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Charcot Joint

Neuropathic Arthropathy, otherwise known as Charcot Joint, is a common side effect of diabetes that produces deformities in the foot and ankle. Symptoms typically include redness, swelling, together with visible deformities. Your Orthopaedic Associates of St. Augustine physician will review your symptoms and establish the most suitable therapy plan for you. For less severe cases, non-surgical options will be advised to try first. If non-surgical therapies fail; or the deformity is severe, your physician may propose a surgical option.

Charcot Joint may affect the ankle and foot anywhere, including the ankle, midfoot, rearfoot, heel, and forefoot. Many areas may be involved at the same time. Dislocations and fractures can encompass numerous bones and joints, with extensive deformity and fragmentation.

Neuropathy (nerve damage) is also a complication of diabetes, leading to a loss of feeling in the feet. Not having any sensation in the foot implies a greater chance you will not realize that something has aggravated or punctured the skin.

Diabetes can also damage blood vessels, thus decreasing the blood flow to the extremities, including the feet. Poor circulation weakens the bones and can cause the bones and joints in the foot to break more easily. If you have broken a bone in your foot or ankle, you may not realize it because of poor circulation and a loss of feeling. Poor circulation also increases the risk of chronic foot sores from abnormal pressure. Neuropathic patients with a tight Achilles tendon tend to develop Charcot Joint.

Symptoms

Usually, individuals with Charcot Joint may not feel much pain, but they could experience other symptoms, such as:

• • Foot swelling without an injury
  • Redness of the foot
  • Foot feels warm to the touch
  • Foot deformities may be existing in severe cases

Diagnosis

One of our Orthopaedic physicians will discuss your symptoms. Afterward, your physician will carefully examine your foot using a variety of tests:
X-rays. X-rays will show detailed images of dense structures, like bone. In the early stages of Charcot Joint, the x-rays may not display much. However, if the condition is in the later stages, then multiple fractures and dislocations of the joints will be seen in the x-ray.

• MRI and ultrasound. This scan creates images of soft tissues in the foot and ankle. Your physician may order these if he thinks you have a bone infection.
  Bone scan. A bone scan is a nuclear medicine assessment that is useful in revealing if you have a bone infection. Both bone infections and Charcot Joint will produce a positive bone scan.
• Indium scan. An indium scan is a specialized scan that places a marker on white blood cells and traces them to determine whether they are moving to the bone to fight an infection. The indium scan is looking for the increased white blood cell activity.

Treatment Overview

The main goal of treatment for Charcot Joint is to repair the broken bones. There are both non-surgical and surgical treatments available.

Non-Surgical Treatment

Non-surgical treatments usually work best when Charcot Joint is still in its initial stages. One of the most successful treatments is casting. Casting helps to reduce swelling as well as protect the bones. The patient will have to keep their weight off of the affected foot. Usually, a patient will need a wheelchair, a knee-walker device, or crutches. Recovery will take at least three months. The cast will be removed, and a new one is applied every couple of weeks to ensure that it continues to fit the foot and leg as the swelling reduces.

Custom shoes may also be advised after the initial swelling has diminished and the bones have begun to fuse back together. The medical shoes are designed to decrease the risk of ulcers on the feet. Some diabetic patients may not be able to wear over-the-counter shoes because they do not fit the deformed foot properly.

Surgical Treatment

If the patient is at high risk for ulcers due to a foot deformity, a surgical procedure will usually be recommended. If non-surgical treatments were ineffective, or if the patient has unstable fractures and dislocations, the next option would be a surgical procedure. Orthopaedic Associates of St. Augustine will establish the best timing and appropriate procedure for each patient.

There are numerous different variations of Charcot Joint, and each requires another type of surgical procedure. For instance, if the deformity is minor and related to the back of the heel, then Achilles tendon lengthening may be the best choice. But if the deformity is more severe and has produced a large bony bump on the bottom of the foot, the technique chosen would be based on the bones and joints’ stability in the patient’s foot. Your orthopedic physician will help determine the best surgical procedure for your specific deformity.

The earlier Charcot Joint is diagnosed, the better the outcome will be. Make sure to follow your physician’s instructions during the recovery period to help expedite the recovery process and avoid future complications.

If you are suffering from foot and ankle pain or believe you have nerve damage, contact Orthopaedic Associates of St. Augustine online or at (904) 825-0540 to request an appointment with our board certified and fellowship trained foot and ankle physicians.