Reviewed by Dr Jessica Gunawan, Physician Ignatius Ooi Yong Chin and Physician Kwek Le Yin

Is There More to Charcot Foot Than Meets the Eye?

Published February 2, 2023| 5 min read

Charcot foot weakens the bones and causes fractures. Find out if you're at risk and what can be done to prevent it from happening.

An X-ray scan of a person’s rocker-bottom foot deformity.

If you have diabetes, your doctor will constantly remind you to look after your feet. This is because you have to check for sensitivity issues, including peripheral neuropathy, which can put you at risk of Charcot foot. It’s a rare but severe complication.

Peripheral neuropathy can result from damage to the smaller vessels that supply blood to the nerves, preventing the supply of essential nutrients. It may cause you to lose sensation in your hands, legs, or feet.

Charcot foot can occur with nerve damage in your lower legs and feet. It makes you susceptible to bones breaking or joints dislocating and causes foot deformities when not caught early.

What are the Primary Causes of Charcot Foot Onset?

Medical experts have yet to determine the specific cause of Charcot foot but several risk factors can make you vulnerable to it.

Unrecognised foot sprain or injury

Woman sitting on a stone surface outdoors as she lifts and holds her left ankle with both hands. — Neuropathy can make you oblivious to pain and discomfort, and structural changes to your feet.

Peripheral neuropathy prevents you from experiencing pain or discomfort from foot fractures. Being oblivious to a foot sprain or injury, you might continue to place constant pressure on your foot which can result in a change in bone and joint structure. Without immediate treatment, your foot can become sore or infected, putting you at risk of amputation.

Post-organ transplant complications

If you have undergone an organ transplant, your doctor will prescribe immunosuppressants to lower the chances of organ rejection. However, these drugs can also make you vulnerable to bone density loss or bone fractures.

Body constitution imbalances

Ancient Traditional Chinese Medicine (TCM) literature has no records of diabetic peripheral neuropathy or Charcot foot. But according to Eu Yan Sang Physician Ignatius Ooi, modern Chinese medicine associate both conditions with damage and diabetes mellitus.

“Early-stage diabetes mellitus is the result of internal imbalances such as Kidney, Liver, and Spleen Deficiencies; damage to qi and bodily fluids. If left untreated, you may endure the four stages of disease – Stagnation, Heat, Deficiency, and Damage – before developing peripheral neuropathy.”

TCM physician Ignatius Ooi

TCM physician Kwek Le Yin explains that Blood and Phlegm Stasis and Phlegm-Toxin damage are the cause of peripheral neuropathy and Charcot foot.

“Qi and Yin Deficiencies are common in diabetes mellitus patients, while weakened qi can result in slower blood and water flow, leading to the formation of blood stasis and phlegm. Obstruction from blood stasis and phlegm can result in symptoms of peripheral neuropathy such as numbness and pain, which then lead to the progression of Charcot’s foot. The main TCM mechanism behind peripheral neuropathy is blood stasis and phlegm obstruction.”

TCM Physician Kwek Le Yin

What are the Available Treatment Options for Charcot Foot?

Clinical therapy for Charcot foot has three primary objectives: to alleviate the pressure applied to the foot, address bone disease, and avoid new fractures.

Offloading

Person standing with their right foot in cast walker and left in a black leather loafer. — A removable cast walker must be worn for up to 12 weeks or until the redness, swelling, and heat in the affected area subsides.

Treating Charcot foot requires offloading or relieving any pressure on your foot to prevent further inflammation. Your doctor will need you to wear a cast or a removable cast walker for up to 12 weeks. The cast stays on the foot until redness, swelling, and heat completely subside. In addition, a wheelchair, knee walker, or crutches will ensure you won’t put any weight on the affected foot.

Prescription footwear

Once your cast is removed, your doctor may recommend using orthopaedic footwear. Properly-fitted shoes like a Charcot Restraint Orthotic Walker (CROW) target the pressure points, preventing injury or a recurrence of ulcers.

A healthcare provider may also suggest changes to your daily routine to avoid foot trauma.

Surgery

Your doctor may suggest surgical treatment for severe and unstable ankle and foot deformities. This option may also be considered if your foot prevents you from using orthotics or braces.

Herbal foot bath

A licensed TCM practitioner recommends using a herbal foot bath to treat Charcot foot. The bath serves to:

Promote blood circulation

Correct Kidney and Liver Deficiencies
Warm yang (active energy) and clearing Heat
Detoxify the organ systems and get rid of carbuncles (boil clusters that surround an infected area)

With these herbs, you can prepare a foot bath.

Ingredients:

10gm Earthworm (di long, 地龙)
10gm Cassia twig (gui zhi, 桂枝)

15gm Eucommia bark (du zhong, 杜仲)

3gm Herba Asari (xi xin, 细辛)

15gm Chinese Taxillus herb (sang ji sheng, 桑寄生)

10gm Divaricate Saposhnikovia root (fang feng, 防风)

20gm Himalayan teasel root (xu duan, 续断)

15gm Largeleaf Gentian root (qin jiao, 秦艽)

30gm Sub-erect Spatholobus stem (ji xue teng, 鸡血藤)

15gm Szechwan Lovage Rhizome (chuan xiong, 川芎)

15gm Two-toothed Achyranthes root (niu xi, 牛膝)

Method:

Place these ingredients in a sterile cloth and boil them in four litres of water. Let it cool to 37 to 42°C. Soak your foot in the bath nightly for 20 minutes and up to four weeks. Remove your foot immediately if you feel discomfort.

Doctors say Charcot foot may be difficult to catch in its early stage. If you’ve been diagnosed with diabetes and peripheral neuropathy, look for warning signs of redness and swelling in the foot with increased skin temperature. Make sure to speak to a medical doctor or licensed TCM practitioner for treatment and avoid self-medicating.