Charcot's Arthropathy-Foot713.5

 

synonyms: Charcot foot

Charcot Arthropathy ICD-9

  • 713.5 Arthopathy associated with neurological disorders; Charcot's arthropathy associated with diesease classifiable elsewhere.

Charcot Arthropathy Etiology / Epidemiology / Natural History

  • Chronic destructive arthropathy involving the foot and ankle. Occurs in patients with diabetic neuropathy
  • 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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