Charcot neuroarthropathy

Charcot neuroarthropathy

; Charcot joint disease; neuropathic osteoarthropathy gross distortion of weight-bearing joints secondary to long-term sensory and autonomic neuropathy, abnormal inflammatory and healing responses; early immobilization for a minimum of 12 weeks is essential to minimize joint distortion; typical of diabetes mellitus and tabes dorsalis (syphilis)
  • atrophic Charcot neuroarthopathy; diabetic osteolysis joint destruction characterized by rapid hyperaemic bone resorption (secondary to autonomic neuropathy, abnormal bone blood flow and local periarticular osteopenia) leading to 'pencilling' ('sucked candy stick') of distal metatarsals

  • hypertrophic Charcot neuroarthropathy joint destruction characterized by rapid loss of joint architecture (secondary to pain and proprioception loss and local cortical microfractures) and associated disorganized osseous proliferation (due to abnormal bone-healing response) with resultant foot deformity, often of midtarsal or ankle joints (Table 1and Table 2)

Table 1: Classification of Charcot neuroarthropathy
StageCharacteristics
0Clinical symptoms only: erythema, oedema, increased temperature (>2°c difference)
IDevelopmental: generalized bone demineralization, periarticular fragmentation, loose-body formation, joint dislocation
IICoalescent: organization and healing of fracture fragments, periosteal new bone formation, resorption of bone debris
IIIReconstruction/consolidation: greater definition of bone contours, reconstruction or ankylosis of involved bone
Table 2: Clinical features of hypertrophic Charcot joint disease
VascularNeuropathicSkeletalCutaneous sequelae
Bounding pulses
Erythema
Oedema
Warmth
Lost or reduced: Pain/vibration awareness
Proprioception
Deep tendon reflexes
'Rocker bottom' foot
Midfoot subluxation
Digital contracture
Hypermobility
Hyperkeratosis
Trophic ulceration
Secondary infection
References in periodicals archive ?
Since its introduction in October 2012, DynaNail has been used to address numerous pathologies, including Charcot neuroarthropathy, severe ankle and subtalar osteoarthritis, failed total ankle replacement and nonunion following a previous arthrodesis procedure.
Schon LC, Easley ME, Weinfeld SB: Charcot neuroarthropathy of the foot and ankle.
23 The Operative Treatment of Charcot Neuroarthropathy of the Foot and Ankle (Michael L.