Charcot neuroarthropathy in diabetes mellitus

Abstract

Charcot neuroarthropathy has been recognised for over 130 years and yet it remains a major cause of morbidity for patients with diabetes mellitus and a continuing challenge for physicians. It is rare but it seems to be increasing in prevalence and this provides hope that with larger studies it will soon be possible to clarify the natural history and optimal treatment regimens. The underlying cause is thought to be trauma in a neuropathic foot that leads to a complex series of pathological processes culminating in bone and joint destruction and subsequent deformity. The acute reaction is often misdiagnosed and many patients present late with established deformity. Even when the diagnosis is considered at an early stage there are no definitive criteria or tests to confirm charcot neuroarthropathy and a high index of suspicion is necessary in any diabetic patient with a swollen warm foot in the presence of somatic or autonomic neuropathy. Treatment has traditionally involved the use of various methods to avoid weight bearing but recent work has begun to suggest that bisphosphonates might be able to arrest the acute process. In the long term, treatment involves a multidisciplinary approach aimed at providing appropriate footwear to reduce plantar pressures and avoid foot ulceration; in some circumstances this involves surgical correction of deformities before adequate footwear can be supplied. Further studies of the emerging treatments for Charcot neuroarthropathy are needed to provide long-term outcome data on morbidity and deformity.

Assessment of technical and biological parameters of volumetric quantitative computed tomography of the foot: a phantom study

“…NCA is characterized by a swollen, temperature-elevated foot, with an accompanying fracture or dislocation of one or more pedal bones [2]. Though the pathogenesis of NCA is incompletely understood, it is generally believed that distal symmetrical polyneuropathy leads to a poorly regulated blood flow and bone resorption, which places a foot at risk for an acute Charcot event [3]. Pedal bone osteopenia, as characterized by low bone mineral density (BMD) of one or more foot bones in the presence of DM+PN, may well be the earliest sign of the onset of NCA.…”

Charcot stage 0: A review and consideratons for making the correct diagnosis early

“…of Cases (No. of Feet)Reported IncidenceSinha et al 1971 [55]101 (N/A)0.1 %Cofield et al 1983 [56]96 (116)7.5–29 %Sella et al 1999 [7]40 (51)5 %Fabrin and Holstein 2000 [13]115 (140)0.3 %/yearSanders et al 2001 [57]N/A0.1–7.5 %Rajbhandari 2002 [58]N/A0.1–0.4 %Hartemann-Heurtier et al 2002 [59]N/A0.2–3 %Lavery et al 2003 [14]N/A0.0085 %/yearAdapted from Frykberg, R and Belczyk, R [17]. A brief review of the literature demonstrating the relative low incidence of CN in the overall population.…”

Diabetic neuroosteoarthropathy: the modern approaches for diagnosis and immobilization period determination (review)

“…Исследования показали, что наиболее распространенными являются типы II и III, приблизительно 45% случаев приходятся на тип II и 35% -на тип III [4]. Данная классификация удобна для оценки тяжести поражения и прогноза: из-за рас-пределения веса во время ходьбы пораже-ние передних отделов стопы имеет более благоприятный прогноз, в то время как за-дние отделы затрагиваются намного реже, но чаще приводят к выраженным деформа-циям [13].…”

“…Характерные рентге-нологические признаки острой ДНОАП вклю-чают в себя фрагментацию и дислокацию фрагментов субхондральной кости, пере ло-мы, вывихи, подвывихи, остеопению и остео-лиз [18][19][20]. Однако такие начальные изме-нения, как скрытые переломы и отек костно-го мозга (ОКМ), рентгенография определить не позволяет, помимо этого чувствитель-ность и специфичность метода при ДНОАП низки (менее 50%) [13,21,22]. Компьютерная томография (КТ) также не имеет значимых преимуществ для диагностики ДНОАП, по-скольку, как и рентгенография, не позволяет обнаружить микропереломы и ОКМ [23,24].…”