THE CHARCCOT FOOT:
ORTHOTIC MANAGEMENT OF NEUROPATHIC ARTHROPATHY
John W. Michael, MEd, CPO/L, FISPO, FAAOP

This presentation begins with a short summary of the many accomplishments of the world’s first neurologist, Jean-Martin Charcot.  The progressive, painless destruction of the joint and bones that he first described in the 1800s is an increasingly common problem for today’s diabetic, with significant morbidity unless it is diagnosed promptly and managed properly.  Mismanagement of the Charcot foot is a significant source of malpractice claims for both physicians and orthotists.

The treatment protocol reviewed is based on the author’s experience at Duke University Medical Center and closely follows the revised Eichenholtz Classification scheme.  Orthotic management differs substantially depending on what stage of the disorder is being treated.  The importance of protection against destructive weight bearing forces that can irrevocably deform the foot is emphasized, along with the need for lifetime protection of the insensate extremity.  Examples of Charcot deformities than cannot be successfully managed by orthoses are also given.

The case example of a 350 pound college professor with bilateral Charcot feet illustrates the treatment principles.  In the Duke experience, more than 90 per cent of those patients whose Charcot disease was managed with orthoses were ambulatory, without ulcers, and did not require amputation at ten-year follow-up.