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Charcot Foot

Charcot Foot

Charcot Foot

Charcot foot is a serious complication of nerve damage in the feet, most often seen in people with diabetes. It weakens the bones and joints of the foot, and without early treatment it can cause the foot to collapse and change shape permanently. Because the foot has lost much of its feeling, Charcot foot often develops with little or no pain, which is why it’s frequently missed in its early stages.

Caught early, the damage can be limited. At East Gosford Podiatry, we help people with diabetes and neuropathy recognise the warning signs, get a fast diagnosis and protect their feet for the long term.

If you have diabetes or neuropathy and one foot is suddenly warm, red or swollen, treat it as urgent. Call us on 02 4325 0600 or see your GP the same day, and stay off the foot as much as possible until it’s been assessed.

What is Charcot foot?

Charcot foot (also called Charcot neuroarthropathy) is a condition where the bones in the foot become weak and start to break down, usually after a minor injury the person didn’t feel. Because there’s no pain to signal a problem, the person keeps walking on the injured foot. Each step causes more damage, leading to fractures, dislocated joints and, over time, changes in the shape of the foot.

The most recognised deformity is a “rocker-bottom” foot, where the arch collapses and the middle of the foot drops below the heel and toes. This creates new pressure points on the sole that can easily develop into ulcers and infection.

What causes Charcot foot?

The main cause is peripheral neuropathy, damage to the nerves that carry sensation from the feet. Neuropathy also affects the nerves that control blood flow, which increases circulation to the bones and causes them to lose strength. A weakened foot combined with no protective pain is what allows the damage to progress.

Charcot foot is often triggered by an injury that would normally be painful, such as a twisted ankle, a stumble, a small fracture or a recent foot operation.

Who is at risk?

You’re at higher risk of Charcot foot if you have:

  • Diabetes, particularly if you’ve had it for many years
  • Reduced sensation or numbness in your feet
  • A previous foot ulcer, fracture or foot surgery
  • Kidney disease or a kidney transplant
  • Neuropathy from other causes, such as alcohol, some medications or spinal problems

Signs and symptoms of Charcot foot

The early signs usually appear in one foot only:

  • Warmth, with the affected foot feeling noticeably hotter than the other
  • Swelling of the foot or ankle
  • Redness of the skin
  • Mild aching or discomfort, though many people have no pain at all
  • Changes in the shape of the foot or ankle as the condition progresses

Charcot foot is commonly mistaken for an infection, gout, a sprain or a blood clot. If you have neuropathy and one foot becomes hot and swollen, Charcot foot should always be ruled out.

The stages of Charcot foot

Charcot foot develops in stages, usually over several months.

Early (active) stage

The foot is warm, swollen and red. X-rays may look normal at first, even though damage is already occurring inside the bones. This is the most important time to act, as offloading the foot now can prevent deformity.

Fragmentation stage

The bones weaken, fracture and break into fragments, and the joints can dislocate. The foot becomes unstable and its shape may begin to change.

Coalescence stage

Swelling and warmth begin to settle as the body starts to repair the damage. The bone fragments start to join back together.

Consolidation (settled) stage

The bones heal and the foot becomes stable again, but any deformity that developed is usually permanent. A changed foot shape leaves ongoing pressure points and a lifelong risk of ulcers.

How is Charcot foot diagnosed?

Diagnosis is based on your symptoms, a hands-on examination and imaging. Your podiatrist will compare the temperature of both feet, as a difference of more than two degrees is a strong warning sign. They’ll also check your sensation, circulation and foot shape.

X-rays are used to look for fractures and changes in the bones. Because X-rays can look normal in the early stage, an MRI may be needed to confirm the diagnosis. If Charcot foot is suspected, the foot should be protected straight away, even before imaging confirms it.

Treatment for Charcot foot

Offloading and immobilisation

The most important treatment in the active stage is taking weight off the foot so the bones can heal without collapsing. This usually involves a total contact cast or a removable boot, sometimes with crutches, a knee scooter or a wheelchair. Treatment typically continues until the swelling and temperature difference settle, which can take several months or longer.

Returning to walking

Once the foot has settled, you’ll move gradually back into footwear. Many people need a Charcot restraint walker (a custom-made boot) for a period, followed by extra-depth or custom-made shoes and custom orthotics to protect pressure points and support the foot.

Surgery

Surgery isn’t needed for most people. It may be considered when the foot is severely deformed or unstable, or when ulcers keep returning despite good footwear and care. Procedures include removing bony prominences, realigning bones or fusing unstable joints, and are performed by an orthopaedic surgeon.

How East Gosford Podiatry can help

Charcot foot is best managed by a team, and your podiatrist plays a key role at every stage:

  • Early detection

    Regular diabetes foot assessments, including temperature checks, help pick up Charcot changes before deformity occurs.

  • Fast referral and coordinated care

    If we suspect Charcot foot, we’ll arrange urgent imaging and work with your GP and the hospital high risk foot service on casting and offloading.

  • Footwear and orthotics

    We help you transition safely out of the cast or boot and into footwear that fits and protects your foot.

  • Ulcer prevention and skin care

    Ongoing care of corns, calluses, nails and pressure areas reduces the risk of wounds on a changed foot.

  • Long-term monitoring

    Regular reviews help protect the affected foot and keep an eye on the other foot, which is also at risk.

  • Worried about a warm, swollen foot?

    If you have diabetes or neuropathy, don’t wait. Call us today and stay off the foot until it’s been assessed.

    Call 02 4325 0600

Living with Charcot foot

Once Charcot foot has settled, the aim is to prevent it flaring up again and to avoid ulcers. This means:

  • Checking both feet every day for warmth, swelling, redness, wounds or changes in shape
  • Wearing your prescribed footwear and orthotics, both inside and outside the house
  • Never walking barefoot
  • Keeping regular podiatry appointments, usually every one to three months
  • Working with your GP and diabetes team to manage blood sugar levels

Read more about how we look after people with diabetes on our diabetic foot care page.

When to seek help urgently

Contact us or your GP on the same day if you have diabetes or neuropathy and notice:

  • One foot that is warmer, redder or more swollen than the other, even without pain
  • A change in the shape of your foot or ankle
  • Your foot or ankle feeling unstable when you walk
  • A new wound, blister or sore, or any discharge
  • Swelling that doesn’t settle with rest

If you also feel unwell or have a fever, seek medical care immediately.

Book an appointment

If you have diabetes or neuropathy, regular foot checks are the best way to catch Charcot foot early. Our podiatrists see patients from across the Central Coast, including Gosford, Wyoming, Erina, Terrigal and Green Point. Call us on 02 4325 0600 to book an assessment, or call today if you’re worried about a warm, swollen foot.

We Accept Patients from all over the Central Coast

If you are in East Gosford and surrounding suburbs and are in need of a Podiatry appointment due to lower limb or feet issues you may need orthotics. Please contact our clinic on (02) 4325 0600

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