1. Foot Architecture

The foot consists of 26 bones organized into three arches:

• Medial longitudinal arch
• Lateral longitudinal arch
• Transverse arch

Key joints include:

• Midfoot joints (talonavicular, calcaneocuboid)
• Hindfoot joints (subtalar, ankle)
• Forefoot joints (metatarsophalangeal, interphalangeal)

2. Neurological Structure

Peripheral nerves of the foot include:

• Tibial nerve (sensory and motor)
• Peroneal nerve (sensory and motor)
• Plantar nerves (sensory to sole)

Autonomic nerves control:

• Blood vessel tone
• Sweating
• Skin moisture

3. Vascular Supply

Blood supply to the foot comes from:

• Posterior tibial artery
• Dorsalis pedis artery
• Peroneal artery

The "Neurotraumatic" theory suggests that:

1. Sensory neuropathy eliminates protective pain sensation
2. Motor neuropathy causes muscle imbalance
3. Autonomic neuropathy reduces blood flow and skin integrity
4. Repeated minor trauma leads to joint damage
5. Normal healing is impaired

Peripheral Neuropathy:

The underlying cause is loss of protective sensation, most commonly from:

• Diabetes mellitus (most common cause)
• Alcoholic neuropathy
• Syphilis
• Leprosy
• Hereditary neuropathy
• Spinal cord disorders

Metabolic:

• Poor glycemic control
• Duration of diabetes
• Hyperuricemia

Mechanical:

• Foot deformities
• Previous ulceration
• Abnormal gait

Vascular:

• Peripheral arterial disease
• Autonomic dysfunction

• Diabetes duration > 10 years
• Age > 60 years
• Male sex
• Family history
• Genetic predisposition

• Poor glycemic control
• Smoking
• Alcohol consumption
• Obesity
• Foot trauma
• Inappropriate footwear

Acute Phase (Active Charcot):

• Sudden onset swelling of foot/ankle
• Redness and warmth (may mimic infection)
• Mild to moderate pain (often less than expected)
• Increased temperature of affected foot
• Often misdiagnosed as infection or gout

Chronic Phase:

• Established foot deformity
• Arch collapse ("rocker-bottom" foot)
• Prominent midfoot bump
• Ulceration at pressure points
• Ankle instability

Key Questions:

1. Diabetes History: How long? How well controlled?
2. Neuropathy Symptoms: Numbness, tingling, burning?
3. Onset: When did swelling/start?
4. Pain: How much pain? Does it match findings?
5. Trauma: Any recent injury?
6. Previous Foot Problems: Ulcers, deformities?
7. Foot Care: Inspections, footwear?

Inspection:

• Swelling and redness
• Deformity
• Skin changes
• Ulcers

Palpation:

• Temperature difference
• Pulses
• Tenderness
• Joint instability

Neurological Assessment:

• Monofilament testing
• Vibration sense
• Deep tendon reflexes

X-Ray:

• Initial imaging of choice
• Shows bone fragmentation
• Assesses joint destruction
• Monitors progression

MRI:

• Assesses soft tissues
• Rules out infection
• Evaluates extent of damage

CT:

• Detailed bone assessment
• Pre-surgical planning

• Blood glucose
• HbA1c
• Inflammatory markers (ESR, CRP)
• Complete blood count

• Fever
• Significant pain
• Elevated white blood cell count
• Single foot involvement

1. Immobilization:

• Total contact cast
• Removable walker boot
• Strict non-weight bearing initially

2. Off-Loading:

• Crutches or wheelchair
• Limited ambulation

3. Medical Management:

• Bisphosphonates (some evidence)
• Calcitonin
• Pain management

1. Custom Orthotics:

• Accommodation of deformity
• Pressure redistribution
• Custom footwear

2. Surgical Intervention:

• Exostectomy (bone removal)
• Arthrodesis (joint fusion)
• Osteotomy (bone realignment)
• Amputation (if necessary)

Supportive Treatment:

• Symphytum: Bone healing
• Arnica montana: Trauma, swelling
• Hypericum: Nerve pain
• Calcaria carbonica: Tissue weakness

Constitutional:

• Individualized treatment
• Addresses underlying susceptibility

Approach:

• Vata-pacifying treatments
• Nerve-nourishing herbs (Ashwagandha, Bala)
• Improved circulation
• Diabetes management

Acute Phase:

• Gentle range of motion when appropriate
• Education on off-loading
• Gait training with assistive devices

Chronic Phase:

• Strengthening
• Balance training
• Proprioception exercises

Supportive Nutrients:

• B vitamins (especially B12)
• Vitamin D
• Calcium
• Magnesium

• Daily foot inspection
• Proper footwear
• Blood sugar control
• Avoid walking barefoot

• Always wear shoes
• Check inside shoes for objects
• Avoid walking long distances

• New swelling
• Increased warmth
• New pain
• Skin changes
• Ulcer development

• Maintain good blood sugar levels
• Regular HbA1c monitoring
• Follow diabetes management plan

• Daily inspection
• Proper nail care
• Moisturize dry skin
• Avoid heating pads/hot water

• Diabetic footwear
• Custom orthotics
• No tight shoes
• Good fit

• Annual foot exams
• More frequent if at risk
• Prompt evaluation of changes

• Early treatment leads to better outcomes
• Without treatment, progressive deformity
• Risk of ulceration and amputation
• Lifelong management required

• Stage at diagnosis
• Compliance with treatment
• Glycemic control
• Presence of complications

Charcot foot is caused by peripheral neuropathy (usually from diabetes) that leads to loss of protective sensation. Without feeling pain, patients continue to walk on damaged joints, causing progressive destruction.

Treatment involves immobilization and off-loading during the active phase, followed by custom footwear and lifelong management. Surgery may be needed for severe deformities.

Prevention focuses on good diabetes control, daily foot inspection, appropriate footwear, and regular foot exams. Early detection leads to better outcomes.

With proper treatment, most patients keep their foot. However, severe cases with chronic ulcers or infection may require amputation. Early intervention is crucial.

Last Updated: March 2026 Content Author: Healers Clinic Medical Team Medical Disclaimer: This content is for educational purposes only.