Ischaemic Charcot Foot

Abstract

The usual presentation of Charcot neuropathic osteoarthropathy (CN) is of a hot red swollen foot but later presentations are characterised by deformity and ulceration, which may be complicated by infection. Having reached the stage of significant foot deformity and sometimes ulceration, patients with CN may also have peripheral arterial disease. It is unlikely that significant ischaemia was present at the onset of the CN but in the time interval from onset of the Charcot foot to acquiring deformity, it may have developed. Such patients can occasionally present with rest pain. Also, an association between Charcot foot, diabetic neuropathy, and medial arterial calcification has also been noted. The disease is usually infrapopoliteal but may be also femoro-popliteal. Arterial disease may compromise ulcer healing and surgical and orthopaedic interventions for the Charcot foot and thus all patients with this advanced presentation of CN should be investigated for vascular disease. A limited number of studies show the effectiveness of endovascular treatment in cases with Charcot foot and peripheral arterial disease. In a series of patients with ischaemic foot and also CN, the limb salvage rate was 90% and mean time to healing was 197 days after endovascular treatment. In conclusion, all Charcot foot patients with ulceration and those being considered for surgery should have vascular investigations. If surgery is planned for the Charcot foot, revascularisation, within a multidisciplinary approach, should be considered before surgery for limb preservation.