Charcot's Arthropathy - The swollen foot

What is it and why is it important ?

Charcot's arthropathy is a complication of diabetic neuropathy. Due to the neuropathy, the bones in the foot become weakened and fractured without major trauma. As the patient notices little pain (a result of the neuropathy), he/she continues to walk on it. This leads to severe deformities of the foot, intractable ulceration, culminating in the need for amputation. It is therefore most important to make the diagnosis early at the acute phase of Charcot's arthropathy because appropriate treatment at this stage can minimise deformities and reduce associated morbidity.

Typical clinical history

Charcot's arthropathy Charcot's arthropathy can affect both people with Type 1 or Type 2 diabetes. In the majority of cases only one foot is affected, however both feet can be affected over a period of years. Diabetes is usually long standing and diabetic neuropathy is always present and quite severe.
Typically, the foot suddenly becomes very swollen and warm to touch . The patient can recall no history of trauma or only a very minor episode (eg. twisted the ankle a few weeks ago). The first clue to the diagnosis is the disproportionate lack of pain. The second clue is the slowness of recovery. (i.e the swelling does not go away).

X-ray at this stage may be normal or show a minor fracture but may already show quite gross bone destruction. To view the X-rays, click on the Technical Info button. Otherwise, click on Next Topic to learn about the management of Charcot's Joints.