CROW - Charcot Restraint Orthotic Walker

What is a CROW?

The Charcot Restraint Orthotic Walker, or CROW, is a rigid boot designed to accommodate and support a foot with Charcot

CROW showing the hard plastic shell and the Velcro fasteners.​

neuroarthropathy (CN). The CROW consists of a fully enclosed ankle/foot orthotic with a rocker-bottom sole. It is a common treatment used after acute CN has calmed down to minimize further deformity and prevent ulcer development.

What is Charcot deformity?

CN occurs when bones and joints in the foot fracture, break up or pop out of place with minimal or no known direct injury. In the United States, this deformity is most commonly seen in people with diabetes. The foot first enters an acute stage of swelling, warmth, and redness that can be mistaken for infection. These symptoms eventually diminish by limiting mobility and weight placed on the foot. Broken bones and dislocations can occur, causing severe deformities of the foot and ankle. Some patients develop pain or ulcers when the affected foot becomes deformed. CN can affect the other foot or happen again in the same foot. The foot does not regain its normal shape. (See Charcot Arthropathy for more information.)

What is a CROW made of?

The boot is custom made for each patient’s foot. The outer shell consists of two plastic or fiberglass clamshell pieces that fit and are strapped together with Velcro. It is sturdy and can prevent other bones from cracking or breaking and can be walked on. The bottom of the boot has a rounded rocker-bottom shape. The boot contains a custom, removable foam insole. Each insole is adjusted to distribute weight equally and also to support the ankle joint.

What does the boot do?

The CROW functions by providing even support to the entire foot, especially to areas that are overstressed due to the CN. CN deformities often cause the foot to bend out of shape. The resulting stress on the foot, in these prominent areas in particular, can cause ulcers that can develop into severe infections if left untreated. By distributing pressure equally throughout the leg and foot, the CROW removes excessive forces and gives the foot time to heal. It is easier to use than a cast, can be removed for wound care and washing, and is more durable.

Which patients can use the CROW?

Patients with acute CN can begin using the CROW after the swelling has receded. It can take months for the swelling to go down. Patients with mild to moderate CN deformities will benefit most from the CROW. Patients with severe CN deformities or extreme foot/ankle instability may need surgery instead of using the CROW.

How does it affect daily life?

Fortunately, the CROW is adaptable to daily life. Because of the clamshell design, the patient can easily remove the boot in order to keep the foot clean and sleep better. In addition, its fitted shape and good support allow people to return to walking, standing and driving more normally.

What are typical outcomes?

The most important outcome is that patients are able to continue to bear weight while minimizing pressure and giving the foot a chance to heal. Healing may require many months. However, CN may return and/or affect the other foot, so regular and lifelong monitoring of the condition is necessary.

What are the possible complications?

Despite the sturdiness of the boot and the distribution of forces, the bones of the foot could still break down further. The foot could develop open sores, though the boot is designed to prevent this. As always with Charcot deformity, some joints may heal incorrectly or not at all. Unfortunately, other factors such as poor glucose control, bad nutrition, obesity, and chronic swelling can prevent healing despite use of a CROW.

Frequently Asked Questions

What options do I have when my foot is still swollen?
Patients often wear special casts until their feet stop swelling enough for them to use a CROW. The cast serves to stabilize the foot and prevent unstable motion, similar to the CROW. However, unlike the CROW, these casts cannot be removed at home.

I am a diabetic. What can I do to prevent getting Charcot Neuroarthropathy?
Unfortunately, any individual who developes neuroarthropathy can develop CN. Good long-term glucose control maintaining close to a normal HgA1c, as well as maintaining an appropriate weight will markedly reduce the risk of developing CN.

The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images, and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find a Surgeon" search to locate a foot and ankle orthopaedic surgeon in your area.