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Kidney disease information and advice to help protect your life and limbs.

What is Charcot foot?

Charcot foot is a very serious complication that can develop if you have nerve damage (peripheral neuropathy) in your feet.

Charcot foot can make the bones of your foot become fragile, which means that they may break or dislocate easily, even if you don’t injure them badly. Most patients cannot recall injuring their feet at all. If you have peripheral neuropathy in your feet, you may still be able to walk on your foot after injuring it without feeling any pain. If this happens, your foot can become severely deformed. The shape of your foot will not return to normal, and this can make it very difficult to find shoes that fit properly. It is important that you notice any problem early and get professional help.

Note: Any change to the shape of the foot increases the risk of foot ulcers. Charcot foot with or without foot ulcers is a very seriious risk of heart attacks, strokes, amputation of the foot or leg and early death.

Controlling your cholesterol and blood pressure, quitting smoking, increasing cardiovascular exercise, controlling weight and managing any other conditions you may have (such as diabetes) helps to reduce the risk of these life- and limb-threatening problems.

People with Charcot foot will need to ask their Multi-Disciplinary Team about non-weight-bearing cardiovascular exercise, so as not to risk further harm to the damaged foot.

Note: You may be at further risk of cardiovascular problems if you have a family history of heart disease.

How will I know if I’ve got Charcot foot?

The early signs of Charcot foot are swelling and warmth in the affected area of the foot or ankle. There may be some redness, which is sometimes mistaken for infection. Usually there is no pain (because of nerve damage), but this is not always the case. In most cases only one foot is affected. However, in some rare cases people can develop Charcot foot in both feet, although not at the same time. Your foot may become deformed if you do not get appropriate treatment early enough and you continue to walk on it.

Who will treat my foot?

Ideally, your Charcot foot should be treated and managed by a specialist foot service. This may be made up of a variety of health-care professionals or an individual with experience in treating this condition. Charcot foot can be a very serious condition and can be difficult to diagnose, treat and manage, so it is important that it is treated and managed by experienced health-care professionals. 

What is the aim of my treatment ?

There are two important aims of treating Charcot foot.
- Preventing a permanent change to the shape of your foot
- Preventing future problems

What will the treatment consist of?

The only effective treatment is to reduce the weight on the foot or affected joint and prevent it from moving. This will need to be done with some form of cast (in the same way as if you had broken a bone). If you have diabetes, you will have to wear this cast up to three times longer than someone who does not have diabetes and who has suffered the same injury. The treatment you receive will depend on the method of treatment that your local specialist foot service prefers.

Treatment options

- A plaster cast that your health-care professional will regularly review and change when needed
- A cast walker with a prescription insole that your health-care professional will regularly review
Both of these methods of treating Charcot foot have been proven to be successful, but you will need to closely follow the advice you are given. There are no known types of medication that will improve the condition, only casting and waiting for the process to stop have proved effective.

What other treatment will I get?

- You will need regular appointments with a member of the specialist foot service to check the temperature of your foot.
- You will have an X-ray when needed.
- You may need prescription footwear and insoles supplied by an orthotist or a podiatrist with specialist training in prescribing footwear.
- Prescription footwear can reduce the risk of ulcers, but cannot remove the risk altogether.

How can I help my condition?

You should follow the medical advice you are given. You will need to keep your weight off your foot as much as possible, especially in the early stages, as Charcot foot can be very disabling if it is not treated appropriately.

The following advice will help you manage your condition.

- Keep any other conditions you may have (such as diabetes) under control by following the advice you have been given in the past.
- Keep checking your other foot between appointments with your specialist foot service, following the care and advice you have been given about protecting this foot. Make sure you wear the correct footwear as there will be more pressure on your foot, which could cause a further problem.
- Contact a member of the specialist Podiatry Department if you notice any change or are worried about your treatment in any way.
- You can get advice from your specialist diabetes foot service about weight-bearing, and aids such as crutches, sticks and wheelchairs that can help keep the weight off your foot.

Your specialist foot service is there to support you, help you manage your Charcot foot, offer advice and answer any questions you may have.

When your condition has settled down

Even with the appropriate treatment, there may be some changes in the shape of your foot. You will need to have regular check-ups with a specialist podiatrist and maybe an orthotist or podiatrist with specialist training in prescribing footwear if you need prescription footwear and insoles. In severe cases, corrective surgery may be necessary.

If you smoke, you are strongly advised to stop. Smoking affects your circulation and can increase the risk of amputation.

If you discover any problems with your feet, contact your Multi-disciplinary Foot Care Service, local Podiatry Department or GP for advice immediately. If they are not available, go to your nearest accident and emergency department. Remember, any delay in getting advice or treatment when you have a problem can lead to more serious problems.

Developed by the London Foot Care Strategic Clinical Network and the London Renal Strategic Clinical Network

More foot care information at the links below

Foot Ulcers

Footwear

Holiday feet

The National Kidney Federation cannot accept any responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.