Current Topics Review:Charcot Neuroarthropathy of the Foot and Ankle

Abstract

Charcot arthropathy is a destructive process, most commonly affecting joints of the foot and ankle in diabetics with peripheral neuropathy. Affected individuals present with swelling, warmth, and erythema, often without history of trauma. Bony fragmentation, fracture, and dislocation progress to foot deformity, bony prominence, and instability. This often causes ulceration and deep infection that may necessitate amputation. Instability or deformity may limit the ability to use standard footwear. Treatment is focused on providing a stable and plantigrade foot for functional ambulation with accommodative footwear and orthoses. Historically, treatment had included nonweightbearing immobilization for the acute phase, and surgery had been reserved only for infection, unresolved skin ulceration, or deformity that precluded the use of therapeutic footwear. Current controversies include weightbearing in the acute or reparative phases and early surgical stabilization. Foot-specific patient education and continued periodic monitoring may reduce the morbidity and associated expense of treating the complications of this disorder and may improve the quality of life in this complex patient population.

High Union Rates and Function Scores at Midterm Followup With Ankle Arthrodesis Using a Four Screw Technique

“…External fixation is still widely used, predominately in cases of critical soft tissues and ongoing infections [37,50,55].…”

Classifications in Brief: Eichenholtz Classification of Charcot Arthropathy

“…Anatomic-based classification systems for Charcot arthropathy also have been developed [2,10,12,19,22]. Of these systems, the most widely used is Brodsky's, which is specific to the foot and based on the most common regions affected ( calcaneal tuberosity [2].…”

“…Of these systems, the most widely used is Brodsky's, which is specific to the foot and based on the most common regions affected ( calcaneal tuberosity [2]. This system subsequently was modified by Trepman et al [22] to include Types 4 (multiple areas) and 5 (forefoot), which correlate with sequential or concurrent involvement of multiple areas and metatarsophalangeal involvement, respectively ( Table 2).…”

“…As a temporal staging system, anatomic location is not taken into consideration. This was the impetus behind the development of other classification schemes, such as Brodsky's, because the specific location and extent of osseous destruction also can influence treatment decisions [2,10,12,19,22].…”

Artropatia de charcot do mediopé no paciente diabético: complicação de uma doença epidêmica

“…In cases in which the residual deformity is very accentuated, or when there is major residual deformity, extending secondarily to the hindfoot (Trepman grade IV) (13) , or it is impossible to fit the foot into a molded orthotic boot made of AFO polypropylene, reconstructive surgery (modeling arthrodesis) is indicated consequent to complications from Charcot arthropathy or by maintenance of a foot that was incapable of supporting the body's weight while walking (with use of crutches or a wheelchair).…”