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Charcot foot

Charcot foot (also known as Charcot arthropathy or Charcot neuroarthropathy ) is a severe degenerative disease of the foot, which is usually caused by neuropathy (especially in diabetes mellitus). The reduced sensation of pain and temperature leads to repeated, often unnoticed micro-injuries to bones and joints. Without timely treatment, these gradually lead to deformities, instability and, in the worst case, to the collapse of the foot structure.

Origin and causes

1. Neuropathy (nerve damage)
   • Often caused by diabetes mellitus (diabetic polyneuropathy).
   • Other causes of neuropathies (e.g. alcohol abuse, nerve compression syndromes) may also be involved.
2. Impaired pain and warning function
   • Minor injuries are not noticed, relief and protective measures are not taken.
3. Permanent stress and microtrauma
   • Bones and joints continue to be stressed despite damage; this leads to fractures or dislocations.
4. Inflammatory reactions and bone remodeling
   • Progressive destruction leads to instability, swelling and deformation (e.g. "rocker bottom foot").

Typical symptoms

• Redness, swelling, overheating of the foot (often despite little or no pain).
• Instability and increasing change in the shape of the foot (flattening of the arch, deformities).
• In the early stages, Charcot foot is often mistaken for a simple inflammation or infection (e.g. arthritis, cellulitis).

Diagnosis

1. Clinical examination
   • Examination of swelling, temperature difference, redness and malposition.
   • Clarification of whether an infection (e.g. osteomyelitis) or other causes are present.
2. Imaging procedures
   • X-ray: Initially unremarkable, bone resorption, fractures or joint destruction can be recognized in the course of the examination.
   • MRI or scintigraphy: More sensitive in early forms and to differentiate from infections.
3. Laboratory findings
   • Inflammation parameters (CRP, leukocytes) may be normal or only slightly elevated.

Treatment

1. Conservative therapy
   • Immobilization and pressure relief: immobilization (e.g. total contact cast, special footwear) to prevent further damage and enable bone healing.
   • Optimum blood sugar control (for diabetes).
   • Medical foot care (podiatry) to prevent pressure points and injuries.
2. Surgical interventions
   • In advanced cases to correct deformities, stabilize the foot or prevent ulcers and impending amputations.
3. Continuous aftercare
   • Regular medical check-ups, diabetological care and fitting of orthoses or special shoes.

Prognosis and prevention

• A Charcot foot that is detected early and treated well can be stabilized and severe deformities or amputations can often be avoided.
• Good foot care, regular foot examinations (self-checks and by specialists) and stable metabolic control (blood sugar levels) are the most important preventive measures for patients at risk(especially diabetics).

Conclusion: Charcot foot is a dreaded but often preventable complication of neuropathy, especially in the context of diabetes mellitus. Rapid diagnosis, decisive relief and close follow-up care are required in order to reduce serious damage and subsequent costs.