Charcot arthropathy is non-infectious, destructive process of the bones and joints of the feet that leads to progressive deformity, putting the patient at very high risk for ulcer formation and possibly even amputation. Charcot arthropathy is typically seen in diabetic patients with neuropathy (loss of protective sensation in the foot).
The exact mechanism of charcot arthropathy is not completely known but is felt to be related to continual micro-trauma to an insensate foot as well as changes in the ability of the body to regulate blood flow which leads to regional bone loss and weakness.
Patients with charcot arthropathy complain of swelling, redness and mild pain in the foot & ankle. There is usually history of a mild trauma such as an ankle sprain. Often time’s patients are incorrectly diagnosed with cellulitis. Without proper treatment, the foot can become deformed, leading to ulceration and deep infection.
Most cases of Charcot arthropathy are diagnosed with an accurate history, orthopedic examination and x-rays. A diagnostic dilemma occurs when there is an ulcer overlying an area of bony deformity. The orthopedic surgeon must determine whether there is a deep bone infection in addition to Charcot changes of the foot. This may require other diagnostic tests such as MRI, bone scan, or even bone biopsy. Deep bone infection may require additional treatment such as long term antibiotics or even surgery.
Most cases of Charcot arthropathy can be treated with casting and a period of non-weight bearing. Once the process of Charcot arthropathy ‘runs its course’ casting is stopped and the patient can usually move over to a protective boot/brace and eventually diabetic shoes with specialized diabetic insoles. This usually prevents the deformation of bones and joints which can lead to ulcers.
Surgery may be needed in the following circumstances:
- Unstable deformity pattern
- Acute dislocation putting skin at risk for necrosis
- Bony prominence leading to recurrent ulceration
- Abscess or osteomyelitis (bone infection)
Surgical procedures include exostectomy, or shaving of a stable bump which is causing an ulcer, and arthrodesis, or fusion surgery. Fusion surgery in patients with Charcot arthropathy is challenging because of poor bone quality, significant deformity which requires realignment, and the possibility of a concurrent bone infection. Recent advances in external fixation allow surgeons to address all of these challenges.
Charcot arthropathy with an underlying ulcer and bone infection puts the patient at high risk for major limb amputation. Dr. Chapman has significant experience in preventing major limb amputations in patients with Charcot arthropathy.