“Silent” bone stress injuries in the feet of diabetic patients with polyneuropathy: a report on 12 cases

Chantelau, Ernst; Richter, Andreas; Ghassem-Zadeh, Nahid; Poll, L. W.

doi:10.1007/s00402-006-0271-x

Cited by 70 publications

(75 citation statements)

References 25 publications

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“…Diabetic Charcot's foot stage 0 (according to a modified Eichenholtz-scale[4]) was defined by severe sensory neuropathy of the feet (vibration, sensation at the first metatarsal head < 4/8 Rydel-Seiffer tuning fork grade [12,13]), disproportionate painlessness, and swelling, hyperthermia, erythema, decreased range of motion of a foot; plain X-ray had to be normal, and skeletal deformities had to be absent [3-5]. As we have shown previously, this stage of Charcot's foot represents a "silent"-i.e.…”

Section: Methodsmentioning

confidence: 99%

Sudeck's disease stage 1, or diabetic Charcot's foot stage 0? Case report and assessment of the diagnostic value of MRI

Poll

Weber

Böhm

et al. 2010

Diabetol Metab Syndr

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BackgroundThe diagnosis of Sudeck's syndrome stage 1 (nowadays termed complex regional pain syndrome I, abbreviated CRPS I) is based on clinical features, namely swelling and pain in a limb. Plain X-ray may be normal. In the absence of pain sensitivity, e.g. in diabetic neuropathy, CRPS I of the foot can be mistaken for Charcot's foot stage 0 (so-called neuro-osteoarthropathy).Case presentationThe case of a type-1 diabetic woman is reported, in whom CRPS I following a calcaneal fracture was mistaken for Charcot's osteoarthropathy (because of bone marrow edema displayed by conventional MR imaging). In addition, a review is presented on 6 consecutive cases with CRPS I of the foot, and on 20 cases with Charcot's foot stage 0, with particular emphasis on MR imaging findings. The number of bones per foot affected with marrow edema was similar in either condition, with a tendency towards a more patchy, diffuse distribution of bone marrow edema in CRPS I. Bone marrow edema apparently regressed more promptly in response to treatment in Charcot's foot stage 0.ConclusionDifferentiation of CRPS I from Charcot's foot stage 0 remains a diagnostic dilemma in patients with pain insensitivity. Conventional MRI may be helpful, when repeated for monitoring the treatment response.

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Section: Methodsmentioning

confidence: 99%

Sudeck's disease stage 1, or diabetic Charcot's foot stage 0? Case report and assessment of the diagnostic value of MRI

Poll

Weber

Böhm

et al. 2010

Diabetol Metab Syndr

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“…Clinically, loadrelated pain is the dominating feature of any bone bruise [31]. This key symptom, may, however, be partially or completely absent in subjects with sensory neuropathy (loss of protective sensation) [32].…”

Section: Bone Bruisesmentioning

confidence: 99%

Bone marrow lesions: a universal bone response to injury?

Eriksen

Ringe

2011

Rheumatol Int

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The ever increasing use of magnetic resonance imaging in clinical practice has led to the recognition of a new entity, bone marrow lesions (BMLs). These lesions are characterized by excessive water signals in the marrow space and have emerged as a central component of many different diseases affecting the musculoskeletal system. BMLs have in particular been associated with a wide variety of inflammatory and non-inflammatory rheumatologic conditions and are not only considered significant sources of pain, but also linked to the worsening of patient prognosis in many disease states. In this review, we summarize the current knowledge on BMLs with an emphasis on the clinical and histological features of this entity in inflammatory and non-inflammatory disease and provide a unifying hypothesis based on the appearance with various imaging technologies. We also try to pair this hypothesis with the apparent beneficial effects of various treatment regimens, mainly within the group of bone antiresorptive drugs (calcitonin, bisphosphonates) on symptoms associated with BMLs.

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“…D iabetes mellitus is the main cause of Charcot neuroarthropathy (CN) (1) and is clinically classified as follows: Charcot foot (CF), acute Charcot foot (ACF) when there is inflammation, and inactive Charcot foot when inflammatory signs are absent (2).…”

Section: Introductionmentioning

confidence: 99%

Risk factors for Charcot foot

Nóbrega

Aras

Netto

et al. 2015

Arch. Endocrinol. Metab.

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Objective: Diabetes mellitus is the main cause of Charcot neuroarthropathy and is clinically classified as follows: Charcot foot, acute Charcot foot (ACF) when there is inflammation, and inactive Charcot foot when inflammatory signs are absent. The aim of this study was to identify the risk factors for ACF in patients with type 2 diabetes mellitus. Materials and methods: A matched case-control study was conducted to assess the factors associated with acute Charcot foot from February 2000 until September 2012. Four controls for each case were selected 47 cases of ACF and 188 controls without ACF were included. Cases and controls were matched by year of initialization of treatment. Conditional logistic regression was used to estimate matched odds ratios (ORs) and 95% confidence intervals (95% CIs). Results: In multivariate analysis, patients having less than 55 years of age (adjusted OR = 4.10, 95% CI = 1.69 -9.94), literate education age (adjusted OR = 3.73, 95% CI = 1.40 -9.92), living alone (adjusted OR = 5.84, 95% CI = 1.49 -22.86), previous ulceration (adjusted OR = 4.84, 95% CI = 1.62 -14.51) were at increased risk of ACF. However, peripheral arterial disease (adjusted OR = 0.16, 95% CI = 0.05 -0.52) of 6.25 (1.92 -20.0) was a protective factor. Discussion: The results suggest that PCA in type 2 diabetes primarily affects patients under 55 who live alone, are literate, and have a prior history of ulcers, and that peripheral arterial disease is a protective factor. Arch Endocrinol Metab.2015;59(3):226-30

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“Silent” bone stress injuries in the feet of diabetic patients with polyneuropathy: a report on 12 cases

Cited by 70 publications

References 25 publications

Sudeck's disease stage 1, or diabetic Charcot's foot stage 0? Case report and assessment of the diagnostic value of MRI

Sudeck's disease stage 1, or diabetic Charcot's foot stage 0? Case report and assessment of the diagnostic value of MRI

Bone marrow lesions: a universal bone response to injury?

Risk factors for Charcot foot

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