Charcot Foot

Diagnosis/Definition

• The Charcot deformity is described as neuroarthropathy of the foot and ankle, which typically manifests in the forefoot, midfoot and ankle region. This presents as hot, red, swollen foot or ankle that may be confused for an infection or gout in the early phase with or without obvious midfoot collapse (reversal of the normal arch height).  This frequently occurs insidiously; is usually painless; involves well perfused feet without significant vascular disease; and is preceded by increased activity or weight bearing on the limb.

Initial Diagnosis and Management

• Red, hot, swollen foot and/or ankle
• Sudden onset of inflammation with warmth and edema, and erythema of the foot and/or ankle without a break in the skin or known point of entry for infection
• Generally presents with the following symptoms:
• Neuropathy, or loss of sensation to foot, ankle, lower leg
• History of diabetes, ETOH, anemias, rheumatoid arthritis or other autoimmune disorders
• Symptoms of acute injury without known incident (i.e. red, hot, swollen foot)
• Will usually have good arterial flow, i.e. good pedal pulses
• May or may not have the following symptoms:
• Pain in the affected foot and/or ankle
• No evidence of osteomyelitis
• Gross foot deformity or ankle malalignment
• History of or loss of foot architecture, i.e. midfoot collapse, severe lowering of arch, obvious deformity
• Arthropathy affecting lower extremity
• Imaging (possible findings: not specifically required for consult):
• During acute onset, may have negative X-ray or bone scan with subtle findings of fracture/ discoloration
• During mid to late stages, may have obvious shards of bone or fracture
• Recommend comparing with previous foot images if available (baseline x-rays)
• Labs (possible findings: not specifically required for consult):
• ESR elevation
• Absent WBC elevation
• Baseline HbA1c of value in diabetic

Treatment of Charcot

• Non-weight bearing on affected lower extremity until diagnosis confirmed (bedrest or wheelchair optimal; caution using crutches or surgical shoes/casts in presence of neuropathy, instability, etc. due to increased risk of creating problems with uninvolved limb)
• ASAP consult to Limb Preservation Service.

Ongoing Management and Objectives

• To decrease the rate of toe, foot and lower extremity amputation with prompt referral of suspected Charcot foot and/or ankle processes’
• To manage each patient’s condition with a combination of mechanical, medical and surgical therapies tailored specifically for the unique characteristics of neuroarthropathy with/without ulcerations

Indications for Specialty Care Referral

• All patients with suspected Charcot foot and/or ankle deformities should be referred for evaluation by the Limb Preservation Service as an ASAP consult.  All patients will require an approved consult to be seen.

Criteria for Return to Primary Care

• All patients should be followed by the primary care provider for treatment of all co-morbid conditions and routine care with the goal of optimal health and wellness for the whole patient