Charcot Fractures (Neuropathic Arthropathy)

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.

In this xray looking at the top of the foot, the disruption of the midfoot can clearly be seen, and mimics the xray appearance of an infection, but this problem is not due to infection.

In the xray below from a different patient, the disruption of the normal bony anatomy of the arch is clearly evident

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.

Often, due to maldistribution of pressure, an ulcer, or breakdown of the skin, can result.  Due to the lack of protective sensation and this opening in the skin, ulceration can often have grave consequences since infection can enter the foot tissues.

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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