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The Charcot foot is a consequence of a relatively painless progressive arthropathy of single or multiple joints, caused by an underlying neurological deficit. This leads to simultaneous presence of bone and joint destruction, fragmentation and remodelling. The initiating event is often an unnoticed trivial injury or repetitive minor trauma which leads to minor, periarticular or major fracture.
In susceptible feet:
Peripheral neuropathy - loss of protective sensation
Autonomic neuropathy - >blood flow - osteopenia
Increased osteoclastic activity - bone resorption
Clinical Presentation
Acute: swollen, hot, painful foot
± history of trauma.??
- # /Sprain
- Infection: osteomyelitis: cellulitis
- Gout
Chronic: Insidious development of painless, deformed and unstable foot.
Demographics
- 0.1- % in patients with diabetic peripheral neuropathy.
- Age 20-70+ years (50-70 common).
- History of longstanding diabetes
- Bi-lateral in about 10%.
- Joints: Tarso-metatarsal 60%
Metaratarso phalangeal 20%
Ankle 10%
Treatment
If you suspect an acute Charcot Joint refer to the Diabetic Foot Clinic to be seen within one week . The mainstays of treatment are:
- Non-weight bearing - rest
- aircast
- shoes. - Watch other foot.
- Bisphosphonates - PAMIDRONATE
- Surgery: - trimming of bony exostosis
- arthrodesis.