Charcot Neuroarthropathy and Treatment

Posted by e-Medical PPT Thursday, January 5, 2012
Charcot Foot
Predisposing conditions:
diabetes mellitus,alcoholism,syringomyelia,spinal cord lesions
Today, most common in diabetics, commonly in the lower extremity

Pathogenesis Neurotraumatic Theory
proposes that Charcot arthropathy results from repetitive mechanical trauma from weight bearing on insensate extremity
this trauma can lead to intracapsular effusions, ligamentous laxity and joint instability
Absence of protective sensation allows continued loading of fractured extremity
Heightened healing response seen

Pathogenesis Neurovascular Theory
Proposes that Charcot is a sequela of increased peripheral blood flow resulting from autonomic sympathectomy
Autonomic sympathectomy produces a failure of the normal regulatory mechanisms that control blood flow
Autonomic dysfunction causes arteriovenous shunting and vasodilitation
Increases rate of blood flow to extremity
Correlated with increased osteoclastic activity
Marked demineralization of bone
Increases susceptibility to subluxation, fracture and collapse

Anatomic Classification
I - forefoot, 10-30%
II - Lisfranc’s joint, most common
III - midtarsal joint, often including naviculocuneiform joint
IV - ankle and subtalar joints, 8-10%
V - (“posterior pillar”) fractures of calcaneus, 2%

Radiographic Staging
I    Developmental (acute) stage
II  Coalescence (quiescent) stage
III  Consolidation (resolution) stage

Clinical Presentation
Red, hot, swollen foot
Typically painless or only mildly painful unilateral swelling of extremity
Can mimic cellulitis, gout, osteomyelitis and even DVT
Plain films may appear normal initially
Ortho exam may reveal joint hypermobility with crepitus +/- cutaneous ulceration
As disease progresses, longitudinal and transverse arches of foot may collapse, creating a rocker bottom foot
Some degree of sensory deficit always present
Deep tendon reflexes, vibratory sensation, and proprioception may be diminished or absent
Due to autonomic sympathectomy, may see bounding pulses, calor, rubor, tumor and anhidrosis +/- xerosis...

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