Midfoot Charcot

Midfoot Charcot Foot from Diabetes

What is Charcot foot?

Midfoot Charcot is a condition caused by diabetic peripheral neuropathy.
Because sensation is reduced, the bones and joints of the foot become weak and can fracture or collapse without the patient realising.

It usually occurs in people with longstanding or poorly controlled diabetes.

The condition is serious but treatable if recognised early.

How do patients present?

Early stage (most common)

• Sudden swelling of one foot
• Foot feels warm or hot
• Usually little or no pain
• Often follows a minor injury
• Temperature difference >2°C compared to the other foot

This is frequently mistaken for infection, sprain or gout.

Ulcer stage (less common first presentation)

• Ulcer on the sole of the midfoot
• Often occurs in patients already known to have a changed foot shape
• May develop suddenly after the arch collapses

Investigations

• Weight-bearing X-rays: main test to confirm bone collapse or instability
• MRI scan: required if there is an ulcer to detect bone infection (osteomyelitis)

Treatment

Early stage (no ulcer)

Initial treatment is non-operative and urgent:

• Non-removable plaster cast or protective boot
• Weekly clinic review
• Monitoring swelling and skin temperature
• Strict protection of the foot from walking without support

An additional procedure such as Achilles tendon lengthening may be performed early to reduce pressure and inflammation.

Early treatment prevents deformity.

Ulcer stage

If ulceration develops, surgery is usually required.

Treatment depends on:

• Presence of infection
• Amount of bone involved
• Stability of the foot

Surgery may include:

• Removal of infected bone
• Realignment of the foot
• Internal fixation (plates/screws)
• Sometimes a circular external frame to protect healing

Why early diagnosis matters

Untreated Charcot foot leads to:

• Severe foot deformity
• Recurrent ulcers
• Infection
• Possible amputation

Early casting treatment can prevent these complications.

Important advice for patients

If you have diabetes and notice:

• A warm swollen foot
• Redness without significant pain

Seek urgent medical attention immediately — do not continue walking on it.