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Diabetes and Charcot Foot

Charcot foot is a disease or progressive degenerative condition that affects the joints of the feet. Closely linked to neuropathy (nerve damage caused by diabetes) it begins with the decreasing ability of the feet nerves to sense stimuli. Pain and muscular reflexes needed to control movement are impaired and as a result feet are damaged often repeatedly and this causes progressive damage to bones, ligaments and cartilage. The main affects of Charcot foot is found in the metatarsal, tarsometatarsal and tarsal joints located in the fore and mid foot areas.

It is surprising how many people are living with Charcot foot and the estimates are hard to get an accurate reading of the numbers who actual do have it but it is estimated that 20% of people with diabetes mellitus will also develop Charcot foot. From a medical point of view it is not even considered a disease but more a complication of diabetic neuropathy. In the US there are about 24 million people who have diabetes and of that 24 million, 60 to 70% will develop neuropathies (nerve damage) that can eventually lead into Charcot foot. According to statistics by the American Diabetes Association they estimate that only about % will have Charcot foot but that is still almost 840,000 people in the United State alone. The majority of case of Charcot foot affects people over the age of 50 and who have been diabetic for a long period. Both types of diabetes seem to be able to lead to this complication but as type 2 diabetes is a later life disease, Charcot foot is more common in type 1 diabetes or as it is sometimes known juvenile diabetes patients.

Symptoms of Charcot foot include dislocation of joints, heat, insensitivity in bottom of feet, instability of the feet joints, redness, strong pulse, swelling of the ankle and foot which may be caused by synovial fluid leaking from joint capsule, and subluxation…which is the misalignment of bones that fit together to form a joint.

Nerve damage from Charcot foot also can cause muscle weakness and slackened ligaments in the foot which often result in joint instability, subluxation and/or dislocation. If subluxation occurs it may imitate and similar symptoms as degenerative joint disease (anthropathy). What happens with the misaligned bones is they begin to grind against each other and small particles of bone and cartilage enter joint producing pain and coarse grating sound (audible crepitus) when joint is used.

Many different complications are credited to Charcot foot including calluses, ulcers (occurring when bony protrusions rub inside the shoes and often become infected), bone inflammation (ostomyelitis) and inflammation of the joint membranes (septic arthritis). Septic arthritis can become quite serious and manifest itself with malaise and fever. Blood vessels and nerves may be compressed but the symptoms can go undetected because of the lack of feeling or sensation in the individual’s feet. It is important to always monitor the condition of your feet if you are diabetic in order to prevent further damage. Because people with Charcot foot do not have normal sensations in their feet all manner of minor injuries go unnoticed and a very minor injury can quickly develop into an ulcer, infection or serious joint fracture. If you are a diabetic any redness or unusual swelling should be reported to your family doctor as soon as possible. If you do have a foot injury resting and elevation of the joint is recommended. Swelling can increase blood flow washing away minerals and leads to bone loss. Although ulcerations are the primary concern of people with Charcot foot the other major risk is that cumulative bone loss will lead to permanent damage and disability.

Living with a Charcot foot complication may require the person to use deep supportive shoes. These should have soft insoles and shock absorbing out soles. Supportive socks, arch supports and ankle supports may be beneficial as well. Anyone with or who suspects they have Charcot foot should avoid walking around barefoot.

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