Charcot Foot

Diabetes is a lifelong condition which can cause foot problems if it is not well controlled. These problems occur because the nerves and/or blood vessels supplying your feet are damaged.

When the nerves in your feet are damaged this is called ‘peripheral neuropathy’ and can affect the feeling in your feet. When the blood vessels supplying your feet are damaged this is called ‘peripheral vascular disease’ or ‘ischaemia’ and can affect the circulation of blood and oxygen to your feet.

These changes can be very gradual and you may not notice them. This is why it is important that every year you have your feet checked by a suitably trained professional or assessed by a podiatrist. You can then agree on a treatment plan to suit your needs.

What is Charcot foot?

Charcot foot (also known as ‘Charcot neuroarthropathy’) is a very serious complication of diabetes that can develop if you have peripheral neuropathy in your feet.

Charcot foot can make the bones of your foot become fragile, which means that they may break or dislocate easily, even if you don’t injure them badly. Most patients cannot recall injuring their foot at all.

If you have peripheral neuropathy in your feet, you may still be able to walk on your foot after injuring it without feeling any pain. If this happens, and it is not picked up in the early stages, your foot can become severely deformed. The shape of your foot will not return to normal on its own, and this can make it very difficult to find shoes that fit properly. It is important that you notice any foot problems early and get professional help.

How will I know if I've got Charcot foot?

The early signs of Charcot foot are swelling and warmth in the affected area of the foot or ankle. There may be some redness, which is sometimes mistaken for infection. Usually there is no pain (because of nerve damage), but this is not always the case. In most cases only one foot is affected. However, in some rare cases people can develop Charcot foot in both feet.

Who will treat my foot?

Ideally, Charcot foot should be treated and managed by a specialist diabetes foot service. This may be made up of a variety of healthcare professionals or one person with experience in treating this condition. Charcot foot can be a very serious condition and can be difficult to diagnose, treat and manage, so it is very important that it is looked after by experienced healthcare professionals.

What is the aim of my treatment? 

There are two important aims of treating Charcot foot:

• Preventing a permanent change to the shape of your foot
• Preventing future foot problems

If your foot changes shape due to Charcot neuroarthropathy, you are at increased risk of foot ulcers. These are wounds or breaks in the skin that can take a long time to heal and can potentially lead to serious infection.

What will the treatment consist of?

The only effective treatment is to reduce the weight on the foot or affected joint and prevent it from moving. This will need to be done with some form of cast (in the same way as if you had broken a bone). The treatment you receive will depend on the method of treatment that your local specialist diabetes foot service prefers.

Treatment options

• A plaster cast that your healthcare professional will regularly review and change when needed
• A cast walker with a prescription insole that your healthcare professional will regularly review

Both these methods of treating Charcot foot have been proven to be successful, but you will need to follow the advice you are given closely.

What other treatment will I get?

• You will need regular appointments with a member of the specialist diabetes foot service to check the temperature of your foot as well as looking for and treating any foot ulcers.
• You will have an X-ray when needed.
• You may need prescription footwear supplied by an orthotist (someone who specialises in prescribing devices to aid walking).

How can I help my condition?

You should follow the medical advice you are given. You will need to keep your weight off your foot as much as possible, as Charcot foot can be very disabling if it is not treated appropriately.

The following advice will help you to manage your condition.

• Keep your blood glucose levels under control by following the advice you have been given.
• Keep checking your other foot as there will be more pressure on it and this could cause a further problem.
• Contact a member of the specialist diabetes service if you notice any change or are worried about your treatment in any way.

Your specialist diabetes foot service is here to support you, help you manage your Charcot foot, offer advice and answer any questions you may have.

When your condition has settled down

Even with the appropriate treatment, there may be some changes in the shape of your foot. You will need to have regular check-ups with a podiatrist and perhaps an orthotist if you need prescription footwear.

If you discover any problems with your feet, contact your podiatry department or GP immediately. If they are not available, go to your nearest accident and emergency department. Remember, any delay in getting advice or treatment when you have a problem can lead to more serious problems.

Useful resources 

For more information have a look at this Charcot foot information sheet produced by Yeovil Hospital Healthcare.