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.