Introduction
Several musculoskeletal conditions can affect bone and associated joint structures. When such conditions develop in vital parts like the foot, it can disable and deteriorate one's quality of life. However, noninvasive and conservative strategies may resolve joint and bone issues. At times, it may completely wreck the joint structure and function, eventually impairing the functional status of the foot. In such cases, to regain the functionality of the foot, surgical options are considered as a final resort. The doctors determine the treatment choice by evaluating the disease type, extent of joint deterioration, patient's general health status, and prognosis.
What Is Charcot Foot?
Charcot foot is an alarming foot condition where the foot structures encompassing the foot joints, bones, and adjoining soft tissues undergo progressive deterioration, disabling the person and compromising the functional status of the involved leg. Injury or harm to the foot nerve is the prime etiological factor that triggers the development of Charcot's foot. Peripheral neuropathy is a neurological condition that deteriorates the nerves in the peripheral parts, like the foot and arms. Peripheral neuropathy is reported to be the leading cause of nerve damage that is potentially paving the way for Charcot's foot. A long-term history of diabetes (elevated or increased blood sugar level) is identified as a risk factor for peripheral neuropathy. Enhanced blood sugar levels gradually impair the blood supply to the nerves in the foot, leading to peripheral neuropathy, which can eventually result in Charcot's foot.
What Are the Clinical Manifestations of Charcot Foot?
The initial manifestations are non-specific, including puffiness, redness, warmth, soreness, or discomfort in the involved leg. As the condition progresses, it manifests fractures in the foot bones, grossly deforming the anatomy and structure of the foot. Rocker bottom fracture is the hallmark feature of Charcot foot, where the foot droops downwards, collapsing the arch. Fractured and fragmented bony parts may get displaced from their actual position, further potentiating the deformity. Displaced bony parts project out, creating sores at the pressure points. These sores may extend and deepen, covering more of the foot's surface, augmented by the enhanced blood sugar level.
Why Are Surgical Corrections Advised for Charcot Foot?
Surgical interventions are not the first line of intervention for Charcot's foot and are preferred only for indicated cases that exhibit resistance to conservative strategies. If non-surgical interventions cannot halt the progression of the condition, the doctors may advise surgical strategies to check further deterioration of the foot structure. Similarly, surgical corrections are undertaken when there is gross structural foot deformity, which conservative approaches cannot rectify. The mal-aligned or displaced bony fragments can be returned to their regular positions, thus restoring the foot structure and functions through surgery. The surgical approaches and techniques for Charcot's foot vary from person to person and are determined by the severity and type of deformity.
What Are the Surgical Interventions Advised for Charcot Foot?
Different surgical approaches are employed for Charcot foot patients. The type of surgical approach may differ from person to person as the structural deformity and the other related comorbidities tend to vary individually. Some of the routinely advised surgical interventions for Charcot's foot include the following:
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Achilles Tendon Lengthening: A fibrous tissue band stretches through the heel and back portion of the foot called the Achilles tendon. Charcot foot tightens or stiffens the Achilles tendon redirecting the weight distribution more toward the front portion of the foot. Added pressure towards the front foot can even result in underfoot ulcers. Achilles tendon lengthening resolves the atypical weight distribution and lessens the added pressure over the front foot. The lengthening of the tendon is achieved with the help of a series of cuts made on the tendon, which allows the tendon to stretch and elongate.
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Exostectomy: Charcot foot deforms the normal structural anatomy of the foot bone. The atypically deformed bone may give rise to sharp, bony protrusions in the foot, which act as pressure points, eventually forming ulcers. These bony bumps in the undersurface of the feet interfere with the even distribution of body weight. Exostectomy is the surgical procedure by which these bony bumps are shaved off to re-establish the weight distribution and facilitate functional restoration. It also checks further ulceration in the bony bump region.
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Arthrodesis: It is a routinely preferred surgical intervention for Charcot's foot with extensive structural foot deformity. Here, the impaired bones that can no longer bear weight are made to join by the arthrodesis technique. It is achieved with the help of mini plates, pins, and screws (fixation devices to hold the bones in close approximation), which ensures stability and makes the condition favorable for the bone to fuse and join. It is often advised as a final resort to get the foot saved from amputation (surgical extraction). The fixation can also be done externally, which is less invasive and facilitates gradual structural realignment. External fixation also reduces the risk of injury or trauma to the associated nerves and blood vessels lying close to the surgically explored area of the foot. Sometimes, internal and external fixation techniques may be used simultaneously to reinforce foot stability through recovery.
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Amputation: It is the final resort for Charcot foot and is advised for only those cases where no other conservative and surgical approaches are fruitful. In amputation, the involved foot is surgically extracted, which is often advised to save the remaining parts of the foot from getting infected and deformed. The level of amputation is often determined by the extent of the foot deformed by Charcot foot condition; accordingly, the technique also varies. Amputation can be distressing and devastating for the patient; therefore, the patients must be made aware of the necessity for this intervention to save their lives. Amputated foot segments can be replaced with prostheses (artificial limbs) that mimic natural limbs in function and structure. It also aids in restoring the functional status of the limb and enhances the quality of life.
Conclusion
Charcot foot is a specific form of foot condition that is often precipitated as a result of diabetes. Foot deformity and deterioration may develop all of a sudden with rapid progression. However, in most instances, desirable treatment outcomes can be obtained with conservative interventions. If the condition fails to elicit a favorable response with conservative strategies, then the concerned doctor may advise for surgical interventions. The surgical approach is determined by considering various patient-related factors like health status, the extent of impairment, and the scope for recovery. Following surgical intervention, the patient should adhere to the post-surgical measures and instructions, which is imperative to ensure the procedure's success.
