Charcot Fractures

This condition refers to fractures, usually foot damage, that occurs because the patient, usually a diabetic, lacks protective sensation, and because they can’t feel pain, walk on their foot or feet to the point where the foot breaks.

The description is also somewhat helpful for understanding:  neuropathic (neuro = nerves, pathic = diseased, dysfunctional) arthropathy (arthro = joints, pathic = diseased, disrupted).

Below are views of normal foot xrays.

When the fractures occur acutely, the foot will appear swollen and warm, and sometimes deformed.  Since the patient has little pain, the process can progress before the patient seeks medical attention.

Often an important issue is to distinguish this problem from infection, since infection would look similar in presentation.

Because the patient lacks protective sensation, they walk on their feet until they literally become fractured, as lack of pain prevents them from knowing they are damaging themselves.  The midfoot disruptions can be seen in the xrays here, with both fractures and dislocations.

With the bone getting ground away, the xray appearance can be confused with osteomyelitis (bone infection), but often is not infected.

When the deformity becomes chronic (long time duration), the patient is often left with a deformity that makes shoewear a challenge, since most shoes are not made to fit this foot.

Although prevention is the best treatment (checking feet daily, using proper shoewear), once Charcot fractures occurs, the options are:

Non surgical: avoid weight bearing, total contact casting

Surgical: removing bony prominences, sometimes repairing the fractures, and sometimes even amputation.

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