An Evidence-Based Introduction to Charcot Foot Arthropathy

Pé diabético. Parte 2: Neuroartropatia de Charcot

“…4,5,20 Eventually, CN can be triggered by repetitive trauma that causes stress fractures in previously osteopenic bones (neurotrauma theory). 21 In contrast, peripheral arterial vasodilation, due to paralysis of the smooth muscle of the blood vessel wall (autosympathectomy), is directly responsible for the reduction in blood flow velocity, and, apparently, it is involved in the increase in bone resorption rate, thus contributing to the installation of the destructive process of CN (neurovascular theory). 21 Anatomical considerations are important in the diagnosis of CN, as shown by the Brodsky classification 4 modified by Trepman et al 22 (►Table 1).…”

“…The vast majority of patients with CN present symptoms related to pain in the midfoot, as well as edema and erythema. 20,21 However, as in the early acute phase of the disease no noticeable deformity is present yet, many patients are misdiagnosed as having cellulitis, gout, or tenosynovitis. 23 Due to misdiagnosis, many patients are mistakenly treated with antibiotics, corticosteroids or even with surgery indicated for "abscess drainage".…”

“…23 Due to misdiagnosis, many patients are mistakenly treated with antibiotics, corticosteroids or even with surgery indicated for "abscess drainage". 21 In most cases, only when the acute condition subsides and the edema disappears, can the patient, and often the doctor himself, be able to detect the presence of residual deformities already installed in the sequela phase of the disease. 20,21 As many of these deformities are of minor magnitude, it is possible to accommodate the feet in therapeutic shoes suitable for insensitive feet together with specially made insoles.…”

“…21 In most cases, only when the acute condition subsides and the edema disappears, can the patient, and often the doctor himself, be able to detect the presence of residual deformities already installed in the sequela phase of the disease. 20,21 As many of these deformities are of minor magnitude, it is possible to accommodate the feet in therapeutic shoes suitable for insensitive feet together with specially made insoles. 20,21 Some patients, whose protective foot sensitivity is more seriously compromised due to peripheral neuropathy, continue to walk leaning on the foot affected by the destructive process of CN, and this further accelerates osteoarticular deformation.…”

“…20,21 As many of these deformities are of minor magnitude, it is possible to accommodate the feet in therapeutic shoes suitable for insensitive feet together with specially made insoles. 20,21 Some patients, whose protective foot sensitivity is more seriously compromised due to peripheral neuropathy, continue to walk leaning on the foot affected by the destructive process of CN, and this further accelerates osteoarticular deformation. [20][21][22] Approximately 40% of patients with CN arrive at the first medical care already presenting plantar ulcer located under the bony prominence on the midfoot, especially when it is affected, and there is collapse of the lateral plantar arch.…”