Charcot Arthropathy

  • Offloading and Immobilization

    Utilizing specialized footwear, custom orthotics, or total contact casts to redistribute weight away from affected areas. This helps to alleviate pressure on the Charcot deformity and promote proper healing.

    Specialized Footwear: This involves providing the patient with custom-made shoes or orthotic inserts. These are designed to redistribute pressure away from the affected areas, particularly over the Charcot deformity. By offering better support and cushioning, specialized footwear helps to prevent further damage and promote healing.

    Total Contact Casts (TCC): TCC is a widely used method for offloading pressure from the affected foot. It involves encasing the foot and lower leg in a cast that is molded to the contours of the patient's foot. This ensures an even distribution of weight, reducing stress on specific areas. TCCs are particularly effective in cases where other methods of offloading may not be sufficient.

  • Activity Modification

    Encouraging the patient to reduce weight-bearing activities and avoid excessive stress on the affected foot. This may involve the use of assistive devices such as crutches or walkers to promote a non-weight-bearing approach.

    Non-Weight-Bearing Activities: Patients with Charcot foot are advised to limit weight-bearing activities on the affected limb. This can include avoiding prolonged standing or walking. Instead, they should engage in activities that do not put undue stress on the foot. This may involve using assistive devices like crutches or walkers to help with mobility.

    Range of Motion Exercises: While it's important to reduce weight-bearing activities, gentle range of motion exercises can be beneficial. These exercises help maintain flexibility and prevent stiffness in the affected joints and muscles.

  • Pharmacological Management

    Administering medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), to alleviate pain and reduce inflammation. Additionally, bisphosphonates may be considered to help strengthen bone density.

    Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs such as ibuprofen or naproxen may be prescribed to manage pain and inflammation associated with Charcot foot. They work by inhibiting the production of prostaglandins, which are chemicals in the body that promote inflammation.

    Bisphosphonates: These medications are used to improve bone density. They work by inhibiting bone resorption, which can be especially important in cases of Charcot foot where there may be weakened bone structure. Bisphosphonates can help to strengthen bones and reduce the risk of further deformity.

Surgical treatment for Charcot Foot

These surgical interventions are carefully chosen based on the specific characteristics of the Charcot foot and the patient's individual circumstances.

  1. Internal Fixation:

    • Pinning or Screw Fixation: This involves using metal pins or screws to stabilize the affected bones or joints. It is particularly useful in cases where there is significant instability or deformity. The pins or screws are carefully placed to realign and secure the bones, promoting proper healing.

    • Plates and Screws: In some cases, metal plates may be used along with screws to provide additional stability. This technique is often employed for more complex deformities or when multiple bones are involved.

  2. External Fixation:

    • Ilizarov Frame: This is an external fixator that consists of rings, wires, and pins. It is attached to the outside of the affected limb and provides stable support for the bones. The Ilizarov frame allows for gradual correction of deformities and promotes bone healing.

    • Circular External Fixators: These are similar to the Ilizarov frame and may be used in cases where there is a need for extensive reconstruction. They allow for precise control over the alignment and stabilization of bones.

  3. Joint Fusion:

    • Arthrodesis: This surgical procedure involves fusing the affected joints together. It is typically performed when there is severe joint destruction and instability. Arthrodesis aims to create a stable, pain-free foot by eliminating motion at the affected joints.

    • Subtalar Fusion: This specific type of fusion targets the subtalar joint, which is commonly affected in Charcot foot. By stabilizing this joint, it helps to restore proper foot alignment and function.