Charcot Arthropathy
Mark A. Cowley
Baker College
Vascular Technology
OVERVIEW
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What is Charcot Arthropahy.
Etiology and Pathophysiology.
Imaging and Diagnostic procedures.
Presentation.
Treatments.
Recent Research.
Quick Review.
Charcot Arthropathy
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1703 William Musgrave described a
neuropathic joint as an athralgia.
1868 Jean-Martin Charcot gave the first
detailed description of this disease.
Charcot Arthropathy is a progressive
condition of the musculoskeletal system that
is characterized by joint dislocations,
pathologic fractures, and debilitating
deformities most commonly in the lower ext.
Etiology
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Any condition that causes sensory or
autonomic neuropathy
Chronic alcoholism, renal dialysis, syphillis,
leprosy, complication of diabetes.
Before 1936 the leading cause of Charcot
was thought to be syphillis, today the disease
is most commonly found to be secondary to
diabetes.
Pathophysiology
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Major theories
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Neurotraumatic theory
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Neurovascular theory
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Most probably both
Imaging and Diagnostic
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Lab- WBC w/diff, erythrocyte sedimentation
rate (ESR), Chem 7.
Imaging- Radiographs, bone scan, MRI,
ultrasound.
Other- Bone probe, lumbar puncture,
synovial biopsy.
Presentation
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Mild swelling w/o deformity-Moderate
deformity with extreme swelling.
Signs of inflammation.
Profound unilateral swelling.
Increase in localized temp(5-10Degrees).
Erythema, joint effusion.
75% pt. have pain. 40% lesions.
Classification
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Brodsky and Rouse
Type 1 Midfoot
Type 2 Hindfoot
Type 3a Ankle 3b Calcis tubercle
Affected joints
Radiographs
Charcot Arthropathy
Treatment
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Primarily nonoperative.
Consists of Acute and Postacute phases.
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Acute
Casting along with crutches and walkers.
Postacute
Include bracing, ankle-foot orthotics(AFO),
specialized shoes.
Treatment
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Casting- changed every 1-2weeks, if
ulcerations are present changed every week
for wound care, duration from 3-6 months.
Shoes, bracing, and orthotics- duration
from 6-24 months.
Typical total healing time 1-2 years.
Surgical Therapy
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Depend and vary on the disease process
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Plate and screw fixation
Bone grafting
Fixations
Amputations
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Recent Studies
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Sohn group: Compared the risk of lower
extremity amputations in patients with
Charcot arthropathy alone and those with
diabetic foot ulcers.
Found that patients with Charcot arthropathy
alone risk was 7 times greater than patients
with ulceration only.
Risk for patients with both increases 12
times.
Recent Studies
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Della Paola group: Alternative to amputation,
use of surgical treatment of osteomyelitis and
external fixation.
45 pt.= 39 healed using surgery to drain an
acute infection and maintaining fixation for an
average of 26 weeks. 4pt. Infection could not
be controlled, 2 pt. additional nails for
fixation.
Quick Review
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Charcot Arthropathy is a progressive condition of the
musculoskeletal system characterized by joint
degeneration and malformities.
Secondary to conditions that cause sensory or
autonomic neuropathy most commonly diabetes.
Presents as swelling, loaclized temp. increase,
Varied Treatments include NWB, orthotics, and
surgical treaments, including amputation.
References
Caputo GM, Ulbrecht J, Cavanagh PR. The Charcot
foot in diabetes: six key points. Am Fam Physician.
Jun 1998;57(11):2705-10. [Medline].
Dalla Paola L, Brocco E, Ceccacci T, Ninkovic S,
Sorgentone S, Marinescu MG, et al. Limb salvage in
Charcot foot and ankle osteomyelitis: combined use
single stage/double stage of arthrodesis and external
fixation. Foot Ankle Int. Nov 2009;30(11):1065-70.
[Medline].
References
Frykberg RG, Zgonis T, Armstrong DG, et al. Diabetic
foot disorders. A clinical practice guideline (2006
revision). J Foot Ankle Surg. Sep-Oct 2006;45(5
Suppl):S1-66. [Medline].
Sohn MW, Stuck RM, Pinzur M, Lee TA, Budiman-Mak
E. Lower-extremity amputation risk after charcot
arthropathy and diabetic foot ulcer. Diabetes Care.
Jan 2010;33(1):98-100. [Medline].