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This leaflet has been produced to give you general information about Diabetic Charcot foot and how to manage it. Diabetic Charcot Foot is also called DCF. This is a complication of diabetes which is very rare, affecting less than 1% of the Diabetic population.
We hope that this leaflet will help in addressing all your questions, but is not replacing the discussion you will have with the healthcare professional. If after reading this leaflet you have still some questions or queries please ask one of the Diabetic Foot Team Professionals.
In DCF the bones in the feet are fragile and soft, causing them to break (fracture) easily. These fractures usually occur in the middle of your foot, and are often painless and go unrecognised. As a result you will continue with your everyday activities, which causes more stress on the weak bone. This produces deformity in the foot and eventually a loss of the arch of the foot.
The usual symptoms include:
Pain is not a common symptom
Your doctor or your Specialist Podiatrist will make a diagnosis based on the above symptoms. They will also measure the temperature difference between your feet. A difference of more than two degrees is considered to be a significant sign of DCF.
X rays can be used to diagnose DCF and monitor progress. In some cases we use MRI scan imaging to aid with the diagnosis if it is not obvious.
Treatment must start as soon as possible and should not be delayed.
As the bones are weak, they need to be protected in a full plaster cast. This is called a TCC: Total Contact Cast. This cast needs to be changed weekly to accommodate the reduction in swelling. This prevents you from moving your foot, allowing the bones to heal and repair and minimise deformity.
The cast will help to take pressure off your foot and will provide a better environment for wound healing.
The cast also stops you from moving your foot. You may also need to wear a cast if you have an active Charcot joint to prevent severe foot deformity or if you have a fracture.
If you experience any of the following symptoms, contact your podiatry team or the plaster room immediately by phone (see contact details below).
Ensure the cast is kept dry at all times. It is possible to purchase or request a cast cover from your GP such as ‘Limbo’ or ‘Bloc’ which can be used when bathing. DO NOT put anything inside the cast. DO NOT try and apply creams / talc to the casted leg / foot.
If you notice any cracks, breaks, strike through, softened areas in the cast or if the cast gets wet: please contact the podiatry team immediately.
This is an important part of the treatment and the cast will help take pressure off the foot.
This is essential in order to protect the bones and prevent further deformity in the plaster cast. You will not be allowed to put weight on your foot until it is safe to do so.
Walking and support aids
During this period, as you are not allowed to put weight on your foot, you may have to be fitted with a stirrup on the bottom of your plaster cast (which you can put weight on), or you may need walking aids like crutches or a wheelchair to manage.
The aim of treatment for DCF is to:
This treatment can take from 18 months to two years in the cast. The TCC is removed once the bones show signs of healing and are strong enough to take your body weight.
As this process occurs in patients who are neuropathic, pain is not a common feature, but is usually managed with simple over the counter medication. However, if this is not enough, GPs can prescribe stronger pain relief.
Once this treatment cycle is complete, you will be given a walking boot to wear. Eventually you should be able to go back to normal footwear. Occasionally, if your foot has developed a deformity, you may have to wear bespoke, custom made shoes. If this is not possible, and the deformity is unstable, surgery may be considered.
Yes. There are some day to day activities that you cannot do while you are wearing a TCC.
It is important not to walk any more than is essential. This will shorten the healing time and will help to prevent deformity.
We would also advise that you get help with tasks around the house when possible. For example you may want to consider doing your shopping online. If you have a job that requires you to be on your feet a lot, alert your workplace of your new requirements (your doctor or GP can provide you with a medical sick certificate).
If you have an automatic you will only be able to drive provided your left leg is in the cast but if you have a manual car then you can only return to driving after the cast is removed. This can in some cases be after 2 years.
Follow up will be on a regular basis with your podiatrist. Your cast will require changing weekly so that we can assess your skin condition. Please allow a period of approximately one and a half hours for the cast application and cast drying time when you have your cast review appointment.
Yes it can. It sometimes flares up again within a year or so of apparent healing, but this may be because it was never properly healed in the first place. On the other hand, DCF may affect the other foot: this happens to about one in five people.
So you must be vigilant about seeking medical advice if you develop any redness, swelling or heat in your feet along with new changes to the shape of your feet.
You do this by:
Although you consent to this treatment, you may at any time after that withdraw such consent. Please discuss with your medical team.
If you experience illness or any major problems with the cast out of normal podiatry clinic hours please attend your nearest Emergency Department and show them this advice leaflet.
Podiatry Clinic Royal Sussex County Hospital.Telephone 01273 696955, extension 64204
Podiatry Clinic Princess Royal Hospital. Telephone 01444 441881, extension 68274
Plaster room Royal Sussex County Hospital. Telephone 01273 696955, extension 4241
Plaster room Princess Royal Hospital. Telephone 01444 441881, extension 8356
This leaflet is intended for patients receiving care in Brighton & Hove or Haywards Heath.
The information in this leaflet is for guidance purposes only and is in no way intended to replace professional clinical advice by a qualified practitioner.
Publication Date: November 2021
Review Date: August 2024