Charcot Neuropathic Arthropathy of the Foot: A Literature Review and Single-Center Experience

Kucera, Tomas; Shaikh, Haroun Hassan; Šponer, Pavel

doi:10.1155/2016/3207043

Cited by 37 publications

(28 citation statements)

References 42 publications

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“…In fact, the pathogenesis of Charcot neuropathy associates both theories with additional blood supply, monocytes, osteoclasts producing bone demineralization while the absence of normal physiological sensation in repeated trauma, associated with muscle weakness, determines joint instability with abnormal plantar pressure values. (14,15) The inflammatory status is maintained by repeated microtraumas, hyperglycemia causes a boost of inflammatory markers of the cytokines TNFα, IL-1β and IL 6, cytokines that will cause changes in the balance of osteoblast -osteoclast homeostasis. Thus, bone destruction occurs by accentuating osteoclastogenesis, a destruction that will potentiate the inflammatory response with entry into a vicious circle.…”

Section: Discussionmentioning

confidence: 99%

Charcot Foot, a Rare and Severe Complication of Diabetes Mellitus

Miheţiu

Matei²,

Sandu

et al. 2020

Acta Medica Transilvanica

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Charcot foot or Charcot neuropathy is a rare disease found in patients with diabetes mellitus and is characterized by bone damage to the foot leading to deformities, instability, functional impotence and even amputation. The mechanism is still under discussion, without a consensus regarding the pathophysiology of this condition. The treatment is a complex one, non-surgical and surgical, the non-surgical one addressing especially the acute phase of the disease, the surgical one being complex and ranging from osteotomy, debridement, arthrodesis, internal or external fixation or even amputation. A good management of diabetes, of its peripheral complications, an early recognition of the Charcot type foot, prevents the evolution towards this serious condition.

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Section: Discussionmentioning

confidence: 99%

Charcot Foot, a Rare and Severe Complication of Diabetes Mellitus

Miheţiu

Matei²,

Sandu

et al. 2020

Acta Medica Transilvanica

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“…This provides some ground for the pathogenesis of unilateral CF in the background of generalized neuropathy. However, it has been found to be bilateral in 9% to 39% of cases[ 24 ]. With the passage of time, we have now come to know that CF results from the combination of these processes.…”

Section: Pathogenesis Of Acute Charcot Footmentioning

confidence: 99%

Role of bisphosphonates in the management of acute Charcot foot

Durgia

Sahoo

Kamalanathan

et al. 2018

WJD

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Diabetes mellitus is the most common cause of Charcot neuropathy affecting foot and ankle. Acute Charcot foot (CF) presents with a red and swollen foot in contrast to the painless deformed one of chronic CF. Enhanced osteoclastogenesis plays a central role in the pathogenesis of acute CF. Many studies have shown elevated levels of bone turnover markers in patients with acute CF confirming it. These findings have led clinicians to use anti-resorptive agents [bisphosphonates (BP), calcitonin, and denosumab] along with immobilization and offloading in acute CF patients. The maximum evidence among all anti-resorptive agents is available for BPs, although its quality is low. Pamidronate has been shown to reduce the markers of activity of CF like raised skin temperature, pain, edema, and bone turnover markers in the majority of studies. Intravenous BPs are known to cause acute phase reactions leading to flu-like illness following their first infusion, which can be ameliorated by oral acetaminophen. Alendronate is the only oral BP used in these patients. It needs to be taken on an empty stomach with a full glass of water to avoid esophagitis. The side-effects and contraindications to BPs should be kept in mind while treating acute CF patients with them.

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“…The process of bone resorption and formation is controlled by the level of RANKL and OPG, and many factors may contribute to this pathway. Hyperglycemia may increase the level of AGEs, ROS, and oxidized lipids, which may all enhance the expression of RANKL in diabetes [ 22 , 33 , 34 ]. The pro-inflammatory state increases cytokines’ expression, TNF-α, IL-1β, and IL-6, which may also enhance the expression of RANKL [ 19 , 28 , 29 , 35 ].…”

Section: Pathogenesismentioning

confidence: 99%

“…RANKL has been shown to mediate osteolysis in DNOAP by stimulating osteoclastic differentiation of monocytes/macrophages and trigger the synthesis of the nuclear transcription factor, nuclear factor-κβ (NF-κβ), to stimulate the maturation of osteoclasts from osteoclast precursor cells [ 28 , 37 ]. A repetitive trauma with the loss of pain sensation results in continual production of pro-inflammatory cytokines, RANKL, NF-κβ, and osteoclasts, which in turn leads to continuing local osteolysis [ 33 ].…”

Section: Pathogenesismentioning

confidence: 99%

Pathogenesis and potential relative risk factors of diabetic neuropathic osteoarthropathy

et al. 2017

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Diabetic neuropathic osteoarthropathy (DNOAP) is an uncommon, but with considerable morbidity and mortality rates, complication of diabetes. The real pathogenesis is still unclear. The two popular theories are the neuro-vascular theory and neuro-traumatic theory. Most theories and pathways focused on the uncontrolled inflammations that resulted in the final common pathway, receptor activator of nuclear factor κβ ligand (RANKL)/osteoprotegerin (OPG) axis, for the decreased bone density in DNOAP with an osteoclast and osteoblast imbalance. However, the RANKL/OPG pathway does not explain all the changes, other pathways and factors also play roles. A lot of DNOAP potential relative risk factors were evaluated and reported in the literature, including age, gender, weight, duration and type of diabetes, bone mineral density, peripheral neuropathy and arterial disease, trauma history, and some others. However, most of them are still in debates. Future studies focus on the pathogenesis of DNOAP are still needed, especially for the genetic factors. And, the relationship between DNOAP and those potential relative risk factors are still need to further clarify.

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Charcot Neuropathic Arthropathy of the Foot: A Literature Review and Single-Center Experience

Cited by 37 publications

References 42 publications

Charcot Foot, a Rare and Severe Complication of Diabetes Mellitus

Charcot Foot, a Rare and Severe Complication of Diabetes Mellitus

Role of bisphosphonates in the management of acute Charcot foot

Pathogenesis and potential relative risk factors of diabetic neuropathic osteoarthropathy

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