BANGALORE: Diabetic foot complications are unfortunately a common occurrence. Of the many complications with which diabetes afflicts the body, few can be as disabling and potentially devastating for the foot and leg as charcot neuroarthropathy. Neurogenic arthropathy is referred to as charcot foot in medical
terminology.
Charcot foot is a progressive degenerative condition that affects the bones in the feet. It is a complication of long standing uncontrolled blood sugars that almost always occurs in those with neuropathy (nerve damage) that decreases the ability to sense stimuli, including pain, and decreases muscular reflexes that control movement. As a result, the bones in the feet are subjected to repeated trauma and injury, causing progressive damage to the ligaments, cartilage, and joints.
Charcot foot is a serious condition that can lead to severe deformity, disability, and even amputation.
In those with charcot foot the ability to sense pain is usually lost or impaired (as a result of diabetic neuropathy). The muscles lose their ability to support the foot correctly. As a result, minor trauma (eg sprains, stress fractures) to the foot goes undetected and do not get treated. This leads to a slackness of the ligaments (laxity), joints being dislocated, bone and cartilage being damaged and deformity to the foot. People with neuropathy (especially those who have had it for a long time) are at risk of developing charcot foot. In addition, neuropathic patients with a tight Achilles tendon have a tendency to develop charcot foot.
Early symptoms
The early signs of charcot’s foot include the foot or affected part of the foot being warmer than the other foot, swelling and redness. Pain may or may not necessarily be a part of the symptom. A deformity will then start to develop (as a result of joint subluxation/dislocation) as the arch of the foot collapses if the midfoot of the foot is affected and is left untreated. It is all too frequent that this condition is mistaken for an infection as the appearance of the foot on examination and on X-rays can resemble a foot and bone infection. If a person who develops this continues to walk, the bone destruction continues and the joint continues to collapse further. When the process ends a few months later, the collapsed foot or ankle will then fuse in that position. After fusion, the foot will be left in an abnormal position. On the foot, the bones that were once part of the arch will collapse into a concave position.
Complications
The skin on the bottom of the foot is not accustomed to pressure from the bones pushing further down towards the skin, and the additional pressure from the ground below will cause the skin to callus in the middle of the foot as it protects itself from the increased pressure. This will eventually lead to a wound developing under this area of high pressure. Since fat padding is limited in the arch and the bone is brought even closer to the skin and wound surface by the joint collapse, bacteria on the wound can easily spread into the bone. Bone infection is a serious complication, and the abnormal bone left after charcot neuroarthropathy can potentially harbor bacteria easily. This can lead to a partial foot or below-knee amputation if the infection gets out of control.
Treatment
Most often the diagnosis is missed and treatment is delayed leading to bone destruction and abnormal shape and instability of the foot causing ulcerations. Nuclear imaging scan is the latest test to diagnose charcot foot at the early stage. Treatment for charcot foot will begin with steps to control the swelling in the foot while simultaneously protecting it from further harm. This involve immobilisation of the affected foot in total contact cast and intravenous medication till the active phase is over. Later, customised foot support or surgical correction may be needed.
Preventive care
Because of its seriousness, it is important that patients with diabetes take immediate care if signs or symptoms appear like:
Warmth to the touch (the affected foot feels warmer)Redness on the foot
Swelling on the foot Pain The patient can play a vital role in preventing charcot foot and its complications by following these measures:
Keeping blood sugar levels under control can help reduce the progression of nerve damage in the feet.
Get regular check-ups from a diabetic foot care centre.Check both feet every day and see a footcare specialist immediately if you notice signs of charcot footBe careful to avoid injury such as bumping the foot or overdoing an exercise programme Follow the footcare specialist’s instructions for long-term treatment to prevent recurrences, ul cers and amputation.