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: The neuropathic area sustains multiple microtrauma leading to joint destruction.
- Neurovascular: Increased vascular flow due to neuropathy results in bone demineralization and bone resorption and destruction.
Clinical Features
Varied presentations: [Acute Charcot Arthropathy] may have the following features:
- Signs of inflammation.
- Profound unilateral swelling.
- Increase in local skin temperature.
- Erythema in the local area.
- Joint effusion.
Differential Diagnosis
Foot infection
- Gout
- PsuedoGout
- Cellulitis
- Gangrene
- Trench foot
- Abscess
- Necrotizing soft tissue infections
- Osteomyelitis
- Diabetic foot infection
- Charcot Foot