Diabetic (Charcot)
foot reconstruction surgery

Diabetic foot reconstruction
(Charcot foot surgery)

Diabetic foot reconstruction (Charcot foot surgery)

Diabetic foot reconstruction (Charcot foot surgery)

What is Diabetic foot reconstruction (Charcot foot surgery)

If you’ve suffered from diabetes for a long time and you have secondary nerve damage (peripheral neuropathy) in your feet, the bones and joints can become misaligned – a complication known as ‘Charcot’ foot. Around 1 in 100 people who have diabetes develop Charcot foot, but it can also occur with other kinds of peripheral neuropathy.

The combination of high blood pressure, raised blood fats and high blood sugars can damage the very fine blood vessels that supply the nerves in the peripheries, and over time, sensation is impaired or lost – known as peripheral neuropathy.

Charcot affects joints and ligaments and soft tissues of the foot and ankle. Neuropathy means you may not be able to feel if you have damaged your foot or broken a bone, and over time, or acutely, the joints may become misshaped and worn, leading to foot collapse, as well as skin ulceration and severe inflammation.  Toes can become clawed and sometimes the ankle may become unstable. When it is severe, bony prominences can form on the bottom of the foot, giving it a rocker-bottom appearance. This is a serious condition and the increased pressure on the bottom of the foot can lead to ulceration, infection and even amputation. Studies (and my own experience) have shown that patients fear amputation more than death.

How is Charcot foot diagnosed?

Some of the symptoms of Charcot (such as swelling, heat, pain, and redness) can mimic infection, so if you’re experiencing such symptoms, it’s really important you seek urgent medical attention. In the early stages of Charcot foot, X-rays may appear normal, and so expert assessment is needed.

Treatment in the initial stages will often involve off-loading the foot, and protecting it in a cast, as well as optimising a person’s diabetic control, blood pressure and blood fats.

It’s very important that peripheral vascular disease (blood vessel disease) and infection, have been ruled out, or have been effectively managed if you have them.

What is diabetic foot reconstruction surgery?

The first goal of diabetic foot reconstruction surgery is to save your limb (and your life).  It’s also to the correct foot and ankle deformities that are severe or unstable and are likely to cause foot ulceration and infection.

In the case of Charcot foot, the goal is to give you an ulcer and infection free, well aligned foot, that you can safely walk on again, whilst wearing protective footwear.

I will often use a combination of techniques to treat the deformity, which may involve:

Damaged joints in foot and ankle lead to instability and collapsing of the foot. To restore stability, I may recommend fusing several joints in the foot and ankle after realigning them, using screws and plates.

Peripheral neuropathy will often cause tightening of the calf muscles and shortening of the Achilles tendon, which shifts the weight onto the front of the foot. The increased pressure can lead to ulceration, and surgically lengthening the Achilles tendon can help redistribute pressures in the foot and help heal or prevent ulcers forming.

Bony prominences which form when foot joints become damaged are common in Charcot foot and removing/shaving the bony bumps can help to reduce the risk of ulceration and improve weight distribution across the foot.

Comprehensive Diabetic Foot Care

Diabetic foot surgery is challenging, and people with diabetes are more susceptible to infections and healing problems, and as such, it carries a greater risk of complications.

I work closely with the patient’s diabetic team, vascular surgeons, podiatrists and specialist wound nurses when assessing a patient with Charcot foot.

In most cases, the surgery can be done as a single stage reconstruction, but if there is infection, the surgery may need to occur in two or more stages.

My main aim is to prevent the need for amputation, and I’ll do everything I can to save your limb.

You need to be mentally prepared for a treatment journey of six months or longer. You will be in a cast, and non-weight bearing for a long time, as healing will be slow.

As one of the few highly trained surgeons who specialise in complex diabetic foot problems, If you suffering from a Charcot foot problem, are worried about amputation, or are looking for a second opinion, I’m here to help.