Charcot foot associated with chronic alcohol abuse

Arapostathi, Christina; Tentolouris, Nicholas; Jude, Edward B.

doi:10.1136/bcr-2012-008263

Cited by 13 publications

(6 citation statements)

References 11 publications

(6 reference statements)

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“…1 , 2 With symptoms ranging from paraesthesia, dysaesthesias, pain, weakness, and sensory loss due to axonal degeneration, alcohol neuropathy affects the distal extremities mostly leading to decreased ability to ambulate, muscle atrophy, pressure ulcers, and Charcot arthropathy. 1 – 4 In the event if there is an accompanying bone or soft tissue injury, the presence of a neuropathy further compromises tissue healing of the skin, muscles, tendons, and bone. 5 – 8 Performing surgery in neuropathic patients necessitates careful planning with realistic expectations expressed to the patient and their family in order to achieve reasonable outcomes.…”

Section: B Ackgroundmentioning

confidence: 99%

Modified Masquelet Technique and Primary Tibial Metaphyseal Shortening for the Management of Proximal Tibial-infected Non-union in a Patient with Alcohol-induced Neuropathy: A Case Study

Mahmoud,

Watson,

Horwitz

2024

Strategies in Trauma and Limb Reconstruction

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A bstract Aim To highlight the role of the Masquelet technique as a limb salvage procedure for a neuropathic patient presenting with infected non-union of proximal tibia. Background The management of an infected non-union in neuropathic patients is most challenging; with various treatment options available, the prognosis is often guarded. Case description A 37-year-old male with chronic polyneuropathy, also possessing a contralateral midfoot Charcot arthropathy secondary to a history of alcohol abuse, developed infection after a proximal tibial osteotomy for a preceding mal-non-union of a proximal tibia fracture. The management included hardware removal, excision of necrotic bone, interim insertion of antibiotic-loaded bone cement followed by an acute shortening and revision of the internal fixation utilising a second surgical incision. Successful bone union and eradication of infection was achieved and maintained after 13 months follow-up. Conclusion A successful outcome was achieved for an infected non-union of a long bone in a neuropathic patient using the Masquelet technique which was then followed with a second-stage removal of the spacer and shortening. By performing the revision ORIF surgery utilising a different skin incision in the setting of complicated previous surgical scars proved to be a viable technique towards reducing risk of recurrence of infection and a good outcome. Clinical significance Utilisation of the Masquelet technique and limb shortening in a staged manner for the management of long bone infections in neuropathic patients has not been reported before and may be valuable in such demanding clinical situations. How to cite this article Mahmoud AN, Watson JT, Horwitz DS. Modified Masquelet Technique and Primary Tibial Metaphyseal Shortening for the Management of Proximal Tibial-infected Non-union in a Patient with Alcohol-induced Neuropathy: A Case Study. Strategies Trauma Limb Reconstr 2023;18(3):181–185.

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Section: B Ackgroundmentioning

confidence: 99%

Modified Masquelet Technique and Primary Tibial Metaphyseal Shortening for the Management of Proximal Tibial-infected Non-union in a Patient with Alcohol-induced Neuropathy: A Case Study

Mahmoud,

Watson,

Horwitz

2024

Strategies in Trauma and Limb Reconstruction

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“…Charcot neuroarthropathy should be considered in cases of midfoot pain, persistent inflammation and walking difficulties. It presents in middle-aged people with diabetes-related peripheral neuropathy and is more commonly misdiagnosed when associated with alcoholism or undiagnosed sensory loss [ 102 ], or dismissed as fragility fractures or progressive flat foot deformity [ 103 ]. Early diagnosis and intervention are key to stabilize the foot; otherwise, the resultant ‘rocker bottom’ deformity increases the risk of amputation [ 104 ].…”

Section: Foot Pain and Red Flagsmentioning

confidence: 99%

Current and future advances in practice: mechanical foot pain

Halstead,

Munteanu

2023

Rheumatology Advances in Practice

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Mechanical foot pain affects ∽20% of the UK population >50 years of age, with ∼10% reporting disabling pain that impacts daily activities. For most people, foot pain improves over time, but for some this can become chronic and disabling, affecting physical activity, participation, mental health and work capacity. Mechanical foot pain can present as localized pain, but more often the pain presents in multiple structures. Traditional treatments for mechanical foot pain are largely based on self-management that includes pain control, reassurance of healing trajectory, and activity or footwear modifications. Randomized controlled trials support the short-term use of exercise and foot orthoses for some foot conditions; however, accessibility can be limited by regional variations in procurement compounded by a lack of long-term trials. The roles of weight loss and strengthening of the foot and leg muscles offer new avenues to explore.

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“…Heavy alcohol use is another risk factor often associated with gout. However, chronic alcoholism has been shown to be a risk factor for the progression of CN, 16 , 17 and so the presence of heavy alcohol use does not necessarily favor one diagnosis over the other. An additional diagnostic clue is the presence or absence of peripheral neuropathy.…”

Section: Patient Case Reportmentioning

confidence: 99%

Charcot Neuroarthropathy of the Foot and Ankle in the Acute Setting: An Illustrative Case Report and Targeted Review

Bagheri,

Anastasio,

Krez

et al. 2023

WestJEM

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Charcot neuroarthropathy (CN) is a rare but serious sequela of diabetes and other diseases that cause peripheral neuropathy. It is most commonly characterized by degeneration of the foot and/or ankle joints leading to progressive deformity and altered weight-bearing. If left untreated, the deformities of CN lead to ulceration, infection, amputation, and even death. Because of the associated peripheral neuropathy and proprioception deficits that accompany CN, patients typically do not perceive the onset of joint destruction. Moreover, in the hands of the untrained clinician, the initial presentation of CN can easily be mistaken for infection, osteoarthritis, gout, or inflammatory arthropathy. Misdiagnosis can lead to the aforementioned serious sequelae of CN. Thus, an early accurate diagnosis and off-loading of the involved extremity, followed by prompt referral to a specialist trained in the care of CN are crucial to prevent the late-term sequelae of the disease. The purpose of this article was to create an opportunity for enhanced understanding between orthopedic surgeons and emergency physicians, to improve patient care through the optimization of diagnosis and early management of CN in the emergent setting.

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Charcot foot associated with chronic alcohol abuse

Cited by 13 publications

References 11 publications

Modified Masquelet Technique and Primary Tibial Metaphyseal Shortening for the Management of Proximal Tibial-infected Non-union in a Patient with Alcohol-induced Neuropathy: A Case Study

Modified Masquelet Technique and Primary Tibial Metaphyseal Shortening for the Management of Proximal Tibial-infected Non-union in a Patient with Alcohol-induced Neuropathy: A Case Study

Current and future advances in practice: mechanical foot pain

Charcot Neuroarthropathy of the Foot and Ankle in the Acute Setting: An Illustrative Case Report and Targeted Review

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