The Charcot foot

Jeffcoate, William; Lima, Jorge Roberto Perrout de; Nóbrega, Lucas da

doi:10.1046/j.1464-5491.2000.00233.x

Cited by 116 publications

(52 citation statements)

References 48 publications

(97 reference statements)

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“…and dislocation of the bones and joints of the foot [1][2][3]. In some cases the structural damage is limited, but in others it is progressive and extensive, leading to deformity, secondary ulceration and osteomyelitis, which can be difficult or impossible to eradicate.…”

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confidence: 99%

Audit of acute Charcot’s disease in the UK: the CDUK study

et al. 2011

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Aims/hypothesis We studied factors associated with the development and resolution of acute Charcot foot using a web-based observational study. centres. Of these, 36% of patients recalled an episode of relevant trauma in the preceding 6 months, while 12% had had surgery to the affected foot. In 101 (35%) cases, ulceration was present at registration and 20% of these had osteomyelitis. Non-removable off-loading devices were used at presentation in 35.4% of cases, with removable off-loading used in 50%. Data on resolution were available for 219 patients. The median time to resolution was 9 months in patients whose initial management included the use of non-removable off-loading, compared with 12 months in the remainder (p=0.001). Bisphosphonates were administered intravenously in 25.4% and orally in 19.4% of cases. The median time to resolution in patients who received bisphosphonates was 12 months and was longer than in those who did not (10 months, p=0.005). Conclusions/interpretation The median time to resolution was longer than in earlier series. Although limited by being observational and non-randomised, these data suggest that the use of non-removable off-loading at presentation may shorten the time to resolution. They provide no evidence to indicate that the use of bisphosphonates is beneficial.

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confidence: 99%

Audit of acute Charcot’s disease in the UK: the CDUK study

et al. 2011

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“…This has been shown to be associated with increased flow of blood to bone [15]. The data in patients with Charcot foot are unequivocal: both neuropathy and osteopenia are universal [16,17].…”

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confidence: 99%

Vascular calcification and osteolysis in diabetic neuropathy?is RANK-L the missing link?

Jeffcoate

2004

Diabetologia

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Diabetic neuropathy is associated with osteopenia and calcification of vascular smooth muscle cells. These changes are most marked in patients with acute neuropathic osteoarthropathy (Charcot foot), in which osteopenia is universal and the prevalence of vascular calcification exceeds 90%. While it has been thought that both osteopenia and vascular calcification may be linked to sympathetic denervation with increased peripheral limb perfusion, the cellular mechanism was not clear. However, the recent recognition that the receptor activator of nuclear factor kappa B ligand (RANK-L)/osteoprotegerin (OPG) signalling pathway is central to the processes regulating bone turnover in a wide variety of medical conditions has raised the possibility that the same cytokines may be involved in the osteolysis which accompanies diabetic neuropathy. This is made more likely by the realisation that the RANK-L/OPG pathway is also thought to mediate the calcification of vascular smooth muscle cells in coronary and peripheral vascular disease. The circumstantial evidence underpinning this hypothesis is reviewed here, and it is suggested that the unregulated activation of RANK-L-mediated effects on bone and arteries may be triggered by the loss of nerve-derived peptides, e.g. calcitonin gene-related peptide, which normally exert a moderating influence on the pathway. Keywords

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“…eripheral sensory neuropathy and autonomic dysfunction are accepted prerequisites for the development of Charcot neuroarthropathy (CN) but are also features of diabetic peripheral neuropathy (DPN) (1,2). CN is rare in comparison with DPN, suggesting that additional factors are involved in its pathogenesis.…”

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Microvascular and C-Fiber Function in Diabetic Charcot Neuroarthropathy and Diabetic Peripheral Neuropathy

et al. 2007

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OBJECTIVE -Sympathetic denervation and hyperemia are implicated in the pathogenesis of Charcot neuroarthropathy (CN) but are also features of diabetic peripheral neuropathy (DPN). Differences in these physiological parameters were sought by determining C-fiber function (laser Doppler imager [LDI]flare technique) and maximum microvascular hyperemia (MMH) in 13 subjects with diabetic CN (DCN), 10 subjects with DPN, and 10 healthy control subjects. Additionally, unaffected limbs of the nine DCN subjects with unilateral CN (UCN) were studied to determine whether any observed differences precede CN.RESULTS -LDIflare area was reduced in DPN (mean Ϯ SD 1.41 Ϯ 0.51 cm 2 ) and DCN (1.42 Ϯ 0.37) groups compared with the healthy control group (5.24 Ϯ 1.33; P Ͻ 0.0001). MMH was higher in DCN (432 Ϯ 88 PU [perfusion units]) than in DPN (262 Ϯ 71; P ϭ 0.001) subjects but lower than in the control group (564 Ϯ 112; P Ͻ 0.01). LDIflare area and MMH were similar in the UCN and DCN groups.CONCLUSIONS -C-fiber function is equally impaired in neuropathic patients with and without CN; however, a higher MMH distinguishes those with CN. Unaffected and affected limbs of those with unilateral CN have the same neurovascular abnormalities, suggesting that these abnormalities precede CN and are not a result of CN. Diabetes Care 30:3077-3079, 2007P eripheral sensory neuropathy and autonomic dysfunction are accepted prerequisites for the development of Charcot neuroarthropathy (CN) but are also features of diabetic peripheral neuropathy (DPN) (1,2). CN is rare in comparison with DPN, suggesting that additional factors are involved in its pathogenesis. Small-fiber neuropathy, measured with quantitative sensory testing, has been implicated in its development (3,4). Moreover, a relatively higher maximum microvascular hyperemia (MMH) has been reported (3,4); however, whether this is a result of CN or preexisting is unknown. This study examines these features in greater detail. Small-fiber neuropathy was assessed using the laser Doppler imager (LDI)flare technique (5), a more sensitive test of small-fiber function than quantitative sensory testing. MMH was assessed using the LDImax technique (5). The unaffected foot in those with CN was also studied to determine whether any defects in these measures were preexisting, and therefore etiological, or consequential of CN. RESEARCH DESIGN AND METHODS -Four matched groupswere studied: the DPN group, 10 subjects with type 2 diabetes and neuropathy (aged 67.2 Ϯ 7.1 years, diabetes duration 19 Ϯ 8.1 years, vibration perception threshold [VPT] 30.3 Ϯ 6.0 V); the DCN group, 13 subjects with type 2 diabetes and quiescent CN (aged 65.5 Ϯ 8.7 years, diabetes duration 20 Ϯ 11.3 years, VPT 36.1 Ϯ 9.7 V) (4 with bilateral and 9 with unilateral CN); the unilateral CN (UCN) group, 9 subjects with UCN from the DCN group in whom the unaffected limb was studied (aged 64.7 Ϯ 10.2 years, diabetes duration 21 Ϯ 10.2 years, and VPT 33.5 Ϯ 8.1 V); and the control group, 10 healthy subjects (aged 61.4 Ϯ 9.7 years, VPT 8.0 Ϯ...

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The Charcot foot

Cited by 116 publications

References 48 publications

Audit of acute Charcot’s disease in the UK: the CDUK study

Audit of acute Charcot’s disease in the UK: the CDUK study

Vascular calcification and osteolysis in diabetic neuropathy?is RANK-L the missing link?

Microvascular and C-Fiber Function in Diabetic Charcot Neuroarthropathy and Diabetic Peripheral Neuropathy

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