Update on charcot neuroarthropathy

Abstract

Charcot neuroarthropathy is not uncommon in diabetic patients with peripheral neuropathy. Often, the condition is misdiagnosed for cellulitis or osteomyelitis and treatment is delayed. A high index of suspicion is required in these patients to initiate appropriate treatment early. This article covers the pathogeneses of this condition and briefly describes the recent studies performed to understand the underlying etiopathogenetic factors of this devastating condition. Lastly, it mentions the recently completed multicenter trial using bisphosphonates in diabetic Charcot neuroarthropathy.

The pathogenesis of Charcot neuroarthropathy: current concepts

“…The exact pathogenesis of CN remains elusive; however, it is known that sensory and autonomic neuropathy are prerequisite to begin the process of uncontrolled inflammation through proinflammatory cytokines TNF-alpha and interleukins, unchecked activation of RANKL, and the resulting imbalance of osteoclasts and osteoblasts (16). Neuropathy decreases the available amounts of CGRP and eNOS that in turn activate RANKL.…”

Severe Sensory Neuronopathy in Primary Sjögren Syndrome Resulting in Charcot Arthropathy

“…The patient then presented with painless left foot swelling and was found to have an atraumatic, posterior calcaneal fracture suspicious for a Charcot joint about 2 years after treatment was initiated (Figure 2). Sensory neuropathy, autonomic dysfunction, and loss of protective pain and proprioceptive sensation are thought to predispose a joint to Charcot arthropathy 2,3 . Charcot arthropathy is associated with diabetes mellitus, syringomyelia, spinal cord lesions, cerebral palsy, polio, leprosy, tabes dorsalis, and chronic alcoholism 3 .…”

Infections in the diabetic foot

“…The metatarsal heads become prominent as a result of structural abnormalities including clawing of the toes and increased arching of the foot. Consequent to these changes neuropathic ulcers and arthropathy (Charcots), 12 may develop.…”