Charcot Foot in Diabetes Is on the Rise

People with diabetes who are significantly overweight are at risk of developing Charcot foot — a deformity caused by nerve damage which can lead to amputation.

If you have diabetes, you know that it can raise your risk for many health problems and potentially cause complications that seem unrelated to the disease itself.

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Charcot foot in diabetes

One growing foot problem is called Charcot foot, a potentially debilitating deformity characterized by dislocated joints and fractures. Diabetes is now considered to be the top cause of the condition. Both the impact of diabetes on foot nerves (especially if blood sugar is not well controlled) and being significantly overweight increase the odds of developing Charcot foot.

Most foot problems in people with diabetes result from the damage the disease can cause to small blood vessels which, in turn, can decrease the blood supply to nerves in their feet, leading to nerve damage (diabetic neuropathy) and numb feet. Without normal pain sensation, a diabetic with neuropathy may continue to walk on an injured foot, worsening the injury and leading to significant deformity and disability — markers of Charcot foot.

Charcot foot (also called Charcot arthropathy and Charcot foot syndrome) is one of the most critical foot problems that can result from diabetic neuropathy, according to the American Academy of Orthopaedic Surgeons (AAOS). Although neuropathy must be present for Charcot foot to develop, the most significant risk factor that contributes to the condition is obesity.

“Simply put, excess weight on a foot that cannot sense pain is a perfect storm for Charcot to develop,” the AAOS warns.

Unfortunately, obesity is a serious problem in the U.S. About 62 percent of U.S. adults with type 2 diabetes are obese, and 21 percent are morbidly obese, meaning they are 100 pounds or more over ideal body weight or have a body mass index (BMI) of 40 or more. Being significantly overweight raises the risk for developing type 2 diabetes and then, if blood sugar and weight are not controlled, Charcot foot may develop as a complication.

Charcot foot treatments

Nonsurgical treatments

• Casts. If Charcot foot is caught early, a special boot or cast can protect and stabilize bones as they heal.
• Custom shoes, braces, and orthotics. The AAOS points out some people with Charcot foot deformities can’t wear regular shoes. Talk to your doctor about special shoe inserts or braces if you have diabetic neuropathy. Specialized over-the-counter diabetic shoes or shoes made to order to fit you can help if regular shoes don’t fit a Charcot-deformed foot.

Surgical treatment

When non-surgical treatments are not effective enough, surgery may treat Charcot foot. No single type of surgical approach can help the condition. Orthopedic surgeons who specialize in treating the problem opt for the best surgical approach for individual patients, depending on how deformed the foot is and whether there are unstable fractures and dislocations that need surgery to heal the foot.

In addition, surgery may be needed to debride (clean and remove dead skin) from ulcers so they heal. What’s more, deformities in Charcot foot can lead to small pieces of bones poking under the skin, and surgery may be needed to remove the bones and prevent ulcers.

In advanced cases of Charcot foot, when there is severe deformity, deep bone infection, or loss of blood supply to the foot, it may not be possible to save your foot. Amputation above the part of the foot with the deformities may be recommended. After surgery, a prosthetic device can help you regain your mobility.

The bottom line

If you have diabetes, work with your doctor to keep your blood sugar and weight under control. It is important to report any symptoms of diabetic neuropathy to your doctor. Paying attention daily to any signs of numbness and injuries to your feet can go far at keeping Charcot foot at bay or, if you already have the condition, help you avoid serious consequences and amputation.

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