Charcot Arthropathy
synonyms: Charcot foot
Charcot Arthropathy ICD-9
Charcot Arthropathy Etiology / Epidemiology / Natural History
- Chronic destructive arthropathy involving the foot and ankle. Occurs in patients with diabetic neuropathy
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- Most commonly involves the
Charcot Arthropathy Anatomy
Charcot Arthropathy Clinical Evaluation
- diffuse swelling, warmth, erythema, tenderness
- bounding pulses, sensory neuropathy
Charcot Arthropathy Xray / Diagnositc Tests
- osteopenia followed by periarticular fragmentation then hypertrophic callus
- multiple bone involvement, fragmentation, new bone formation
- dx is confirmed with indium labeled WBC scan which is not hot
Charcot Arthropathy Classification / Treatment
- Stage I: acute, foot inflamed, hyperemic, some pain despite peripheral neuropathy. Xray=periarticular soft-tissue swelling. Duration=2-6 months. Treatment = total contact cast, consider weight bearing as tolerated. (de Souza LJ, JBJS 2008;90A:754). Requires weekly cast change and biweekly xrays.
- Stage II: stage of coalescence. Decreased swelling, redness and warmth. Structural weakness leading to joint subluxation, dislocation and fracture with foot and ankle deformity. Treatment = total contact cast, consider weight bearing as tolerated. (de Souza LJ, JBJS 2008;90A:754), solid ankle patellar tendon bearing brace/UCBL/Charcot Restraint Orthotic Walker for late stage II.
- Stage III: Consolidation and healing. No warmth or swelling. Foot thickened and deformed. Treatment = solid ankle patellar tendon bearing brace/UCBL/Charcot Restraint Orthotic Walker (Mehta, Foot Ankle Int 19:619;1998)
- Total contact cast: see (de Souza LJ, JBJS 2008;90A:754) for method of applying cast.
- Consider intravenous pamidronate (Jude EB, Diabetologia 2001;44:2032).
- Eichenholtz staging
Charcot Arthropathy Associated Injuries / Differential Diagnosis
- Osteomyelitis
- Cellulites
- PVD(decreased pulses, hair loss)
- Abcess
Charcot Arthropathy Complications
Charcot Arthropathy Follow-up Care
- Weekly cast changes, biweekly xrays for patients with total contact casts.
Charcot Arthropathy Review References
- de Souza LJ, JBJS 2008;90A:754
- Eichenhltz SN, Charcot Joints. 1966 textbook
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