Muscle strength in the feet and legs or a person without sensation is usually decreased as part of the disease process. This loss leads to a muscle imbalance affecting how a person walks and the way the foot functions. The foot will strike the ground harder during walking, resulting in greater impact to the bones and joints, causing greater and more frequent injury. Twists or sprains of the foot and ankle are more common, and even though there is significant injury, the person without sensation will continue to use the foot.

Another complication occurring with the insensate foot is a loss of muscle tone in the blood vessels supplying blood to the feet.

This results in increased blood flow which can remove some of the minerals which normally keep bones strong. Weakened bones are more likely to break when stressed.

What Does This Mean to you as a Person With An Insensate Foot?
In the insensate foot, pain that would warn a person with normal sensation of injury is not present. You need to be aware of other signs that an injury has occurred. If a bone is broken or a Charcot joint has occurred, you will have one or all of the following signs:

• Swelling (mild or great).
• An increase in skin temperature in the area.
• Redness in the area.
• A lack of sweating resulting in dryness of the skin over the area.

Some patients wait until a fifth sign appears... Destruction and Structural change (the foot appears shorter and wider). An untreated Charcot foot develops a "rocker bottom" shape much like a rocker on a rocking chair. The arch of the foot collapses and joints are destroyed.

TREATMENT
The best treatment is prevention:

• Insensate feet need special attention, visit your doctor regularly.
• Insensate feet need support, protection and cushioning to help prevent fractures and movement of the bones. This includes special footwear, extra depth shoes, molded insoles, special custom made shoes.
• Inspect your feet daily.

If prevention fails and the signs of charcot joints appear, seek medical attention IMMEDIATELY to determine the severity. If a fracture has occurred, healing will include protecting the foot from further injury. Forms of protection may involve any of the following:

• Casts
• Wheelchair
• Crutches
• Bed rest

Sometimes joint destruction is severe enough to result in a permanently misshapen foot with bony bumps or prominences. This condition will always require special shoes. Sometimes surgery to fuse broken joints or remove bony prominences may be necessary.

CHARCOT JOINTS - WHAT IS IT?
In the late 1800's, a French physician, Dr. J.M. Charcot, first described the destructive changes in the joints of people with decreased feeling in their legs and feet. Today the term Charcot joint is used to refer to any joint in the insensate foot that is destroyed or dislocated. The term Charcot foot is used to refer to a foot with many Charcot joints and which has actually changed shape.

There is usually not a single event or major injury to the insensate foot which causes fractures or destruction of the joints, but an accumulation of many small injuries which result in Charcot joints or a Charcot foot.

• Loss of protective sensation.
• Activities or conditions which put increase stress on the feet.
• Shoes which do not provide support.