Imaging of the Charcot Foot

Rogers, Lee C.; Bevilacqua, Nicholas J.

doi:10.1016/j.cpm.2008.01.002

Cited by 38 publications

(48 citation statements)

References 27 publications

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“…The characteristic bony changes apart from osteomyelitis include osteolysis, osteopenia, subluxations, dislocations and fragmentation of subchondral bone. 30,31 The bony changes seen in present study are osteomyelitis 15.6%, subluxation 7%, fracture 4% and charcot joint 23%. Surgical correction of these bony lesions should be done simultaneously for better healing of the ulcer.…”

Section: Discussionmentioning

confidence: 88%

Risk factors deciding the prevention and healing of diabetic foot ulcer: a prospective study in Chennai Medical College Hospital and Research Center Irungalur, Trichy, Tamil Nadu, India; a rural based tertiary medical care centre

Murugan¹,

Padma²,

Senthilkumaran³

2018

Int Surg J

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Background: Diabetic foot ulcer is the one among and the most common complication of diabetes mellitus patients. Various studies from over the world for the past 2 decades discuss the important risk factors that decide the prevention and outcome of diabetic foot ulcer. In our prospective study we have discussed the risk factors focused on prevention and treatment of diabetic foot ulcer in a rural tertiary medical care centre.Methods: Totally 940 patients with the clinical diagnosis of diabetic foot ulcer admitted in our hospital surgical department were studied prospectively with their clinical symptoms and signs of diabetic foot ulcer and various evaluations done for the comorbid conditions with the help of other specialty departments. All these risk factors studied in our rural based tertiary medical centre were collected in a designed format were studied and discussed in comparison to the chosen data available in various studies done at various countries.Results: All the 940 patients admitted for diabetic foot ulcer who underwent a methodical evaluation for risk factor showed an elevated HbA1c more than 8 in 720 (77.5%) patients, bony involvement like osteomyelitis in 274 patients (29%) , peripheral vascular disease in 421 (44.9%), neuropathy in 533 patients (56.7%), nephropathy 163 (17.34%), retinopathy in 102 (10.85%) and heart disease in 375 (39.89%).Conclusions: Proper protocols to the prevention and management of foot ulcer in diabetic patients have not reached many health care centres and it is imperative to stress on the related comorbid risk factors which influence the prevention and healing of diabetic foot ulcer. Present study done at a rural tertiary health care centre is mainly focused on the incidence of risk factors which modulates and modify the diabetic foot ulcer prevention and management. This study aims to support the health professionals to identify the risk factors apart from the clinical picture of diabetic foot ulcer that may enhance the efficient management and avoid the unnecessary morbidity and mortality.

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Section: Discussionmentioning

confidence: 88%

Risk factors deciding the prevention and healing of diabetic foot ulcer: a prospective study in Chennai Medical College Hospital and Research Center Irungalur, Trichy, Tamil Nadu, India; a rural based tertiary medical care centre

Murugan¹,

Padma²,

Senthilkumaran³

2018

Int Surg J

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“…An abnormal XR can be highly suggestive of CN [4], but an apparently normal XR does not exclude CN. Fortunately, in CN, the bone scan is never normal [4], and an MRI will demonstrate microfractures and bone marrow edema even in the early stages when XRs are still normal [5•,6,7].…”

Section: Background Diagnosis and Prevalencementioning

confidence: 94%

“…Thus, it is probable that tests that claim the ability to differentiate CN from osteomyelitis are examining laterstage CN cases rather than very acute cases. Theoretically, tests that image bacteria could be useful, but such imaging is not ready for prime time [4]. In practice, however, this is rarely a problem.…”

Section: Background Diagnosis and Prevalencementioning

confidence: 96%

“…Over the years, each new imaging technique has claimed the ability to differentiate CN from osteomyelitis, only for these claims to be discredited. Currently, positron emission tomography scanning is offered as a possible solution, in which osteomyelitic bone appears to be more metabolically active than CN bone [4,8]. Along the same lines, it has been suggested that C-reactive protein is less elevated in CN that in osteomyelitis [9].…”

Section: Background Diagnosis and Prevalencementioning

confidence: 98%

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The charcot foot: Medical and surgical therapy

Ulbrecht

Wukich²

2008

Curr Diab Rep

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Charcot neuro-osteoarthropathy (CN) is among the most devastating complications of neuropathy and now most commonly occurs in the feet of diabetic patients. Because it is relatively rare and because most patients and practitioners do not expect major bone pathology in the absence of significant pain, CN is often misdiagnosed as cellulitis, deep venous thrombosis, or gout. Also, radiographs early in the process are often relatively unremarkable. Although MRI findings are characteristic, treatment should not wait for the MRI result. The hot swollen erythematous neuropathic foot suspected to be CN should be emergently mechanically protected, usually in an irremovable total contact cast. Mechanical protection is the mainstay of conservative therapy, but surgical reconstruction of a deformed foot can usually also be successful. Unless diagnosed very early, significant decrements in quality of life result. Controlled studies are urgently needed to identify best practices.

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“…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].…”

Section: современные возможности диагностикиunclassified

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

Kaminarskaya¹

2015

Endo Serg

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Диабетическая нейроостеоартропатия (ДНОАП) является редким, но тяжелым ос-ложнением диабетической полинейропатии. Это состояние, характеризующееся про-грессирующей деструкцией костей и суста-вов стопы, неизбежно приводит к выражен-ной деформации стоп. Причины развития ДНОАП не до конца ясны. Существуют убеди-тельные доказательства, что провоцирую-щим фактором ДНОАП является нераспоз-нанная травма, инфицированная язва или оперативное вмешательство на стопе. Распространенность ДНОАП среди пациен-тов с сахарным диабетом (СД), по данным разных авторов, составляет от 0,08 до 7,5%. (В некоторых работах были зафиксированы более высокие показатели распространен-ности ДНОАП: у 13% среди всех больных СД и у 29% пациентов с диабетической поли-нейропатией [1, 2]; однако эти цифры вызы-вают ряд вопросов, в том числе касающихся критериев постановки диагноза и формиро-вания выборки.)ДНОАП ассоциирована с высокой часто-той ампутаций и уровнем смертности. Согласно исследованию Pakarinen T.-K. и соавт., в котором был отслежен 41 пациент с острой ДНОАП, общая смертность соста- Endocrinology Research Centre, Moscow, Russian FederationДиабетическая нейроостеоартропатия -осложнение сахарного диабета, ассоциированное с высокой частотой ампутаций и уровнем смертности. Благодаря развитию методов диагностики сегодня стало возможным выявление диабетической нейроостеоартропатии на ранней рентген-негативной стадии. Лечение на данном этапе способно предотвратить развитие выраженной деструкции костного скелета стопы и формирование серьезных деформаций. Однако не существует единого подхода к диагностике рентген-негативной стадии диабетической нейро остео-артропатии. Также остается спорным вопрос о сроках иммобилизации пораженной конечности и методах определения завершения острой стадии диабетической нейроостеоартропатии. Данный обзор посвящен современному состоянию знаний о диагностике, классификации и критериях завершения активной стадии диабетической нейроостеоартропатии. Клю че вые сло ва: сахарный диабет, стопа Шарко, ранняя диагностика, МРТ.Diabetic neuroosteoarthropathy is complication of diabetes associated with high rates of amputations and mortality. The development of diagnostic methods may identify diabetic neuroosteoarthropathy at early X-ray negative stage before the development of radiographic changes. Treatment at this stage can prevent the development of progressive bone and joint deterioration. However, there is no unified approach to diagnose of X-ray negative stage. The timing of immobilization of the affected limb is still controversial among experts, and where is no objective methods for determining the completion of the acute stage of diabetic neuroosteoarthropathy. This review focuses on the current state of knowledge about the diagnosis, classification and criteria for completion of the active phase of diabetic neuroosteoarthropathy.

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Imaging of the Charcot Foot

Cited by 38 publications

References 27 publications

Risk factors deciding the prevention and healing of diabetic foot ulcer: a prospective study in Chennai Medical College Hospital and Research Center Irungalur, Trichy, Tamil Nadu, India; a rural based tertiary medical care centre

Risk factors deciding the prevention and healing of diabetic foot ulcer: a prospective study in Chennai Medical College Hospital and Research Center Irungalur, Trichy, Tamil Nadu, India; a rural based tertiary medical care centre

The charcot foot: Medical and surgical therapy

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

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