Patients with neuropathy, most commonly from diabetes, cannot feel their foot and ankle normally. They experience numbness because of nerve damage that makes it difficult for them to know when they damage or injure their bones and joints. Because they cannot feel pain, they continue to walk on the leg which can make their injury progressively worse.
Patients with Charcot disease can present with a red, hot, swollen foot and ankle that on X-ray shows bone fractures and dislocations. These patients are often mistakenly diagnosed with an infection, but if there was never a history of an open wound, Charcot is the most likely diagnosis.
Early diagnosis and aggressive treatment is necessary to maximize leg function and avoid amputation.
Initial treatment usually involves serial total contact casts that are changed frequently to reduce swelling and maintain the shape of the foot and ankle as the bones heal. Often times conservative treatment with casting followed by a custom shoe or brace is all that is needed to achieve a stable foot and ankle. However, if the Charcot heals with excessive deformity, large bony prominences, or recurrent skin ulcers, surgical reconstruction will be necessary to salvage the leg.
Charcot reconstruction can be as simple as removing large bony prominences to avoid pressure on the overlying skin. It can also be very extensive surgery that requires complex bone cuts and joint fusions. Metal hardware is usually required to fix the bones in position while they heal. This is frequently with metal plates and screws, but can also sometimes require an external fixator which is a cage that is applied to the outside of the leg to hold the bones in position and to protect the leg.