Charcot Deformity

The underlying cause of charcot foot (also commonly called charcot arthropathy or neurogenic arthropathy) is neuropathy. Since patients with neuropathy have a loss of sensation in their feet, they cannot feel the pain that accompanies the breakdown of the bones in their feet (

Charcot is characterized by fractures and dislocation of bones and joints that occur with minimal or no trauma. The earliest sign of charcot deformity is a sudden or unexpected change in the appearance of the foot or ankle.

There is also typically accompanying redness, swelling, and heat.

This deformity most commonly affects the midfoot, but can also affect the hind foot, forefoot, and ankle. We see this deformity in some of our diabetic patients since diabetes causes neuropathy and loss of circulation in the feet. Loss of circulation can lead to resorption of bone, which weakens the bone and increases susceptibility to further fracture and dislocation.

Stages of Charcot Deformity

There are 3 general stages of charcot deformity:

  • Stage 1 is considered the acute stage. In this stage, there is redness, swelling, and warmth in the foot. X-rays may reveal soft tissue swelling. Fractures and joint dislocation may be seen several weeks after the onset of this stage.
  • Stage 2 is the subacute phase. Patients will experience decreased redness, swelling, and warmth, and X-rays will show some early healing of the fractures.
  • Stage 3 is the chronic stage, characterized by reconstruction and consolidation of the bones. A deformity is often present, typically as a collapsed arch with rocker bottom deformity. Redness, swelling, and warmth have resolved.

Severe charcot deformities are typically referred to as a “rocker bottom foot” deformity, and can also be accompanied by an ulcer on the bottom of the midfoot. Ulcers are caused by excessive bony pressures against the shoe or ground.

The goals of treatment are primarily to protect the foot.; typical treatment includes unweighting the foot or distributing pressures over the bottom of the foot to allow healing, as well as to slow or stop the progression of bony breakdown.

In early stages, doctors may recommend total contact casts for 3-5 weeks to prevent micro-fractures from occurring in the bones of the foot. In later stages when the significant deformity is present, doctors may suggest a custom CROW or OWL boot. ( (

Total contact boots that offload the bottom of the foot and prevent excessive motion of the foot and ankle when you are walking, which will slow development of further deformity.

Charcot foot and ankle can recur or flare up over time, and regularly occurs in both feet. Impairment and deformity resulting from charcot foot are permanent. If you have charcot, it is recommended that you use protective footwear or a custom boot any time you are walking or standing, as well as maintain regular follow up appointments with a specialist that can monitor your feet. This will help prevent further breakdown or deformity.