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Charcot joint; Charcot foot; Charcot arthropathy

A severe form of osteoarthritis (joint degeneration) from loss of pain sensation &/or proprioception [3]. Etiology: 1) diabetes mellitus 2) tabes dorsalis (syphilis) 3) syringomyelia 4) meningomyelocele 5) leprosy 6) congenital indifference to pain 7) frequent, repeated corticosteroid injections Pathology: 1) repeated trauma to joint 2) progressive cartilage damage 3) resorption (demineralization) of tarsals, metatarsals & phalanges in diabetics 4) demineralization leads to fracture, subluxation, & dislocation 5) bony overgrowth 6) synovial effusion Clinical manifestations: 1) relatively painless - painless swelling of the foot & lower leg [8] - pain suggests neuropathy [4] 2) severe deformity - Charcot foot unlikely if foot not structurally abnormal [4] - foot may not yet be deformed in early stage [8] - collapsed arch pes planus in later stage - appearance of a rocker bottom plantar foot in chronic phase [8] 3) joint instability 4) hypermobility of joint 5) crepitus 6) skin temperature may be higher on affected side [8] 7) no erythema [8] 8) loose bodies may be palpated in joint cavity 9) generally begins in a single joint & extends to involve other joints 10) may evolve rapidly to totally disorganized joint in weeks to months 11) distribution of joint involvement a) diabetes mellitus - tarsal & tarsometatarsal joints b) syringomyelia - glenohumeral, elbow, wrist c) tabes dorsalis - knees, hips, ankles Laboratory: - synovial fluid is generally non-inflammatory Radiology: 1) typical features of osteoarthritis early in the disease 2) marked joint destruction & hypertrophic changes occur as disease progresses 3) large, bizarre osteophytes 4) intra-articular bone fragments 5) osteopenia 6) may be difficult to distinguish from osteomyelitis a) sharp cortical margins in Charcot's disease b) bone margins less distinct in osteomyelitis Compllications: - often the first outward evidence is formation of a pressure injury over a new plantar prominence - pressure injury complicates diagnosis & management because of a potential for soft tissue infection, skin infection or osteomyelitis [8] Management: 1) non-weight-bearing for 8 weeks (Charcot's foot in a diabetic) 2) shoe care 3) pain control 4) surgery

Related

Charcot, J.M.

General

osteoarthritis (OA) neurogenic arthritis (neurogenic arthropathy)

References

  1. DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 873
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  3. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 1952
  4. NEJM Question of the Week. Oct 10, 2017 https://knowledgeplus.nejm.org/question-of-week/1405/
  5. Schmidt BM, Holmes CM. Updates on diabetic foot and Charcot osteopathic arthropathy. Curr Diab Rep 2018 Aug 15; 18:74 PMID: 30112582
  6. Trieb K. The Charcot foot: pathophysiology, diagnosis and classification. Bone Joint J 2016 Sep; 98-B:1155 PMID: 27587513
  7. Marmolejo VS, Arnold JF, Ponticello M, Anderson CA.. Charcot foot: clinical clues, diagnostic strategies, and treatment principles. Am Fam Physician 2018 May 1; 97:594 PMID: 29763252 Free full text
  8. Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022