Charcot foot

The Charcot foot is a rare complication of diabetes mellitus seen in patients who have had diabetes for more than 10 years. Although prompt recognition and direct immobilization are important to prevent serious damage to the foot, Charcot foot is often initially misdiagnosed. The pathogenesis of the Charcot foot is becoming clearer: all patients with Charcot foot have neuropathy with loss of protective sensation. Because the patient does not feel anything, he/she continues to use the foot, so that even a minor injury can lead to activation of the inflammatory cascade and bone breakdown. The symptoms of Charcot foot are a warm, red, swollen, and tender foot; the mid-foot is most often affected. In the early stages abnormalities are usually not seen on standard X-rays, but the diagnosis can be established with MRI, CT, or PET. The foot should be immediately immobilized in a non-weight bearing total contact cast. After symptoms have resolved, the patient can start to put weight on the foot. This should be done under close supervision and an adapted or customized shoe should be used. Delayed recognition of Charcot foot can rapidly lead to severe foot deformation.