Although from time to time I read in defence to Clinical Negligence Claims that Charcot’s foot (or Charcot Arthropathy) is a rare condition, it is one we encounter all the time.
I am currently acting for 2 people who suffered catastrophic delays in diagnosis because doctors failed to recognise it. It may be uncommon but it should be well-known particularly to doctors treating Diabetics.
Diabetes can lead to changes in the sensation so that patients do not necessarily know when they have injured their feet. At the same time it damages blood supply to the feet making it harder for these injuries to heal. Where patients are walking on damaged feet the bones can gradually collapse without the patient feeling pain and realising anything is wrong. Where doctors are not alive to this condition it can be allowed to deteriorate to the point where the patient suffers permanent disability and in some cases Amputations.
It is therefore important to recognise it early and NICE Guidelines require GPs encountering diabetic patients with foot problems (particularly swollen, discoloured or ulcerated feet) to refer them urgently to a specialist diabetic foot clinic. Often the signs are swelling in one foot only, redness and heat. During the early stages there is often little to be seen on x-ray.
Treatment involves immobilisation in plaster and off-loading the foot until the condition has settled. Surgery may be necessary if there is a fracture. The foot will then probably require lifelong surveillance and good foot care.
GPs, orthopaedic surgeons, general physicians and specialists in diabetes should all be able to recognise Charcot’s Foot. Sadly in several of my cases they have failed to do so. Getting it wrong can be disastrous. Some of my clients have been left with mis-shapen feet and find it very difficult to walk. Others have had amputations. All have real disability.
Given that Diabetes is on the increase - some studies suggest cases of Diabetes may double in the next 10 years – Charcot’s Foot is likely to be encountered more often in practice. It is therefore important that doctors are alive to it to avoid more cases where patients have become seriously disabled because the diagnosis has been missed.
Clinical Negligence Solicitor Paul Sankey.