Charcot arthropathy is a relatively rare, progressive neuroarthropathic
disorder with deterioration of the weight-bearing joints.
The foot is the most frequent site affected. Osteoporosis,
fracture, acute inflammation and disorganisation of the foot
architecture are common.
What are the
signs and symptoms?
The acute Charcot foot is characterised by an erythematous,
swollen and possibly painful foot in the absence of infection
(Figure 3). It is associated with increased bone
blood flow, osteopenia and fracture or dislocation. Increased
blood flow as a result of autonomic neuropathy is one of the
primary etiological factors in the development of Charcot’s
joint and severe foot deformity [Armstrong
et al, 1997; Brower and Allman, 1981].
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Figure 3. The acute Charcot
foot
Reproduced with permission from
www.gensurg.co.uk |
The disease process can become quiescent with increased bone
formation, osteosclerosis, spontaneous arthrodesis and ankylosis
[Jeffcoate et al, 2000].
Charcot foot may often be unrecognised, especially in the
acute phase, and may be confused with cellulitis or gout.
Although the exact pathogenesis is not known, underlying sensory
neuropathy is almost universal [Caputo
et al, 1998].
How is
it diagnosed?
Radiographs may be normal in acute Charcot foot. However,
with time, serial radiographs reveal minor fractures, osteolysis,
bone fragmentation and remodeling of bone, considered to
be radiographic hallmarks of the disease [Caputo
et al, 1998]. Although not a prerequisite for Charcot
foot, minor trauma may rapidly develop into Charcot changes.
A diagnosis of Charcot foot should be considered in neuropathic
diabetes patients where there is a minor increase in heat
or swelling after even a slight injury [Sommer
and Lee, 2001]. Thermographic measurement is useful in
the diagnosis of acute Charcot foot, as skin temperature is
2–8°C higher than the contralateral foot [Armstrong
and Lavery, 1997; Fabrin et al, 2000; McGill et al, 2000].
Treatment
Treatment of Charcot foot is by immobilisation in a
total contact cast to offload the pressure on the foot, non-weightbearing
and the use of therapeutic shoes [Fabrin
et al, 2000; McGill et al, 2000]. Early recognition (even
where radiographs are normal) can minimise foot deformities,
ulceration and potential loss of function [Sommer
and Lee, 2001]. Recent evidence suggests that the bisphosphonates
may be efficacious when used together with offloading in acute
Charcot neuroarthropathy [Jude
et al, 2001].
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