What is Charcot Osteoarthropathy?
Charcot osteoarthropathy is a progressively destructive and degenerative joint disorder that most commonly affects the foot and ankle in diabetic patients with peripheral neuropathy.
Peripheral neuropathy is a condition of nerve damage, usually in the lower extremities. It is a complication of uncontrolled diabetes, resulting in diminished sensation and decreased ability to feel pain and temperature in the feet. Because of this loss of sensation, you may not be aware of infections or trauma, and therefore not seek treatment. This can lead to Charcot osteoarthropathy, a condition characterised by gross structural deformities of the foot and ankle that can lead to skin ulceration and even amputation due to infection.
Risk Factors for Charcot Osteoarthropathy
Risk factors that can cause peripheral neuropathy and subsequently Charcot osteoarthropathy include:
- Trauma, damage, or infection in the peripheral nerves
- Inflammatory disorders, such as psoriasis and sarcoidosis
- Drug or alcohol abuse
- Spinal cord injury or disease
- Parkinson’s disease
Signs and Symptoms of Charcot Osteoarthropathy
You may experience redness, swelling, and increased skin temperature in the affected foot. If left untreated, your foot may become deformed, leading to severe disability, and even require amputation.
Diagnosis of Charcot Osteoarthropathy
Charcot osteoarthropathy can be diagnosed by reviewing your medical history, performing a thorough physical examination of your foot and ankle, and conducting specific tests. These may include:
- Pinprick test to assess your pain sensitivity
- Neurometer tests to detect peripheral nerve dysfunction
- Semmes-Weinstein 5.07/10-gram monofilament test to assess your sensitivity to touch and pressure in nerve fibres
- Imaging tests such as X-rays and MRIs to detect any deformity or injury to the bone and soft tissues
If you suffer from diabetes, daily foot inspections and regular checkups with your doctor is imperative.
Treatment of Charcot Osteoarthropathy
Charcot osteoarthropathy can require non-surgical or surgical treatment, based on the severity of the condition.
Nonsurgical treatment is centred on reducing swelling and pain and limiting weight on the foot. Medications are prescribed to reduce pain, warmth, and inflammation. Your doctor will apply a cast or brace to the foot to immobilise it and instruct you to walk only with the support of crutches or a wheelchair. Following immobilization, you may be instructed to wear shoes with special inserts. You will also be instructed on certain activity modifications.
Severe cases of foot deformity and formation of sores or ulcers usually require surgery and may involve the following surgical techniques:
- Exostectomy: A surgical procedure to remove plantar prominences in the foot, which may cause ulcer formation.
- Ankle fusion: A surgical procedure to fuse the ankle joint using fixation devices such as plates, screws, or rods to prevent motion.
- Realignment bone surgery: This is also known as a reconstructive osteotomy, in which your surgeon shortens or lengthens the bone in the ankle or foot in order to alter its alignment and better support the joints.
- Amputation and prosthetic fitting: The severely damaged foot or part of the foot is removed and a prosthetic device is fitted.
Prevention of Charcot Osteoarthropathy
You can prevent or reduce the risk of developing Charcot osteoarthropathy through the following healthy lifestyle habits:
- Maintaining healthy blood sugar levels
- Avoiding trauma or damage to your feet if you are diabetic or at risk for neuropathy
- Regular self-examination to detect early symptoms
- Refraining from alcohol or substance abuse
- Eating a healthy and balanced diet
- Using footgear to protect the foot
- Regular follow-ups with your doctor