Charcot’s foot is a serious diabetes-related complication that typically affects people with peripheral neuropathy (nerve damage). When neuropathy dulls the protective sensation of pain, the bones and joints of the foot become vulnerable. Without feeling discomfort, patients often continue walking normally, unknowingly placing excessive pressure on their feet. What may begin as small stress fractures can soon progress to complete fractures simply because the person does not feel pain and continues to overload the weakened foot.
A simple way to understand this is by imagining driving a car with a flat tyre: the steel rim gradually cuts through the tyre, destroying it completely. In Charcot’s foot, the same happens—continued pressure on a fractured foot causes bone displacement and severe deformity.
Why Does Charcot’s Foot Occur Mostly in Diabetic Patients?
The exact trigger for bone destruction remains unclear. However, Charcot disease most often appears in individuals with poorly controlled diabetes and neuropathy. Even a minor injury can set off the destructive cycle, but because there is no pain, patients remain unaware of the damage until it becomes severe.
Signs That You May Have Charcot Foot
Charcot foot can be difficult to diagnose early. Deformity usually becomes noticeable only after significant bone displacement has already occurred. Still, some early clues include:
- Redness
- Swelling
- Increased warmth in one foot compared to the other
As ligament failure progresses, fractures worsen, joints dislocate and a deformity gradually forms.
Which Areas of the Foot or Ankle Are Affected?
Charcot disease can affect any part of the foot or ankle. Even a small injury can trigger it.
The midfoot is most commonly involved, often resulting in collapse of the tarsal bones and the classic rocker-bottom deformity. These abnormal bony prominences can lead to ulcers. Charcot changes can also appear after ankle injuries, causing a highly unstable ankle.
Treatment Options for Charcot’s Foot
The primary goal is preventing further joint destruction and deformity. Early management is vital.
- Total Contact Casting (TCC):
In the early stages, the affected limb is immobilized in a total contact cast to offload pressure and prevent additional damage. This cast needs regular replacement and may be required for 6–9 months, until the temperature difference between the two feet normalizes. - Protection of the Opposite Foot:
Since the unaffected foot also bears risk, special care and proper footwear are important. - Custom Footwear and Orthoses:
Once the bones have stabilized, custom shoes and orthotic devices help prevent recurrence and support deformity.
When deformity is severe or ulcers keep returning, surgery becomes necessary. Surgical options range from simple removal of bony prominences to extensive reconstruction and realignment of bones and joints. Because this surgery is highly complex, it must be performed by an experienced foot and ankle surgeon familiar with Charcot disease to avoid complications.
What Happens if Charcot Foot Is Left Untreated?
Although Charcot foot may not be painful, ignoring it can have devastating consequences. The progressive deformity becomes unstable, leading to ulceration. Over time, uncontrolled bone destruction can become so severe that amputation may be required to protect the patient’s life. Amputation significantly increases mortality risk, making timely treatment essential. Due to the condition’s complexity, patients must seek care from specialists trained in managing foot and ankle Charcot disease.