The hyperemic phase of the Eichenholtz classification can last for weeks. It should intervene in the acute or chronic Charcot phase. In the acute phase, it is essential to immobilize the foot and restrict the weight load to avoid permanent deformity. In a non-surgical way, this is achieved by ceasing to support the weight using protective devices or devices that do not support any total weight.
Assistive devices, such as crutches and wheelchairs, can help keep you from supporting weight. Full contact splints (TCC) and a walker with controlled ankle movement (CAM) can provide weight-bearing protection. CBT redistributes and reduces pressure on the plantar foot and, at the same time, allows walking. By using these types of protective measures, the foot can heal fractures in a stable position if the tension does not exceed the speed of healing.
The treatment of the Charcot joint is interprofessional; any error in the diagnosis or lack of treatment can lead to the progression of damage and amputation. The goal of treatment is to prevent neuropathic joint progression and prevent amputation. Subsequently, the patient may be asked to limit the weight load. Most of these patients can benefit from an outpatient device.
Full contact (TCC) casts with a walker with controlled ankle movement (CAM) can provide a protected weight load. The splints should be replaced approximately every one to two weeks. The foot should be inspected and the skin temperature measured. Serial simple x-rays should be taken approximately every month during the acute phase.
The molds must be kept in place until the active phase of the Charcot process ends, as demonstrated by the normalization of temperature and radiographic stability. The casting usually lasts three to six months. While cellulitis should be considered in any patient with diabetes, omitting the diagnosis of Charcot foot can be disastrous, as not initiating appropriate treatment of Charcot foot aggravates the problem. Charcot neuropathic osteoarthropathy Lateral and oblique radiographs of the foot showing Charcot's foot of the midfoot.
Once the diagnosis of Charcot foot has been made, patients should be referred to an orthopedist, a podiatrist or a center specialized in diabetic feet for treatment of the acute phase of the process if the primary care physician has no experience treating acute Charcot foot.
