Charcot Arthropathy Hanan ElSoutouhy Gawish Prof Int Med

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Charcot Arthropathy. Hanan El-Soutouhy Gawish. Prof Int Med, Diabetes Unit, Mansoura University International Working

Charcot Arthropathy. Hanan El-Soutouhy Gawish. Prof Int Med, Diabetes Unit, Mansoura University International Working Group of Diabetic Foot Egypt Representative Charcot Arthropathy Mansoura 2 nd International DF Training Course

History Mitchell, 1831: The first association between joints and neurological diseases. Charcot 1868: Arthropathy

History Mitchell, 1831: The first association between joints and neurological diseases. Charcot 1868: Arthropathy and tabes dorsalis. Jordan 1936: Neuritic manifestation of DM Charcot Arthropathy Mansoura 2 nd International DF Training Course

Charcot’s Foot A Neuropathic Arthropathy Caused by repetitive trauma in the setting of: •

Charcot’s Foot A Neuropathic Arthropathy Caused by repetitive trauma in the setting of: • Diminished sensation & proprioception • Motor neuropathy results in muscle imbalance & abnormal weight bearing. • “Rocker Bottom Deformity” a convex deformity of the foot’s plantar aspect caused by the collapse of metatarsal bones Charcot Arthropathy Mansoura 2 nd International DF Training Course

Charcot Arthropathy Mansoura 2 nd International DF Training Course

Charcot Arthropathy Mansoura 2 nd International DF Training Course

Charcot Arthropathy Mansoura 2 nd International DF Training Course

Charcot Arthropathy Mansoura 2 nd International DF Training Course

Aetiopathogenesis Ø Peripheral sensory neuropathy is always present +/- motor. Ø Autonomic neuropathy leads

Aetiopathogenesis Ø Peripheral sensory neuropathy is always present +/- motor. Ø Autonomic neuropathy leads to increased blood flow. ( plethysmography & uptake of isotopes). Ø Trauma may be an important precipitating factor, although 2/3 rd of patients don’t remember any injury. Ø Bone metabolism both osteoblastic and osteoclastic activities are increased. Charcot Arthropathy Mansoura 2 nd International DF Training Course

Charcot Arthropathy Mansoura 2 nd International DF Training Course

Charcot Arthropathy Mansoura 2 nd International DF Training Course

Charcot Arthropathy Mansoura 2 nd International DF Training Course

Charcot Arthropathy Mansoura 2 nd International DF Training Course

Epidemiology Ø Incidence : 0. 1 – 0. 5 %. Increased in patients with

Epidemiology Ø Incidence : 0. 1 – 0. 5 %. Increased in patients with neuropathy. Ø Common in the 4 th or 5 th decades of life. Ø Bilateral in 30 % of patients. Ø Sex difference : No Ø Type 1 or type 2: Both are at risk. Ø Majority: in the mid foot but any bone or joint in the foot or ankle can be affected. Charcot Arthropathy Mansoura 2 nd International DF Training Course

Clinical Features and Diagnosis Acute Charcot Ø Warm, inflamed and swollen. Ø Misdiagnosed as

Clinical Features and Diagnosis Acute Charcot Ø Warm, inflamed and swollen. Ø Misdiagnosed as cellulitis, osteomyelitis or inflammatory arthropathy as gouty or septic. Ø Although sensory neuropathy, pain is common feature followed by discomfort. Ø Diagnosis by exclusion as investigations in early stages are negative. Charcot Arthropathy Mansoura 2 nd International DF Training Course

Clinical Features and Diagnosis High index of suspicion is necessary so that appropriate treatment

Clinical Features and Diagnosis High index of suspicion is necessary so that appropriate treatment is immediately instituted to prevent severe deformity! Charcot Arthropathy Mansoura 2 nd International DF Training Course

Clinical Features and Diagnosis Chronic Charcot, may be months, painless, without temperature difference and

Clinical Features and Diagnosis Chronic Charcot, may be months, painless, without temperature difference and deformed. Ø Reactivation by further trauma is frequent. Ø Patients are at high risk of ulceration and amputation, so long term follow up is recommended. Charcot Arthropathy Mansoura 2 nd International DF Training Course

Investigations Ø X-ray : Early; absent or subtle finding. Late; bone and joint destruction,

Investigations Ø X-ray : Early; absent or subtle finding. Late; bone and joint destruction, fragmentation. Ø Tc bisphonate bone scan: Increased bone uptake. Ø In labeled leucocytes scan to differentiate from osteomyelitis. Ø MRI: Bone marrow oedema is the earliest sign. Charcot Arthropathy Mansoura 2 nd International DF Training Course

Treatment 1. 2. 3. 4. Immobilization Radiotherapy and Ultrasound. Pharmacological Treatment. Surgical Treatment. Charcot

Treatment 1. 2. 3. 4. Immobilization Radiotherapy and Ultrasound. Pharmacological Treatment. Surgical Treatment. Charcot Arthropathy Mansoura 2 nd International DF Training Course

Treatment 1. Immobilization: Total Contact Cast (TCC), Removable Cast Walker (RCW). Charcot Arthropathy Mansoura

Treatment 1. Immobilization: Total Contact Cast (TCC), Removable Cast Walker (RCW). Charcot Arthropathy Mansoura 2 nd International DF Training Course

Removable Cast Walker Charcot Arthropathy Mansoura 2 nd International DF Training Course

Removable Cast Walker Charcot Arthropathy Mansoura 2 nd International DF Training Course

Treatment 1. Immobilization: Almost 16 weeks (3 -6 months) but may be more. (temp

Treatment 1. Immobilization: Almost 16 weeks (3 -6 months) but may be more. (temp gradient less than 1 on 2 occasions or radiology). Charcot Arthropathy Mansoura 2 nd International DF Training Course

Treatment 2. Radiotherapy and Ultrasound: May be useful in conjunction to offloading but only

Treatment 2. Radiotherapy and Ultrasound: May be useful in conjunction to offloading but only few small studies. Charcot Arthropathy Mansoura 2 nd International DF Training Course

Treatment 3. Pharmacological Treatment. ü Pilot study first using pamidronate, 1994. Other Bisphonates were

Treatment 3. Pharmacological Treatment. ü Pilot study first using pamidronate, 1994. Other Bisphonates were used to decrease disease activity and bone turnover markers. ü Calcitonin were also used. ü Given for 12 weeks or till temp gradient is less than 2 on 2 consecutive visits. Charcot Arthropathy Mansoura 2 nd International DF Training Course

Treatment 4. Surgical treatment: No role in acute. Later may be to remove bony

Treatment 4. Surgical treatment: No role in acute. Later may be to remove bony deformities or constructive surgeries to achieve a stable shape. Techniques include; Arthrodesis, exostectomies, reconstruction and Achilles tendon lengthening. Charcot Arthropathy Mansoura 2 nd International DF Training Course

Charcot Arthropathy Mansoura 2 nd International DF Training Course

Charcot Arthropathy Mansoura 2 nd International DF Training Course

Charcot Arthropathy Mansoura 2 nd International DF Training Course

Charcot Arthropathy Mansoura 2 nd International DF Training Course

Charcot Arthropathy Mansoura 2 nd International DF Training Course

Charcot Arthropathy Mansoura 2 nd International DF Training Course

Charcot Arthropathy Mansoura 2 nd International DF Training Course

Charcot Arthropathy Mansoura 2 nd International DF Training Course

Conclusion Ø High degree of suspicion to diagnose acute Charcot arthropathy. Ø High risk

Conclusion Ø High degree of suspicion to diagnose acute Charcot arthropathy. Ø High risk categorization. Ø Immobilization and Bisphonate. Charcot Arthropathy Mansoura 2 nd International DF Training Course

Thank You Charcot Arthropathy Mansoura 2 nd International DF Training Course

Thank You Charcot Arthropathy Mansoura 2 nd International DF Training Course

Gihan Gawish Dr Dr Gihan Gawish Coagulation CoagulationGihan Gawish Dr Dr Gihan Gawish Coagulation Coagulation
Charcot Arthropathy Mark A Cowley Baker College VascularCharcot Arthropathy Mark A Cowley Baker College Vascular
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