Charcot Foot

Background

• Charcot neuropathic osteoarthropathy (Charcot joint) is a destructive joint disorder initiated by trauma to a neuropathic extremity. It can lead to dislocations and fractures of the foot. Diabetes, neuropathy, trauma, and metabolic abnormalities of the bone result in an acute localized inflammatory condition. The inflammatory response can permanently disrupt the bony architecture of the foot resulting in abnormal plantar pressures that are at risk for ulceration, osteomyelitis, and amputation.

• Charcot arthropathy can occur at any joint; however, it occurs most commonly in the lower extremity, at the foot and ankle in patients with diabetes.

Epidemeology

• Charcot joint develops in about 0.1% to 0.9% of people with diabetes.
• Majority of these patients will develop a foot ulceration.
• There is a significant association between elevated body mass index and Charcot arthropathy.

Pathophysiology

[Two commonly accepted theories]

• Neurotraumatic:
• Neurovascular:

Clinical Features

Varied presentations: Acute Charcot Arthropathy, may have following features:

Differential Diagnosis

Foot infection

• Gout
• PsuedoGout
• Cellulitis
• Gangrene
  • Dry gangrene
  • Wet gangrene
• Trench foot
• Abscess
• Necrotizing soft tissue infections
  • Necrotizing fasciitis
  • Necrotizing myositis
  • Necrotizing cellulitis
• Osteomyelitis
• Diabetic foot infection
• Charcot Foot

Look A-Likes

• Peripheral artery disease
• Sporotrichosis
• Deep venous thrombosis

• Cellulitis
• Gangrene
  • Dry gangrene
  • Wet gangrene
• Trench foot
• Abscess
• Necrotizing soft tissue infections
  • Necrotizing fasciitis
  • Necrotizing myositis
  • Necrotizing cellulitis
• Osteomyelitis
• Diabetic foot infection
• Charcot Foot
• Wet-sock erosions