KOCHI: Charcot feet is a bone and joint disease involving the foot and ankle region causing fragmentation and destruction of the bones leading to permanent deformity, limb loss, besides other morbidities.The most common cause is diabetes, complicated by neuropathy. It starts innocuously as simple swelling with warmth, and usually gets mistreated and misdiagnosed as cellulitis or infection.
The limb slowly changes its shape but the patient is unaware of changes until it aggravates and leads to instability or difficulty in walking. It is painless and, hence, often ignored.The incidence of Charcot foot problem in India is 5% to 9%. Notably, the country’s adult diabetic population is expected to increase to 73 million by 2025. The volume of Charcot disease patients would exceed the whole population of a country like, say, Denmark.
Charcot ailments can, however, be treated with a better understanding of the disease. In the early stages, simple plaster techniques with offloading save the limb from deformity progression.Once the deformity has set in, customised footwear, and charcot restraining orthotic walkers (CROW) help save the feet from further issues.
In those feet where the deformity has become severe with a non-healing wound, a major surgical repair would be needed. The most important aim is to prevent the limb from amputation.
What are the causes?
The exact reason for what triggers the bone destruction is unknown, but it usually happens to the feet that have neuropathy (nerve damage), with some blood-flow alteration. The bone starts fragmentation with some trivial injury. However, there is no pain felt; we call this loss of protective sensation (LOPS).
Treatment options
Is there any medication? No. Unfortunately, no specific medications are helpful in preventing or treating this.The disease cannot be reversed into normal, but the devastating deformity can be prevented by just offloading with a proper total-contact cast. One may need prolonged therapy of offloading and proper diabetes management. In case of already developed deformity or ulcer with deformity, staged surgical intervention can save the limb, and help one walk back in a near-normal way.
The writer is a senior consultant (foot and ankle), trauma and Arthroscopy Surgeon, and president of the Indian Foot and Ankle Society