Bone Disease (Charcot Neuropathy)

As a result of neuropathy, the nerve supply to bones and joints is not normal. From very minor trauma or prolonged walking, small areas of stress can build up in the bone or in a joint leading to a crack or a stress fracture. This is the same type of stress fracture that the athlete develops. However, the patient with diabetes is unable to perceive the pain from the stress injury and walking is continued. The stress crack in the bone now begins to get worse and develops into a fracture. The fracture also gets worse as more walking occurs on the injured foot or ankle. Very significant bone deformities can result from this condition, called Charcot Disease.

The most important aspect of treatment is to limit any weight bearing, walking and loading of the foot and ankle until the bone has healed. The goal of treatment is to prevent severe deformities of the foot from occurring and for the patient to be able to wear a shoe without difficulty. Continued walking with weight bearing can lead to very significant joint destruction and bone deformities. The treatment depends on the severity of the bone deformity at the time of diagnosis. Some cases require surgery immediately and others can be treated in a boot. The use of a boot or cast is important and no weight should be put on the foot until healing occurs. It can take up to a year for the bone to heal and the boot may have to be worn during this healing phase.