Overview

Charcot foot, or rocker-bottom foot, is a deformity most common in people with diabetes. Severe nerve and blood vessel damage caused by uncontrolled blood sugar leads to weakened bones and joints which can easily fracture or dislocate during normal daily activities. Because the nerves of the feet are so damaged, these injuries may be unrecognized and left untreated.

Continuing to walk on the injured foot causes the bones to heal in an unnatural position, resulting in the classic rocker-bottom shape. This deformity can lead to further complications over time, such as foot ulcers and infections.

Recognizing the early signs of Charcot foot will allow you to seek treatment sooner and reduce the risk of developing permanent and disabling deformities.

The 3 Stages of Charcot Foot

Charcot foot is a condition that develops slowly over a period of weeks, months, or years. It is a cycle of bone weakening, injury, and improper healing that eventually changes the shape of the foot. There are three phases of Charcot injury and healing.

1. The Development Phase

In the first stage of Charcot foot, the bones and ligaments suffer an injury or fracture. Because the damage is new, a doctor can treat Charcot foot at this stage with minimal permanent effects. If left untreated, the injury will progress to the next stage.

2. The Merging Phase

In the second phase, the fractures in the foot begin to heal. If Charcot foot is not identified before this stage, the bones will start to heal out of a natural position, putting you at risk for deformities. Treating Charcot in the merging stage is still possible, but recovery will take longer, and there is a higher chance of improper healing that can have lasting effects.

3. The Reconstruction Phase

In the final phase of Charcot healing, the bones and ligaments will heal in the classic rocker-bottom formation. Treatment of Charcot foot at this stage focuses on preventing further injuries and managing immobility. In severe cases, surgery may be necessary to reshape the foot.

Recognizing the Early Signs of Charcot Foot

The best way to manage Charcot foot is to recognize the early warning signs and prevent an injury from occurring. The first indications of Charcot foot are typically mild and may present before a bone or ligament becomes severely damaged. Early symptoms include:

• Swelling of the foot
• Redness
• Warmth

Pain may or may not be present depending on the severity of your neuropathy. It is important to know that the absence of pain does not mean there is not an injury to your foot.

If you are experiencing these symptoms, notify your doctor right away and limit the amount of time on your feet.

Treatment

The goals of treating early-stage Charcot foot are to support the foot bones so they can heal in a natural position, and to avoid weight bearing activities that can increase the risk of reinjury. Rest, protective casts and braces, and close monitoring will ensure timely recovery. Your doctor will fit you with a foot orthotic and provide you with instructions about any activity restrictions.

It is crucial that you follow the instructions given to you by your doctor. Failure to do so may lead to further injury to your foot, a longer recovery time, and permanent foot deformities that can limit your ability to walk.

Prevention

Practicing these habits will reduce your risk of developing Charcot foot.

• Maintain your blood sugar within the parameters set in place by your doctor.
• Check your feet daily and report any signs of Charcot foot to your doctor.
• Avoid potential injuries by wearing proper footwear.
• Get regular check-ups from a foot specialist.

Sources

American College of Foot and Ankle Surgeons. Charcot Foot. n.d

Cleveland Clinic. Charcot Foot. Reviewed January 2019.

Medline Plus. Charcot Foot. Reviewed November 2020.

Rosenbaum AJ, DiPreta JA. Classifications in brief: Eichenholtz classification of Charcot arthropathy. Clinical Orthopaedics and Related Research. Published March 2015.