Charcot Foot: Causes, Symptoms & Treatment Options

Charcot Foot is a serious and often overlooked condition that can lead to severe deformities, chronic wounds, and even amputation if left untreated. It primarily affects individuals with diabetes and neuropathy, making early detection and proper management crucial for preserving foot health. Understanding the causes, symptoms, and treatment options can help at-risk individuals take proactive steps to prevent complications and maintain mobility.

What is Charcot Foot?

Charcot Foot is a serious and progressive condition that affects the bones, joints, and soft tissues of the foot and ankle, often leading to severe deformities and disability. This disorder occurs most commonly in individuals with peripheral neuropathy, particularly those with diabetes mellitus. Since neuropathy reduces sensation in the feet, people with Charcot Foot may continue walking on an injured foot without realizing the extent of the damage, exacerbating the condition over time.

The hallmark of Charcot Foot is the weakening of bones due to repetitive trauma or injury, which leads to fractures, dislocations, and eventual collapse of the foot’s structure. This can result in a rocker-bottom foot deformity, where the arch of the foot collapses, causing the sole to bulge downward. If left untreated, Charcot Foot can lead to severe disability, chronic ulcers, infections, and even amputation.

Why is Charcot Foot Dangerous?

One of the biggest challenges of Charcot Foot is that it often goes undiagnosed in the early stages. Since the condition primarily affects individuals with nerve damage, many patients do not feel pain, despite significant changes occurring in the foot. The lack of pain allows the condition to progress unnoticed until significant deformity and disability have already set in.

Causes of Charcot Foot

Charcot Foot develops when the bones in the foot weaken due to an underlying medical condition, leading to fractures, joint dislocations, and, eventually, foot deformity. The primary cause of Charcot Foot is peripheral neuropathy, a condition that reduces sensation in the feet, making it difficult to feel pain, pressure, or injury. Without the ability to sense discomfort, individuals continue to walk on an injured foot, worsening the damage over time. Below are the most common causes and risk factors for developing Charcot Foot.

Diabetes and Neuropathy

The most common cause of Charcot Foot is diabetic peripheral neuropathy. Individuals with diabetes are at a higher risk of nerve damage due to prolonged high blood sugar levels, which affect blood circulation and nerve function in the feet.

• The foot loses protective sensation, meaning minor injuries go unnoticed.
• The body’s normal response to trauma, pain, and swelling is diminished and allows damage to progress unchecked.
• The weakened bones become prone to fractures and micro-injuries.
• The lack of awareness causes individuals to continue walking on an unstable foot, leading to joint dislocations, bone collapse, and deformity.

Trauma and Repetitive Stress Injuries

Charcot Foot can also be triggered by minor trauma, which can include:

• A small fracture or sprain that goes unnoticed due to neuropathy
• Repeated stress injuries from walking or standing for long periods
• Foot surgery or previous fractures that weaken bone structure
• Blunt trauma, such as stubbing the toe or dropping a heavy object on the foot

Peripheral Vascular Disease and Poor Circulation

Poor blood flow to the feet, commonly seen in individuals with peripheral artery disease (PAD), can also contribute to Charcot Foot. When circulation is compromised:

• The bones and tissues in the foot receive less oxygen and nutrients, making them weaker.
• Healing slows down, meaning small injuries can take longer to recover or may not heal at all.
• Weakened blood vessels make it harder for the body to fight infections, increasing the risk of ulcers and complications.

Charcot Foot Symptoms

Charcot Foot often begins subtly, making early detection challenging, especially for individuals with diabetes and peripheral neuropathy, who may not feel pain in their feet. The condition can rapidly progress if left untreated, leading to severe deformities, chronic ulcers, infections, and even amputation. Recognizing the early warning signs of Charcot Foot is crucial for preventing irreversible damage.

Early Symptoms of Charcot Foot

In the initial stages, Charcot Foot may mimic other conditions, such as an infection or a simple sprain, making diagnosis difficult. The most common early warning signs include:

• Swelling: One foot may appear noticeably larger or puffier than the other, even without a history of injury.
• Redness: The affected foot may have an inflamed appearance, resembling an infection.
• Warmth: The foot often feels significantly warmer than the other due to increased blood flow from inflammation.
• Mild discomfort or aching: Some individuals experience dull pain, while others with severe neuropathy feel nothing at all.
• Increased joint instability: Weakening bones and ligaments can cause the foot and ankle to feel wobbly or unsteady.

Progressing Symptoms and Structural Changes

If left undiagnosed and untreated, Charcot Foot advances to more severe stages, leading to:

• Foot shape changes: The arch collapses, creating a “rocker-bottom” deformity where the middle of the foot bulges downward.
• Bone fractures and joint dislocations: The bones become weak and prone to breaks and misalignment.
• Unstable or misaligned toes: Toes may curl, shift, or appear misshapen due to pressure from the collapsing foot structure.
• Skin breakdown and ulcers: Abnormal foot pressure points increase the risk of wounds that may not heal properly.

Risk Factors

Charcot Foot is a serious and progressive condition that primarily affects individuals with neuropathy, but not everyone with nerve damage will develop it. Certain risk factors significantly increase a person’s likelihood of experiencing bone weakening, fractures, and foot deformities. Understanding these risk factors can help prevent complications by promoting early detection and proactive foot care.

Diabetes

The vast majority of Charcot Foot cases occur in individuals with diabetes-related neuropathy. High blood sugar levels, over time, damage nerves, reducing sensation in the feet.

Previous Foot Injuries or Surgery

Any trauma to the foot—even minor injuries like sprains, fractures, or foot surgery—can trigger the development of Charcot Foot, particularly in individuals with nerve damage. Since neuropathy masks pain, patients may continue walking on an injured foot, causing further damage.

Peripheral Artery Disease (PAD)

Peripheral artery disease (PAD) is a condition where narrowed blood vessels reduce circulation to the feet. This contributes to bone weakness and slower healing, increasing the risk of Charcot Foot.

Diagnosis of Charcot Foot

Charcot Foot can be difficult to diagnose in its early stages, as its symptoms often mimic other foot conditions like infections, sprains, or simple swelling. Because early detection is crucial in preventing severe deformities, individuals at risk, especially those with diabetes and neuropathy, should seek immediate evaluation if they notice unexplained swelling, redness, or warmth in the foot.

Podiatrists use a combination of clinical examinations, imaging tests, and patient history to confirm a Charcot Foot diagnosis.

Physical Examination

A podiatrist will begin by assessing the affected foot for:

• Swelling and redness (often in one foot)
• Increased warmth compared to the other foot
• Joint instability or abnormal foot shape

Patient History

The doctor will ask about:

• Any history of foot trauma or fractures
• Diabetes management and history of neuropathy
• Previous ulcers, infections, or foot deformities

Imaging Tests

Since early-stage Charcot Foot may not appear on standard X-rays, multiple imaging tests may be required to identify bone changes, fractures, and joint misalignments.

Treatment Options for Charcot Foot

The goal of Charcot Foot treatment is to prevent further bone damage, stabilize the foot, and preserve mobility. Since Charcot Foot can progress rapidly, early intervention is essential to avoid severe deformities, chronic ulcers, infections, and potential amputation. Treatment varies based on the severity of the condition, but it typically involves immobilization, custom orthotics, and long-term foot management.

Non-Surgical Treatment Approaches

For most individuals diagnosed in the early stages, non-surgical treatments can help stabilize the foot and prevent progression.

• Total Contact Casting (TCC) – A specially designed cast that protects the foot while redistributing pressure evenly. It is worn continuously for 8–12 weeks or longer, depending on the severity of the condition.
• Removable Walking Boots – In some cases, a controlled ankle movement (CAM) walker boot may be recommended after the initial immobilization period.
• Wheelchair or Crutches – To fully relieve pressure on the foot, patients may need assistive devices to avoid bearing weight during healing.

Custom Orthotics and Bracing

Once the acute inflammatory phase resolves and bones have partially healed, custom footwear and bracing are necessary to:

• Prevent further foot injuries
• Distribute pressure evenly across the foot
• Accommodate any existing deformities

When Surgery May Be Considered

While most cases can be managed non-surgically, surgery may be necessary if:

• The foot becomes severely deformed, making walking difficult
• Recurrent ulcers or infections develop due to foot misalignment
• The foot remains unstable despite bracing and footwear modifications

Surgical procedures may involve bone realignment, fusion, or, in extreme cases, amputation if infections become life-threatening.

People Also Ask

How Long Does It Take for Charcot Foot to Heal?

• Charcot Foot typically takes 3 to 6 months to heal with proper immobilization, but severe cases may take up to a year.

Can Charcot Foot Be Reversed?

• Charcot Foot cannot be reversed, but early treatment can prevent further damage and help stabilize the foot.

What Happens If Charcot Foot Is Left Untreated?

• If left untreated, Charcot Foot can lead to severe deformities, chronic ulcers, infections, loss of mobility, and in extreme cases, amputation.

Charcot Foot Treatment at Red Mountain Footcare

Charcot Foot is a serious condition that requires early detection and proper management to prevent severe deformities and mobility loss. If you have diabetes, neuropathy, or unexplained foot swelling, seeking prompt podiatric care can help protect your foot health and prevent complications. With specialized treatment, custom orthotics, and ongoing monitoring, many patients can maintain stability and avoid more invasive interventions. If you’re experiencing symptoms or are at risk for Charcot Foot, schedule an appointment with Red Mountain Footcare in Mesa, AZ today for expert evaluation and personalized care.