months later there was gross destruction of the foot bones as seen in the xray picture below.
This is the result of walking on an already damaged foot for two months. The patient had no pain and that is why continued to walk on the damaged foot with multiple fractures.
CHARCOT FOOT 2
This patient presented with a Charcot foot with osteomyelitis and multiple ulcers on the foot. There was pus discharge from them since the past three – four months. Patient came for treatment from saudi arabia, where below knee amputation had been suggested.
Patient was operated and not allowed to put pressure on the foot. 12 months later the patient had healed completely and there was no sign of osteomyelitis on the Xray. Patient was mobilized in customized pressure reducing footwear.
If correctly managed, it is possible to salvage Charcot feet. However lifelong these patients need to be in customized pressure reducing footwear and must be reviewed regularly preferably at three monthly intervals.