What we all need to know about Charcot Foot

[guidoLaMoto]

Originally Posted by Corn-fused

….. I was still wearing a surgical boot and seeing the podiatrist for followups from the surgery healing and when he saw my foot he knew it was Charcot right away. .. .

A good deal of confusion on this thread.


Charcot described chronic inflammation and deformity in joints (usually the knee &/or ankle/foot) in syphilitics over a century ago. They had long standing neuropathy and had trouble telling where their foot & leg was when walking, so they unconsciously developed a clumsy "stomping" gait that sent vibrations up the leg until they could feel it. The repeated trauma caused the joint to become inflamed (hot, red & swollen) and eventually to deteriorate and calcify.


Nowadays, diabetes is the most common cause of peripheral neuropathy, but the principle is the same-- long standing, repeated trauma from a clumsy gait causing arthritis.


In your case, Corn, if the problem didn't show up until the immediate post-op period, then infection has got to be the first consideration (missing that diagnosis would be tragic). In a diabetic who has required an amputation, circulation is obviously compromised already and further redness & swelling could also be the first stage of gangrene. Walking in a clumsy boot in the post-op period could also cause trauma and acute inflammation-- which technically is not Charcot Joint- a chronic condition- but we're splitting hairs to say that.


Yes, Charcot Joint is a nasty situation because its existence means the damage has already been done, and not being a salamander, you can't grow a new one. Now the problem is to individualize the orthotics (braces, bandages, pads, etc) to compensate as best you can for the deformity.

[bluedevilz]

Originally Posted by guidoLaMoto

A good deal of confusion on this thread.


Charcot described chronic inflammation and deformity in joints (usually the knee &/or ankle/foot) in syphilitics over a century ago. They had long standing neuropathy and had trouble telling where their foot & leg was when walking, so they unconsciously developed a clumsy "stomping" gait that sent vibrations up the leg until they could feel it. The repeated trauma caused the joint to become inflamed (hot, red & swollen) and eventually to deteriorate and calcify.


Nowadays, diabetes is the most common cause of peripheral neuropathy, but the principle is the same-- long standing, repeated trauma from a clumsy gait causing arthritis.


In your case, Corn, if the problem didn't show up until the immediate post-op period, then infection has got to be the first consideration (missing that diagnosis would be tragic). In a diabetic who has required an amputation, circulation is obviously compromised already and further redness & swelling could also be the first stage of gangrene. Walking in a clumsy boot in the post-op period could also cause trauma and acute inflammation-- which technically is not Charcot Joint- a chronic condition- but we're splitting hairs to say that.


Yes, Charcot Joint is a nasty situation because its existence means the damage has already been done, and not being a salamander, you can't grow a new one. Now the problem is to individualize the orthotics (braces, bandages, pads, etc) to compensate as best you can for the deformity.

A good deal of confusion in your post...

Corn-fused describes a very typical course for development and treatment of Charcot foot including the typical rocker bottom appearance, tendency to form ulcers and callous on the sole and treatment with a total contact cast.

Initial presentation of Charcot foot is often similar to and often confused with cellulitis...

You don't really seem to understand what a Charcot foot is Guido other than what you may have read on a Wiki page....

[Corn-fused]

Originally Posted by bluedevilz

A good deal of confusion in your post...

Corn-fused describes a very typical course for development and treatment of Charcot foot including the typical rocker bottom appearance, tendency to form ulcers and callous on the sole and treatment with a total contact cast.

Initial presentation of Charcot foot is often similar to and often confused with cellulitis...

You don't really seem to understand what a Charcot foot is Guido other than what you may have read on a Wiki page....

Agreed.

[guidoLaMoto]

Originally Posted by bluedevilz

You don't really seem to understand what a Charcot foot is Guido other than what you may have read on a Wiki page....

Au contraire, mon ami. Re-read my post. Chronic vs acute & splitting hairs. The timing is a technicality. It's the pathophysiology I was trying to explain.


I suppose you would say an 80 y/o who develops dementia must have Alzheimer's Disease, when, by definition, Alzheimer's is pre-senile dementia. The 80 y/o may have dementia of Alzheimer type, but technically not Alzheimer's. For that matter, how many CV surgeons do you know who call CABG "open heart surgery?" Valve replacement is open-heart, not CABG.

Of course a Charcot foot can be confused with cellulitis-- they're both inflammation-- rubor, calor, tumor and functio laesa. But in a post -op setting where the pt never had the problem before, you better treat empirically as infection first and consider Charcot secondarily.


My post was meant to shed some light on the pathogenesis of chronic arthritis resulting from peripheral neuropathy. The people posting seemed to think it was some magic diagnosis that most physicians miss and therefore they never get proper treatment. Whether or not it's called Charcot Joint, I'm sure most MDs correctly treat an acutely inflamed joint as infection first and then find appropriate ways to deal with the chronic condition as time goes by. Nothing lost because there is no specific treatment for any chronic arthritis.