A patient with a chronic Charcot foot has the typical “rocker bottom foot” with a noninfected neuropathic ulcer on the bottom of the midfoot resulting from increased pressure from ambulation. There is increased hyperkeratotic skin seen around the ulcer from walking.
Charcot neuroarthropathy most often affects persons with diabetes. Misdiagnosing or overlooking the disorder is easy because the initial signs often are subtle and misinterpreted. The consequences include ulceration, infection, loss of mobility and limb, and an early demise.
The main reason why clinicians do not recognize Charcot neuroarthropathy is that the clinical presentation often is similar to that of more common conditions, such as cellulitis and osteomyelitis, both of which are well documented among patients with diabetes.
Early diagnosis of Charcot foot is critical to preventing the long-term consequences. Charcot neuroarthropathy should be considered in all patients with diabetes who have peripheral neuroarthropathy and present with leg or foot edema, erythema, and increased skin temperature.
Case and photo courtesy of Jackie Pham, PMS-IV, Bora Rhim, DPM, and Jonathan Labovitz, DPM