People suffering from
neuropathy (considerable nerve damage) have weakened bones in the foot, which
are prone to stress buildup, and may eventually suffer a crack or fracture. This
condition is called Charcot foot. With continued walking, the injured foot or
ankle is subjected to continuous pressure. As the disorder reaches an advanced
stage, it can finally lead to a collapse of the joints, which would give an
abnormal shape to the foot.
Charcot foot is an
extremely serious disease that can cause disability and deformity. Some cases
may even lead to amputation. That’s why it becomes important for those with
diabetes, a disease connected to neuropathy, to take preventive measures and
consult a doctor as soon as they spot symptoms of Charcot foot.
Symptoms
Common symptoms of Charcot
foot could include:
- Redness in the foot
- Feeling of warmth in the affected foot
- Soreness
- Swelling in the area
- Pain
Treating
Charcot Foot
The optimal treatment for
this condition, which could be either amputation or salvage, has been a subject
of long-term debate among orthopedic surgeons. Though non-operative treatment
options include limiting any walking, weight bearing and loading of the foot
and ankle until the bone has healed, it may not give effective results in
severe cases. During such instances, surgical intervention may become
necessary.
Depending on the extent of
ulcerations, foot deformities and instability, the best surgical option is
assessed. From simple exostectomy with ulcer excision, exostectomies with
rotational flaps, free tissue transfers, to arthrodesis (major elective
reconstruction) as well as internal and external fixation, there are various
surgical treatment options available today. However, the key to successful
reconstruction depends on proper selection of the procedure and patient
compliance. Though patient compliance may seem like a foregone conclusion, it
becomes important to educate patients about the need for a period of non-weight
bearing post-operative phase where the foot heals slowly and eventually becomes
free of pain.
For treating Charcot
joints, the clear winner is arthrodesis. This procedure involves joint fusion
between two bones via surgery that helps in realignment and correction of
deformities, improves function, eliminates instability and helps in the maintenance
of such corrective steps.
Usually, the level of
fusion (triple, mid-foot or ankle arthrodesis) is determined by the extent of
the deformity. In these complex fusions, the use of screws, plates and
intramedullary nails has become a standard practice these days as they offer improved
outcomes with better solid fixation. In recent years, an increase in the usage
of external fixation has been noticed. In reconstructive surgery of the Charcot
foot and ankle, surgeons may use external, internal and combined fixation,
after assessing what the situation demands.
Past
vs. Present
Earlier, standard methods
of internal fixation were used for corrective surgery, which was performed as a
staged procedure. The first stage involved resection of the infected bone while
internal fixation was applied at the second operation. Today, fine-wire
external fixation is used to conduct a single-stage resection along with
correction. To maintain the correction, a fine-wire (multi-plane) external
fixator is used.
Charcot foot adversely
affects the patient’s quality of life and creates a severe negative impact on
his/her overall health. Therefore, it becomes important to consult an
orthopedic or foot and angle surgeon on time to avoid amputation and get the
limb salvaged.
