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Carro GV, Ricci A, Torterola I, Saurral R, Portillo V, Amato PS, Breppe P, Rosito B, Flores B, Ortiz MT. Differential Diagnosis of Charcot Neuroarthropathy in Subacute and Chronic Phases: Unusual Diseases. INT J LOW EXTR WOUND 2024; 23:181-190. [PMID: 34779675 DOI: 10.1177/15347346211054326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Charcot Neuroarthropaty (CN) is a complication of diabetes with devastating consequences as it produces severe deformities in the foot developing in recurrent ulcers that rise the probability of amputation. There are several diseases mentioned in the literature that have to be considered for the differential diagnosis of CN, often related to the acute phase (gout, ankle sprain, inflammatory arthritis, cellulitis, venous thrombosis) but there is paucity of information related to the differential diagnosis in later stages (coalescence, remodeling) when there is deformity of the foot. Clinicians and diabetologists are not familiarized with orthopedic pathology and do not have in mind certain diseases that could mimic CN in the subacute or chronic phases and this can develop in a wrong diagnosis. It is important to make a correct diagnosis in patients with suspected CN not only in the acute phase but also in the chronic phase to establish an accurate treatment. This article is a review of the differential diagnosis of CN in subacute and chronic phases showing similarities and differences that can help clinicians and diabetologists to make an accurate diagnosis and treatment. We describe unusual diseases like tendon and muscles disorders, Frieberg's disease, complex pain regional syndrome, transient regional osteoporosis and osteomyelitis superimposed to CN and the main features of each one that could help in making a differential diagnosis.
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Affiliation(s)
| | - Anahí Ricci
- Hospital Nacional Prof. A. Posadas, Argentina
| | | | - Rubén Saurral
- Hospital Municipal de Trauma y Emergencias Dr Federico Abete, Buenos Aires, Argentina
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Luo Z, Ding X, Yuan Y, Hou L. Rare complication of rheumatoid arthritis: Charcot Neuro-osteoarthropathy. BMC Musculoskelet Disord 2024; 25:340. [PMID: 38685038 PMCID: PMC11057095 DOI: 10.1186/s12891-024-07424-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/08/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is an autoimmune disease.However, there are few cases of Charcot Neuro-osteoarthropathy (CN) caused by rheumatoid diseases in clinical reports. It is not easy to pay attention to the diagnosis of CN in the complications of rheumatoid disease, which greatly increases the probability of misdiagnosis and missed diagnosis. This case reported a rare complication of rheumatoid arthritis, Charcot arthritis, and the molecular mechanism and diagnosis and treatment of CN caused by RA were systematically discussed. CASE PRESENTATION The patient, a 79-year-old woman, was hospitalized due to bilateral shoulder pain, limited activity for half a year, aggravated for 4 months to the hospital. During this period, the symptoms did not improve after treatment with acupuncture and Chinese medicine. The patient was previously diagnosed with rheumatoid arthritis for more than 3 years and intermittent irregular use of methylprednisolone and methotrexate for 2 years. She had a history of osteoporosis. PHYSICAL EXAMINATION symmetrical malformed swelling of the finger joints of both hands; Bilateral supraspinatus and deltoid muscle atrophy, tenderness at the acromion, and attachment of the long head tendon of the biceps brachii were observed. The left Dugas test and the right Dugas test were positive.Blood test: anti-cyclic citrullinated peptide antibody (A-CCP) 33.10U/ml (normal range: 0-5RU/ml); antinuclear antibody quantification (ANA) 47.40AU/ml (normal range: Negative or < 32); anti-double stranded DNA IgG antibody quantification (dsDNA) 31.00 IU/ml (normal range: 0-100 IU/ml); D-Dimer 6.43 µg/ml (normal range: 0-0.5 mg/L); erythrocyte sedimentation rate (ESR) was 27 mm/h (normal range: < 20 mm/60 min). C-reactive protein (CRP) 39.06 mg/L(0.068-8 mg/L).MRI 3.0 T enhancement of bilateral shoulder joints, cervical spine and thoracic spine showed: 1.Large bone destruction, cartilage injury, multiple effusion, synovitis, obvious on the right side. 2.Intervertebral disc degeneration, cervical 3/4, 4/5, 5/6, 6/7 disc herniation, with cervical 3/4 obvious, posterior central herniation; CONCLUSIONS: Rheumatoid arthritis complicated with Charcot's joint is rare. Clinically, patients with rheumatoid diseases should not ignore Charcot's joint complications because of rareness. Early blood inflammatory markers, neuro electrophysiology, and imaging MRI of rheumatoid CN are of great significance for the diagnosis of this mild or early neurovascular inflammation. Early diagnosis and treatment are helpful to prevent further joint injury. The clinical diagnosis, treatment, and molecular mechanism of osteolysis in RA and peripheral sensory nerve injury remain to be further revealed.
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Affiliation(s)
- Zhiyuan Luo
- The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan, Guangdong, China
| | - Xinxiang Ding
- The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan, Guangdong, China
| | - Yu Yuan
- The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan, Guangdong, China
| | - Lei Hou
- The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan, Guangdong, China.
- Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, China.
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Early JS. Management of the Hindfoot and Ankle in
Charcot Arthropathy. Instr Course Lect 2024; 73:221-230. [PMID: 38090900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Neuropathic destabilization of the hindfoot and/or ankle is a significant complication for the patient with diabetes/neuropathy. The loss of ligamentous integrity and bony destruction results in a limb that is not stable for weight bearing. This loss of independence adds significant health risks to the patient. Management of this disease process is both time consuming and technically demanding for both the practitioner and the patient. Attention to detail and aggressive decision making is often necessary to salvage the limb. The goal for treatment is to produce a stable, weight-bearing limb that is shoeable and free from soft-tissue ulceration.
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Pinzur MS. Management of Infections and Osteomyelitis in
Patients With Charcot Foot Arthropathy. Instr Course Lect 2024; 73:263-267. [PMID: 38090903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
There is growing interest in performing reconstruction of deformities associated with Charcot foot arthropathy. At least half of the patients undergoing this reconstruction will have chronic wounds and osteomyelitis overlying the deformity. It is important to provide orthopaedic surgeons with tools for making the diagnosis of osteomyelitis in this patient population and creating a strategy for treatment.
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Kii S, Sonohata M, Mawatari M. Total knee arthroplasty for neuropathic arthropathy in a patient with leprosy. Mod Rheumatol Case Rep 2023; 8:219-223. [PMID: 37862242 DOI: 10.1093/mrcr/rxad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 10/22/2023]
Abstract
Patients with leprosy are known to tend to develop neuropathic arthropathy, known as Charcot joint. There are no case reports of total knee arthroplasty (TKA) in patients with leprosy with polyarticular neuropathic arthropathy, and the results are unknown. In this study, we report a case of TKA in a patient with leprosy with polyarticular neuropathic arthropathy and discuss its outcomes and indications. Right TKA using the NexGen Legacy Constrained Condylar Knee implant was performed in a 62-year-old man with neuropathic arthropathy in multiple joints with clinical symptoms, particularly in the right knee. Seven years post-operation, the American Knee Society Score-knee and -function, which represent knee function and activities of daily living on a scale of 100 points, were significantly improved compared with preoperative values, from 30 to 99 points and 0 to 60 points, respectively. Indications for arthroplasty for neuropathic arthropathy should be carefully considered in each individual case. In this case, the patient had neuropathic arthropathy in multiple joints; however, TKA was performed because recovery of function in the right knee was expected to significantly improve the patient's activities of daily living, and a good mid-term clinical outcome was achieved. Therefore, indications for arthroplasty should be considered in patients with systemic neuropathic arthropathy such as leprosy, and with accurate assessment and appropriate implant selection, good long-term outcomes may be expected.
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Affiliation(s)
- Sakumo Kii
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Motoki Sonohata
- Department of Orthopaedic Surgery, Saga Central Hospital, Saga, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
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Bertero G, Wetzel-Weaver A, Jordan X. Early Diagnosis of Late-Onset Below-Level Neuropathic Pain in an 83 Year-Old Incomplete Tetraplegic Patient: A Charcot Spinal Neuro-Arthropathy Case Report. Am J Case Rep 2023; 24:e940830. [PMID: 38151858 PMCID: PMC10763639 DOI: 10.12659/ajcr.940830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 11/24/2023] [Accepted: 10/25/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Charcot spine (CS), also called neuropathic arthropathy, appears to be triggered by damage to the nervous system (either central or peripheral) impairing proprioception and pain/temperature sensation in the vertebral column. Therefore, the defense mechanisms of altered joints lead to a progressive degeneration of the vertebral joint and surrounding ligaments, which can provoke major spinal instability. Beyond the sensory aspects, mechanic factors are identified as risk factors. While its etiology and pathophysiology remain contested, CS represents a rare and difficult pathology to diagnose at an early stage, owing to its nonspecific clinical symptoms. The diagnosis of CS is probably still underestimated and often occurs only quite late in the disease course. CASE REPORT An 83-year-old male patient who had a history of a post-traumatic tetraplegia was diagnosed with CS after 3 years, after describing a recent progressive worsening of neuropathic pain. The diagnosis was earlier than the majority of cases described in the literature. Indeed, in a recent review, the mean time lag between the onset of neurological impairment and the diagnosis of CS was 17.3±10.8 years. CONCLUSIONS This case report demonstrates the benefits of early diagnosis of CS when confronted by the clinical and radiological criteria. Therefore, it seems important to be able to evoke this neuropathic spinal arthropathy sufficiently in time to prevent its disabling consequences in patients with spinal cord injury, in terms of quality of life and independence.
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Affiliation(s)
- Giulio Bertero
- Orthopaedic Rehabilitation Unit, Romande Rehabilitation Clinic, Sion, Switzerland
| | - Audrey Wetzel-Weaver
- Neurologic Rehabilitation Unit, Romande Rehabilitation Clinic, Sion, Switzerland
- Rehabilitation Department, Fribourg Hospital, Fribourg, Switzerland
| | - Xavier Jordan
- Spinal Cord Rehabilitation Unit, Romande Rehabilitation Clinic, Sion, Switzerland
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Gutteck N, Delank KS, Schilde S. Comparative results of arthroscopic ankle arthrodesis vs. open arthrodesis in patients with diabetes-associated Charcot Neuro-Arthropathy. Eur J Orthop Surg Traumatol 2023; 33:3577-3584. [PMID: 37245183 PMCID: PMC10225040 DOI: 10.1007/s00590-023-03592-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/14/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Several studies demonstrated a considerable complication rate for open ankle or TTC arthrodesis in patients with diabetes, revision surgery and ulceration. Extensive approaches in combination with multimorbide patients have been suggested as the rationale behind the increased complication rate. METHODS Single-centre, prospective case-control study compared arthroscopic vs. open ankle arthrodesis in patients with Charcot Neuro-Arthropathy of the foot. 18 patients with septic Charcot Neuro-Arthropathy Sanders III-IV received an arthroscopic ankle arthrodesis with TSF (Taylor Spatial Frame®) fixation combined with different additional procedures required for infect treatment and hindfoot realignment. The ankle arthrodesis was required for the realignment of the hindfoot in Sanders IV patients, arthritis or in case of infection. 12 patients were treated with open ankle arthrodesis and TSF fixation combined with various additional procedures. RESULTS A significant improvement has been shown in radiological data in both groups. A significant lower complication rate has been registered in arthroscopic group. A significant correlation was seen between major complications and therapeutic anticoagulation as well as smoking. CONCLUSION In high-risk patients with diabetes and plantar ulceration excellent results could be demonstrated in arthroscopically performed ankle arthrodesis with midfoot osteotomy using TSF as fixation devise.
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Affiliation(s)
- Natalia Gutteck
- Department of Orthopaedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube str. 40, 06120, Halle, Germany.
| | - Karl-Stefan Delank
- Department of Orthopaedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube str. 40, 06120, Halle, Germany
| | - Sebastian Schilde
- Department of Orthopaedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube str. 40, 06120, Halle, Germany
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Shi X, Li P, Wang L, Zhang J. Multi-joint Charcot arthropathy caused by cervical spondylotic myelopathy and adult degenerative scoliosis with syringomyelia: a case report. Br J Neurosurg 2023; 37:1843-1849. [PMID: 34184598 DOI: 10.1080/02688697.2021.1940861] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Charcot arthropathy, also known as neuropathic arthropathy, is a rare disease whose early diagnosis and treatment are very difficult. Generally, diabetes is considered the most common cause of Charcot arthropathy. Although Charcot arthropathy of other secondary etiology has been reported, in most cases only a single joint is accumulated, and rarely involving the feet and shoulders. Clinically, Charcot arthropathy due to delayed diagnosis leads to joint destruction and severe cases abound. CASE PRESENTATION What we report is an unprecedented case, in which the patient was diagnosed as left shoulder joint, interdigital joint Charcot arthropathy caused by cervical spondylotic myelopathy (CSM) and left knee and right ankle Charcot arthropathy caused by adult degenerative scoliosis (ADS) complicated by syringomyelia. The 82-year-old male patient was admitted to the hospital for complaining of pain in the left knee joint. Except for scoliosis that was discovered 10 years ago, the patient denied any other obvious past medical history. Clinical/surgical manifestations, detailed physical examinations and auxiliary examinations all indicated the presence of polyarticular Charcot arthropathy, but common causes of Charcot arthropathy such as diabetes and syphilis have not been detected. After making a comprehensive differential diagnosis, we finally made the above diagnosis. CONCLUSIONS This previously unreported case describes the complexity and etiological diversity of Charcot arthropathy. We recommend that patients with CSM and/or scoliosis, spinal deformity undergo further examination and regular follow-up. A detailed medical history and careful physical examination are necessary for the correct diagnosis of Charcot arthropathy. Although the early diagnosis of Charcot arthropathy cannot change the natural course of the disease, it is beneficial to alleviate symptoms and prevent serious complications.
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Affiliation(s)
- Xin Shi
- Department of Orthopedics, Shangqiu Yadong Hospital, Shangqiu, China
- University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Panpan Li
- University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Radiology, Shangqiu Yadong Hospital, Shangqiu, China
| | - Lanying Wang
- Department of Nursing, First People's Hospital of Shangqiu, Shangqiu, China
| | - Jia Zhang
- Department of Computed Tomography, Xuzhou Center Hospital, Xuzhou, China
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岳 洋, 冯 慧, 刘 培, 刘 亮, 梁 景, 梁 晓, 赵 宏. [Progress in clinical diagnosis and treatment of diabetic Charcot neuroarthropathy of foot and ankle]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2023; 37:1438-1443. [PMID: 37987057 PMCID: PMC10662415 DOI: 10.7507/1002-1892.202307068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/26/2023] [Accepted: 09/26/2023] [Indexed: 11/22/2023]
Abstract
Objective To summarize the progress of clinical diagnosis and treatment of diabetic Charcot neuroarthropathy (CNO) of foot and ankle to provide reference for clinical treatment. Methods The research literature on diabetic CNO of foot and ankle at home and abroad was widely reviewed, and the stages and classification criteria of CNO were summarized, and the treatment methods at different stages of the disease course were summarized. Results CNO is a rapidly destructive disease of bone and joint caused by peripheral neuropathy, which leads to the formation of local deformities and stress ulcers due to bone and joint destruction and protective sensory loss, which eventually leads to disability and even life-threatening. At present, the modified Eichenholtz stage is a commonly used staging criteria for CNO of foot and ankle, which is divided into 4 stages by clinical and imaging manifestations. The classification mainly adopts the modified Brodsky classification, which is divided into 6 types according to the anatomical structure. The treatment of diabetic CNO of foot and ankle needs to be considered in combination with disease stage, blood glucose, comorbidities, local soft tissue conditions, degree of bone and joint destruction, and whether ulcers and infections are present. Conservative treatment is mainly used in the active phase and surgery in the stable phase. Conclusion The formulation of individualized and stepped treatment regimens can help improve the effectiveness of diabetic CNO of foot and ankle. However, there is still a lack of definitive clinical evidence to guide the treatment of active and stable phases, and further research is needed.
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Affiliation(s)
- 洋 岳
- 西安医学院(西安 710016)Xi’an Medical University, Xi’an Shaanxi, 710016, P. R. China
| | - 慧 冯
- 西安医学院(西安 710016)Xi’an Medical University, Xi’an Shaanxi, 710016, P. R. China
| | - 培珑 刘
- 西安医学院(西安 710016)Xi’an Medical University, Xi’an Shaanxi, 710016, P. R. China
| | - 亮 刘
- 西安医学院(西安 710016)Xi’an Medical University, Xi’an Shaanxi, 710016, P. R. China
| | - 景棋 梁
- 西安医学院(西安 710016)Xi’an Medical University, Xi’an Shaanxi, 710016, P. R. China
| | - 晓军 梁
- 西安医学院(西安 710016)Xi’an Medical University, Xi’an Shaanxi, 710016, P. R. China
| | - 宏谋 赵
- 西安医学院(西安 710016)Xi’an Medical University, Xi’an Shaanxi, 710016, P. R. China
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Rich MD, Ward CM. Charcot Arthropathy of the Digit: A Report of 2 Cases. JBJS Case Connect 2023; 13:01709767-202312000-00042. [PMID: 38064585 DOI: 10.2106/jbjs.cc.23.00315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
CASE Charcot arthropathy (CA) is a progressive degenerative joint disease typically affecting lower extremity weight-bearing joints, with only a few cases reported in the fingers. We present 2 cases of interphalangeal joint CA: the long finger distal interphalangeal joint in a 73-year-old man with severe carpal tunnel syndrome and the ring finger proximal interphalangeal joint of a 71-year-old woman with diabetic neuropathy. CONCLUSION Two cases of CA of the digits were treated with splinting with resolution of symptoms and no wound complications.
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Affiliation(s)
- Matthew D Rich
- Division of Plastic Surgery, Regions Hospital, University of Minnesota, St. Paul, Minnesota
| | - Christina M Ward
- Department of Orthopaedics, Regions Hospital, University of Minnesota, St. Paul, Minnesota
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Coe C, Chirputkar K, Joseph L, Jude EB. Pedal acrometastasis secondary to urothelial carcinoma masquerading as Charcot arthropathy in a patient with diabetes. BMJ Case Rep 2023; 16:e254468. [PMID: 37730428 PMCID: PMC10514597 DOI: 10.1136/bcr-2022-254468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
A woman in her 80s with known diabetes mellitus and bladder cancer presented to her general practitioner (GP) with pain and swelling in her left foot following trauma. Initial radiographs were reported as normal, prompting a diagnosis of a simple sprain and conservative management. Three months later, the patient was referred to the orthopaedic team due to progressively increasing pain and swelling. Repeat X-rays revealed lytic lesions in both the talus and navicular bones; MRI confirmed the presence of a lytic and proliferative defect in the mid-foot, which was reported as acute Charcot arthropathy with superimposed infection. This was also considered the most likely diagnosis when imaging was reviewed in two separate multidisciplinary team) meetings. However, biopsy demonstrated that the cause of the presentation was in fact acrometastasis from urothelial carcinoma, an infrequently described entity.
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Affiliation(s)
- Calvin Coe
- Endocrinology and Diabetes, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Kedar Chirputkar
- Trauma and Orthopaedic Surgery, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Leena Joseph
- Histopathology, Manchester University NHS Foundation Trust, Manchester, UK
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Huynh TM, Pilkey B, Trepman E, Dascal M, Dascal R, Embil JMA. Charcot arthropathy outcomes after early referral to a regional tertiary care foot clinic. Can J Surg 2023; 66:E513-E519. [PMID: 37875304 PMCID: PMC10609890 DOI: 10.1503/cjs.006022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Community physicians may not encounter Charcot arthropathy frequently, and its symptoms and signs may be nonspecific. Patients often have a delay of several months before receiving a formal diagnosis and referral for specialty care. However, limited Canadian data are available. We evaluated the clinical history, treatment and outcomes of patients treated for Charcot arthropathy after prompt referral and diagnosis. METHODS We performed a retrospective chart review of 76 patients with diabetes (78 feet) who received nonoperative treatment for Charcot arthropathy in a specialty foot clinic between Jan. 20, 2009, and Mar. 26, 2018. Patients were referred to the foot clinic by community physicians for evaluation or were pre-existing patients at the foot clinic with new-onset Charcot arthropathy. RESULTS Of the 78 feet included in our analyses, 52 feet (67%) were evaluated initially by a community physician and referred to the foot clinic, where they were seen within 3 ± 5 weeks. The remaining 26 feet (33%) were already being treated at the foot clinic. Most feet had swelling, erythema, warmth, a palpable pulse and loss of protective sensation. Ulcers were present initially in 23 feet (29%). Sixty-four feet (82%) with Charcot arthropathy were in Eichenholtz classification stage 1 and most had midfoot involvement. Nonoperative treatment included total contact casting (60 feet, 77%). Mean duration of nonoperative treatment until resolution for 55 feet (71%) was 6 ± 5 months. Surgery was performed on 20 feet (26%) for the treatment of infection and recurrent ulcer associated with deformity, including 6 (8%) lower limb amputations. CONCLUSION Charcot arthropathy may resolve in most feet with early referral and nonoperative treatment, but remains a limb-threatening condition.
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Affiliation(s)
- Tiffany M Huynh
- Department of Surgery, Section of Orthopedic Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Huynh, Pilkey, M. Dascal); Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Trepman, Embil); Faculty of Medicine, University of Manitoba, Winnipeg, Man. (R. Dascal); Section of Infectious Diseases, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Embil)
| | - Brad Pilkey
- Department of Surgery, Section of Orthopedic Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Huynh, Pilkey, M. Dascal); Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Trepman, Embil); Faculty of Medicine, University of Manitoba, Winnipeg, Man. (R. Dascal); Section of Infectious Diseases, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Embil)
| | - Elly Trepman
- Department of Surgery, Section of Orthopedic Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Huynh, Pilkey, M. Dascal); Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Trepman, Embil); Faculty of Medicine, University of Manitoba, Winnipeg, Man. (R. Dascal); Section of Infectious Diseases, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Embil)
| | - Mario Dascal
- Department of Surgery, Section of Orthopedic Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Huynh, Pilkey, M. Dascal); Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Trepman, Embil); Faculty of Medicine, University of Manitoba, Winnipeg, Man. (R. Dascal); Section of Infectious Diseases, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Embil)
| | - Roman Dascal
- Department of Surgery, Section of Orthopedic Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Huynh, Pilkey, M. Dascal); Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Trepman, Embil); Faculty of Medicine, University of Manitoba, Winnipeg, Man. (R. Dascal); Section of Infectious Diseases, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Embil)
| | - John M A Embil
- Department of Surgery, Section of Orthopedic Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Huynh, Pilkey, M. Dascal); Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Trepman, Embil); Faculty of Medicine, University of Manitoba, Winnipeg, Man. (R. Dascal); Section of Infectious Diseases, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Embil)
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Kocyigit BF, Kızıldağ B. Neuropathic arthropathy of the shoulder secondary to operated syringomyelia: a case-based review. Rheumatol Int 2023; 43:777-790. [PMID: 36271191 DOI: 10.1007/s00296-022-05234-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/08/2022] [Indexed: 11/11/2022]
Abstract
Neuropathic arthropathy (NA) is a long-term progressive disorder that causes joint destruction in the existence of a neurologic deficit. Minor injuries and fractures are commonly overlooked until the visible joint deterioration becomes persistent. Syringomyelia is one of the important causes of NA. The appearance of clinical signs in syringomyelia is caused by longitudinal cysts formed in the cervical and cervicothoracic regions of the spinal cord. Depending on the existence of the underlying disorder, the number and localization of the syrinxes, a range of symptoms, involving pain, sensation deficit, loss of motor function, and deep tendon reflex abnormality, emerge. The case is here described of a 68-year-old female patient with shoulder NA following syringomyelia, who partially responded to the rehabilitation program. Furthermore, the available case reports were comprehensively reviewed on Web of Science, Scopus, and PubMed/Medline. Furthermore, the available case reports were comprehensively evaluated on Web of Science, Scopus, and PubMed/Medline. Thus, we aimed to present the demographic characteristics, symptoms, physical examination signs, treatment, and follow-up parameters of syringomyelia-related shoulder NA cases.
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Affiliation(s)
- Burhan Fatih Kocyigit
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey.
| | - Betül Kızıldağ
- Department of Radiology, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
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14
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Byrne R, Forde H, Smith D. Acute Charcot arthropathy as a first presentation of type 2 diabetes mellitus. BMJ Case Rep 2023; 16:e253544. [PMID: 36805878 PMCID: PMC9943911 DOI: 10.1136/bcr-2022-253544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Charcot arthropathy in people with diabetes is generally seen when diabetes has been well established, and therefore it is not routinely considered as a differential diagnosis in people presenting with erythematous and oedematous joints in primary care. We present two cases of acute Charcot arthropathy as a first presentation of type 2 diabetes mellitus. The first case describes a man in his 70s, who presented with a 5-week history of right foot pain, treated initially in the community as cellulitis. A diagnosis of acute Charcot arthropathy was made in the emergency department following review by the orthopaedic and podiatry department. The second case describes a woman in her 40s who presented with a 2-week history of ankle pain. Charcot arthropathy is associated with significant morbidity and mortality, and these cases highlight the importance of including Charcot arthropathy in the differential diagnosis when people present with atypical joint swelling.
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Affiliation(s)
- Ruth Byrne
- Department of Medicine, Beaumont Hospital, Dublin, Ireland
| | - Hannah Forde
- Department of Diabetes and Endocrinology, Beaumont Hospital, Dublin, Ireland
| | - Diarmuid Smith
- Department of Diabetes and Endocrinology, Beaumont Hospital, Dublin, Ireland
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15
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Hegde A, Kamath SH, Mane PP, Shetty CB. Case of bilateral hip joint Charcot arthropathy in a paediatric patient. BMJ Case Rep 2023; 16:e252420. [PMID: 36593076 PMCID: PMC9809251 DOI: 10.1136/bcr-2022-252420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
An adolescent girl came with swelling of both thighs with difficulty in walking for a few months. Based on clinical, and radiological evaluation and nerve conduction studies, she was diagnosed to be having bilateral hips Charcot's arthropathy due to hereditary sensory autonomic neuropathy type 4. Other common causes of Charcot arthropathy were ruled out. The patient was conservatively managed and parents were educated about preventive measures. Through this case report, we want to highlight the myriad number of manifestations and clinical presentations of a child presenting with hereditary sensory autonomic neuropathy type 4.
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Affiliation(s)
- Atmananda Hegde
- Department of Orthopaedics, Kasturba Medical College Mangalore, Manipal Academy of Higher Education (MAHE), Manipal, Mangalore, Karnataka, India
| | - Shruthi H Kamath
- Kasturba Medical College Mangalore, Manipal Academy of Higher Education(MAHE), Manipal, Mangalore, Karnataka, India
| | - Prajwal Prabhudev Mane
- Department of Orthopaedics, Kasturba Medical College Mangalore, Manipal Academy of Higher Education (MAHE), Manipal, Mangalore, Karnataka, India
| | - Chethan B Shetty
- Department of Orthopaedics, Kasturba Medical College Mangalore, Manipal Academy of Higher Education (MAHE), Manipal, Mangalore, Karnataka, India
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16
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Kim SH, Kim WJ, Park ES, Kim JY, Lee YK. Iatrogenic Ankle Charcot Neuropathic Arthropathy after Spinal Surgery: A Case Report and Literature Review. Medicina (B Aires) 2022; 58:medicina58121776. [PMID: 36556978 PMCID: PMC9785748 DOI: 10.3390/medicina58121776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/05/2022] Open
Abstract
Charcot neuropathic arthropathy is a relatively rare, chronic disease that leads to joint destruction and reduced quality of life of patients. Early diagnosis of Charcot arthropathy is essential for a good outcome. However, the diagnosis is often based on the clinical course and longitudinal follow-up of patients is required. Charcot arthropathy is suspected in patients with suggestive symptoms and an underlying etiology. Failed spinal surgery is not a known cause of Charcot arthropathy. Herein we report a patient with ankle Charcot neuropathic arthropathy that developed after failed spinal surgery. A 58-year-old man presented to the emergency room due to painful swelling of the left ankle for 2 weeks that developed spontaneously. He underwent spinal surgery 8 years ago that was associated with nerve damage, which led to weakness of great toe extension and ankle dorsiflexion, and sensory loss below the knee. CT and T2-weighted sagittal MRI showed a fine erosive lesion, subluxation, sclerosis, fragmentation, and large bone defects. Based on the patient's history and radiological findings, Charcot arthropathy was diagnosed. However, the abnormal blood parameters, positive blood cultures, and severe pain despite the decreased sensation suggested a diagnosis of septic arthritis. Therefore, diagnostic arthroscopy was performed. The ankle joint exhibited continued destruction after the initial surgery. Consequently, several repeat surgeries were performed over the next 2 years. Despite the early diagnosis and treatment of Charcot arthropathy, the destruction of the ankle joint continued. Given the chronic disease course and poor prognosis of Charcot arthropathy, it is essential to consider this diagnosis in patients with neuropathy.
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Affiliation(s)
- Sung Hwan Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, 170, Jomaru-ro, Wonmi-gu, Bucheon-si 14584, Republic of Korea
| | - Woo-Jong Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Sooncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea
| | - Eun Seok Park
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, 170, Jomaru-ro, Wonmi-gu, Bucheon-si 14584, Republic of Korea
| | - Jun Yong Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, 170, Jomaru-ro, Wonmi-gu, Bucheon-si 14584, Republic of Korea
| | - Young Koo Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, 170, Jomaru-ro, Wonmi-gu, Bucheon-si 14584, Republic of Korea
- Correspondence:
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17
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Benard T, Lequint C, Jugnet AC, Bouly M, Winther T, Penfornis A, Dardari D. Delayed Diagnosis of Bilateral Neuroarthropathy: Serious Impact on the Development of Charcot's Foot, a Case Report. Medicina (Kaunas) 2022; 58:medicina58121763. [PMID: 36556964 PMCID: PMC9783763 DOI: 10.3390/medicina58121763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/08/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022]
Abstract
Charcot neuroarthropathy (CN) is a destructive complication of the joints in patients with diabetes and should be managed from the onset of the first symptoms to avoid joint deformity and the risk of amputating the affected joint. Here, we describe the case of a young 24-year-old patient living with type I diabetes who developed active bilateral CN in both tarsal joints. This case of neuroarthropathy was uncommon due to the bilateral presentation at the same level of the joint. Despite the patient consulting from the beginning of the symptoms, none of the physicians suspected or diagnosed CN, leading to a delay in management and the aggravation of bone destruction by CN. This highlights the importance of early management of CN with the need to refer people with suspected CN to specialised diabetic foot care centres.
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Affiliation(s)
- Tatiana Benard
- Centre Hopitalier Sud Francilien, Diabetology Department, 91100 Corbeil-Essonnes, France
| | - Corinne Lequint
- Centre Hopitalier Sud Francilien, Diabetology Department, 91100 Corbeil-Essonnes, France
| | - Anne Christine Jugnet
- Centre Hopitalier Sud Francilien, Diabetology Department, 91100 Corbeil-Essonnes, France
| | - Marie Bouly
- Centre Hopitalier Sud Francilien, Diabetology Department, 91100 Corbeil-Essonnes, France
| | - Thomas Winther
- Centre Hopitalier Sud Francilien, Diabetology Department, 91100 Corbeil-Essonnes, France
| | - Alfred Penfornis
- Centre Hopitalier Sud Francilien, Diabetology Department, 91100 Corbeil-Essonnes, France
- Paris-Sud Medical School, Paris-Saclay University, 91100 Corbeil-Essonnes, France
| | - Dured Dardari
- Centre Hopitalier Sud Francilien, Diabetology Department, 91100 Corbeil-Essonnes, France
- LBEPS, IRBA, Université d’Evry, Université Paris Saclay, 91025 Evry, France
- Correspondence: ; Tel.: +33-6-61-54-28-09
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18
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Masmoudi K, Feki A, Akrout R, Baklouti S. Neuropathic arthropathy of the wrist revealing a syringomyelia. BMJ Case Rep 2022; 15:e249804. [PMID: 36428034 PMCID: PMC9703310 DOI: 10.1136/bcr-2022-249804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Syringomyelia is uncommonly revealed by a neuropathic arthropathy (Charcot joint) and characterised by its slow progression with late neurological symptoms. In this particular field, neuropathic arthropathies mainly affect the shoulders and the elbows.We report a new case of neuropathic arthropathy of the wrist caused by syringomyelia, because of the rarity of this condition as well as its uncommon location.Neuropathic arthropathy caused by syringomyelia is poorly published in the literature. This atypical entity should be considered in case of Charcot arthropathy associated with neurological loss, especially when it affects the upper limbs.
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Affiliation(s)
- Karim Masmoudi
- Orthopedic surgery department, Sidi Bouzid Hospital, Sidi Bouzid, Tunisia
| | - Afef Feki
- Rheumatology Department, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Rim Akrout
- Rheumatology Department, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Sofien Baklouti
- Rheumatology Department, Hedi Chaker University Hospital, Sfax, Tunisia
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19
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Mahmoud I, Zarrouk Z, Ben Tekaya A, Ben Salah M, Bouden S, Rouached L, Tekaya R, Saidane O, Abdelmoula L. Neuropathic arthropathy of the shoulder as a presenting feature of Chiari malformation with syringomyelia: a case report with a systematic literature review. Eur Spine J 2022; 31:2733-2752. [PMID: 35841440 DOI: 10.1007/s00586-022-07299-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 02/12/2022] [Accepted: 06/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Neuropathic arthropathy (NA) of the shoulder is a chronic progressive process characterized by joint destruction in the presence of a neurosensory deficit. Syringomyelia, a spinal cord disease, is the leading cause of NA in the upper extremity. OBJECTIVE We present a systematic review of NA with syringomyelia cases alongside a case report of an adult with NA of the shoulder that occurs a few 4 years after a revelation and surgical management of a Chiari malformation with syringomyelia. METHODS A systematic review was conducted following PRISMA guidelines. A PubMed, Scopus, Isiknowledge, and manual search through references of relevant publications were used to identify all published case reports of NA. Data were collected from each case report on patient characteristics. RESULTS The systematic review identified 56 publications and 85 patients (including ours): nearly the same number of males (n = 41) and females (n = 44). The mean age was 50,69. Presentations included reduction of mobility (n = 66), swelling (n = 61) and sensory disorder (n = 63). The pain was absent in 41 cases. In the majority of reported cases 56 (65.1%), syringomyelia was revealed by neuropathic arthropathy, and eleven patients (12.9%) had a history of syringomyelia. Treatment was categorized into non-operative management (37[43.5%]), operative management (27[31.7%]). Following-up was non-reported in 31 (36%) cases. Improvement was reported more with patients who underwent a surgical approach than medical one 28.5% versus 8.1%. CONCLUSION Physicians need to be more aware of this destructive joint disease, rare, and often misdiagnosed. Also, it is imperative to integrate clinical, pathological, and imaging findings for accurate diagnosis and for delivering appropriate therapy.
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Affiliation(s)
- I Mahmoud
- Department of Rheumatology, Charles Nicolle Hospital, 1007, Tunis, Tunisia
- University of Tunis El Manar, Tunis, Tunisia
| | - Z Zarrouk
- Department of Rheumatology, Charles Nicolle Hospital, 1007, Tunis, Tunisia.
- University of Tunis El Manar, Tunis, Tunisia.
| | - A Ben Tekaya
- Department of Rheumatology, Charles Nicolle Hospital, 1007, Tunis, Tunisia
- University of Tunis El Manar, Tunis, Tunisia
| | - M Ben Salah
- Department of Orthopedic Surgery, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar, Tunis, Tunisia
| | - S Bouden
- Department of Rheumatology, Charles Nicolle Hospital, 1007, Tunis, Tunisia
- University of Tunis El Manar, Tunis, Tunisia
| | - L Rouached
- Department of Rheumatology, Charles Nicolle Hospital, 1007, Tunis, Tunisia
- University of Tunis El Manar, Tunis, Tunisia
| | - R Tekaya
- Department of Rheumatology, Charles Nicolle Hospital, 1007, Tunis, Tunisia
- University of Tunis El Manar, Tunis, Tunisia
| | - O Saidane
- Department of Rheumatology, Charles Nicolle Hospital, 1007, Tunis, Tunisia
- University of Tunis El Manar, Tunis, Tunisia
| | - L Abdelmoula
- Department of Rheumatology, Charles Nicolle Hospital, 1007, Tunis, Tunisia
- University of Tunis El Manar, Tunis, Tunisia
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Phillips A, Rice L. Identification of Charcot Foot: A Case Report. Nephrol Nurs J 2022; 49:419-425. [PMID: 36332122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Neuropathy is a painful and potentially devastating complication of diabetes mellitus affecting many patients. Neuropathy can lead to foot ulcers, infections, and subsequent amputations. Nerve damage from peripheral neuropathy may lead to Charcot neuropathic osteoarthropathy, commonly known as Charcot foot. Flesh wounds and weakened bones causing microfractures of the foot and ankle may lead to foot malformations. Early recognition and care are essential for the treatment of Charcot foot and prevention of further injury. This article discusses the use of monofilament testing for diabetic neuropathy, increasing awareness of Charcot foot, and introducing a screening algorithm for Charcot foot.
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Affiliation(s)
- Angela Phillips
- Associate Professor and the Family Nurse Practitioner Program Director, West Texas A&M University, Canyon, TX
- member of ANNA's Heart of Texas Chapter
| | - Louise Rice
- Assistant Professor, Texas Tech University Health Science Center, School of Nursing, Amarillo, TX
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21
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Bai YP, Yu Y, Qi W, Liu L, Chen H. The Shoulder Charcot Arthropathy and Secondary to Hemangioblastoma in Conus Medullari with Syringomyelia. J Coll Physicians Surg Pak 2022; 32:531-534. [PMID: 35330532 DOI: 10.29271/jcpsp.2022.04.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/16/2020] [Indexed: 06/14/2023]
Abstract
Charcot arthropathy of the shoulder joint is usually referred to as shoulder joint involvement of Charcot arthropathy, which is a chronic, degenerative, destructive condition resulting from decreasing or loss of sensorial innervation. To date, several reports have described the shoulder Charcot arthropathy, caused by malformations of the occipital region with syringomyelia; but nobody has reported the shoulder Charcot arthropathy secondary to hemangioblastoma in conus medullari with syringomyelia. Therefore, we report a 32-year male patient who was diagnosed with Charcot arthropathy of the shoulder joint, which was misdiagnosed as a soft tissue tumor and treated surgically. After the operation, the whole-spine MRI examination was performed as a presenting feature of hemangioblastoma in conus medullari with syringomyelia. Key Words: Arthropathy, Neurogenic, Hemangioblastoma, Syringomyelia.
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Affiliation(s)
- Yu Ping Bai
- Department of MR, Lanzhou University Second Hospital, Lanzhou, China
- Department of Tumor Surgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Yang Yu
- Department of Tumor Surgery, Lanzhou University Second Hospital, Lanzhou, China
- The Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Wenbo Qi
- Department of Tumor Surgery, Lanzhou University Second Hospital, Lanzhou, China
- The Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - le Liu
- Department of Tumor Surgery, Lanzhou University Second Hospital, Lanzhou, China
- The Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Hao Chen
- Department of Tumor Surgery, Lanzhou University Second Hospital, Lanzhou, China
- The Key Laboratory of the Digestive System Tumors, Lanzhou University Second Hospital, Gansu Province, Lanzhou, China
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22
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Engberg S, Andersen HU, Rasmussen A, Kirketerp-Møller K. The clinical course and mortality of persons with diabetic Charcot foot. Dan Med J 2021; 69:A05210398. [PMID: 34913432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The aim was to study the mortality and the clinical course of diabetic Charcot foot. METHODS This was a retrospective cohort study including all persons with diabetes and a Charcot diagnosis from 2000 to 2016. RESULTS In the mortality sub-study, 164 persons had the Charcot diagnosis, 52 (31.1%) died in the follow-up period. The mortality rate was 4.6/100 person-years at risk. Rate ratios for death were insignificantly different among smokers and non-smokers, among persons with type 1 and type 2 diabetes, among persons with a diabetes duration below or above ten years and among persons with a glycated haemoglobin (HbA1c) level above or below 60 mmol/mol after adjustment for age and gender. In the clinical course sub-study, 114 persons with Charcot were identified whereof 97 (85%) had an active Charcot. The duration from start of symptoms to diagnosis was ten weeks, the treatment period was 7.5 months and 46 (40%) had bony prominences (rocker bottom) in the planta at follow-up. CONCLUSIONS The mortality rate among persons with Charcot was 4.6/person-years at risk, which was unaffected by smoking, diabetes type, diabetes duration and HbA1c level. The persons with Charcot had a long delay from symptom onset to diagnosis, a long treatment period and often developed complications. FUNDING This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors. TRIAL REGISTRATION not relevant.
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Klag EA, Fisk FE, Maier LM, Zeni F. Staged Percutaneous Treatment of a Complete Lisfranc Dislocation Secondary to Charcot Arthropathy: A Case Report. JBJS Case Connect 2021; 11:01709767-202112000-00070. [PMID: 35102063 DOI: 10.2106/jbjs.cc.21.00242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
CASE A 36-year-old woman with diabetic neuropathy presented with complete dorsal dislocation of the midfoot secondary to Charcot arthropathy. She was treated in a staged fashion with a Taylor spatial butt frame to distract and reduce the midfoot followed by percutaneous preparation of the tarsometatarsal (TMT) joints and fixator-assisted fusion. The arthrodesis healed successfully with maintenance of function at the 30-month follow-up. CONCLUSION Staged treatment with a Taylor spatial frame can be used successfully to treat complete TMT dislocations in the setting of Charcot arthropathy. Complications are not uncommon and must be addressed appropriately.
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Affiliation(s)
- Elizabeth A Klag
- Department of Orthopaedic Surgery, Henry Ford Health System Detroit, Michigan
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Abstract
Charcot's joint is a type of neuro-arthropathy, where asymmetrical damage of the involved joint happens haphazardly, without following any described pattern. We present a rare case of Charcot's joint involving the knee joint in an adult male following spina bifida. His knee joint was successfully fused after two surgeries. Later, he sustained a fracture through the arthrodesis after a fall, which we managed surgically. The fracture through the knee arthrodesis was managed surgically by an open reduction and internal fixation, using a 14-hole broad low contact dynamic compression locking plate with bone grafting. Union was achieved at the knee arthrodesis site in 6 months. Fracture through a fused knee requires surgical management. Re-arthrodesis was done using a stable fixation. Postoperative rehabilitation should include protected weight bearing with braces and splints until a sound bony union is achieved.
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Affiliation(s)
- Sai Sabharish Reddy
- Department of Orthopedics, Indraprastha Apollo Hospital, New Delhi, Delhi, India
| | - Abhishek Vaish
- Department of Orthopedics, Indraprastha Apollo Hospital, New Delhi, Delhi, India
| | - Raju Vaishya
- Department of Orthopaedic & Joint Replacement Surgery, Indraprastha Apollo Hospital, New Delhi, Delhi, India
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Wawrzyniak A, Lubiatowski P, Kordasiewicz B, Brzóska R, Laprus H. Shoulder arthropathy secondary to syringomyelia: case series of 10 patients. Eur J Orthop Surg Traumatol 2021; 32:1275-1281. [PMID: 34430987 DOI: 10.1007/s00590-021-03102-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 08/16/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE Neuroarthropathy is a progressive joint degeneration secondary to neurological diseases. In the upper extremity, the shoulder is the most exposed, and it is mainly caused by syringomyelia. This condition is rare; therefore, the literature has documented only a few case reports or case series of small groups of patients. METHODS We collected data about patients with shoulder arthropathy due to syringomyelia who were treated in our two institutes and collected among members of the Polish Shoulder and Elbow Society. Our analysis was based on epidemiological data, symptoms, and clinical examinations. We also examined the results of diagnostic tests, including-spinal cord MRI and shoulder X-ray, and treatment methods and their effectiveness. RESULTS The examined group included 10 women with an average age of 63 years. Of these, nine patients reported pain, seven reported-swelling, and nine reported-weakness. In every patient, diagnosis was confirmed by X-ray of the shoulder with joint degeneration and MRI of the spinal cord with syrinx. Two patients were operated with reverse shoulder arthroplasty; the first one had excellent result-significant active range of motion improvement and reduction of symptoms, and the second one had a good result-pain relief and moderate range of motion improvement. Other patients were conservatively treated, resulting in total or partial symptoms relief but without significant range of motion improvement. CONCLUSION Charcot shoulder secondary to syringomyelia was mainly manifested by range of motion limitation, swelling, and pain. Both conservative and surgical treatments could be a good solution. However, if reverse arthroplasty is technically possible, it seems to be the most promising treatment for recovering function.
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Affiliation(s)
| | - Przemysław Lubiatowski
- Rehasport Clinic, Poznań, Poland
- Sport Traumatology and Biomechanics Unit, Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Science, Poznań, Poland
| | - Bartosz Kordasiewicz
- Trauma and Orthopedics Department, Centre of Postgraduate Medical Education, SPSK Im. A. Grucy, Otwock, Warsaw, Poland
- Idea Ortopedia, Warsaw, Poland
| | - Roman Brzóska
- Department of Orthopedics, St Luke's Hospital, Bielsko-Biała, Poland
| | - Hubert Laprus
- Department of Orthopedics, St Luke's Hospital, Bielsko-Biała, Poland
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26
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Fontalis A, Doorgakant A, Zahra W, Blundell C. Midfoot Charcot Neuro-arthropathy Precipitated by First or Fifth ray Amputation. Foot Ankle Surg 2021; 27:673-676. [PMID: 33132011 DOI: 10.1016/j.fas.2020.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/04/2020] [Accepted: 08/31/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Charcot Neuro-arthropathy (CN) can occur spontaneously in a neuropathic foot but is often precipitated by an insult to the foot, such as trauma. We noted an association between 1st and 5th ray amputations and the development of midfoot CN in our clinics. We therefore set out to analyse our data over a 6-year period to evaluate and improve our practice. METHODS Our project encompassed all diabetic adults with peripheral neuropathy undergoing an amputation of the first or fifth ray between January 2013 and January 2019. Patient demographics, stump length, progression to CN, imaging reports, the need for further operative management, length of stay and operating specialty were collected. Cases that developed CN after 1st or 5th ray amputation ("CN group") were compared with a cohort composed of patients that did not ("non-CN group"). RESULTS We identified 92 patients (98 surgical episodes) who had previous 1st or 5th ray amputations [77 males (83.7%), 15 females (16.3%), mean age 61.5 ± 13.5]. Midfoot CN developed in 16 cases (17.4%; nine following 1st ray and seven following 5th ray amputation). This represented 30.9% of all our new CN cases. CN was diagnosed within six months in six cases and up to three years in the remaining 12. Five of the 1st ray amputations were conducted with a stump length of ≤10 mm from the tarsometatarsal joint and a further one had resorbed down to it before the Charcot process. Three of the 5th ray amputations were carried out leaving a stump length ≤25 mm. Receiver Operator Curve (ROC) analysis showed no obvious diagnostic value of stump length in predicting CN (area under the curve 0.42 (95% CI 0.26 - 0.59)). Following a logistic regression analysis into effect of age, gender and peripheral vascular disease, only age was found to significantly affect the risk of developing CN (Nagelkerke R2 = 0.122, p = 0.013). CONCLUSION This is the first report of midfoot CN developing after 1st or 5th ray amputations. The foot could be destabilised following these procedures, leading to increased pressures across the midfoot. Our small sample was unable to demonstrate a significant correlation between stump length and CN risk. However, more work is needed to ascertain this. Meanwhile, we believe this translates clinically into a need for enhanced foot protection following 1st and 5th ray amputations in our practice.
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Affiliation(s)
- Andreas Fontalis
- Trauma and Orthopaedics Department, Sheffield Teaching Hospitals NHS Trust, Herries Rd, Sheffield S5 7AU, UK; Academic Unit of Bone Metabolism, The University of Sheffield, Sheffield S10 2RX, UK.
| | - Ashtin Doorgakant
- Trauma and Orthopaedics Department, Warrington and Halton Hospitals NHS Foundation Trust, Lovely Ln, Warrington WA5 1QG, UK
| | - Wajiha Zahra
- Royal Berkshire Hospital, London Rd, Reading, RG1 5AN, UK
| | - Chris Blundell
- Trauma and Orthopaedics Department, Sheffield Teaching Hospitals NHS Trust, Herries Rd, Sheffield S5 7AU, UK
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Giryes S, Militianu D, Balbir-Gurman A. Neuropathic Arthropathy of a Knee Joint: A Case Report. Isr Med Assoc J 2020; 22:650-651. [PMID: 33070492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Sami Giryes
- Shine Rheumatology Institute, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Daniella Militianu
- Department of Diagnostic Imaging, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Alexandra Balbir-Gurman
- Shine Rheumatology Institute, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Al-Rubeaan K, Aburisheh KH, Al Farsi Y, Al Derwish M, Ouizi S, Alblaihi F, ALHagawy AJ, AlSalem RK, Alageel MA, Toledo MH, Youssef AM. Characteristics of Patients with Charcot's Arthropathy and its Complications in the Saudi Diabetic Population: A Cross-Sectional Study. J Am Podiatr Med Assoc 2020; 110:441589. [PMID: 32730596 DOI: 10.7547/18-197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Charcot's arthropathy (CA) is a destructive rare complication of diabetes, and its diagnosis remains challenging for foot specialists and surgeons. We aimed to assess the clinical presentation and characteristics of CA and the frequencies of its various types. METHODS This cross-sectional study was conducted from January 1, 2007, to December 31, 2016, and included 149 adults with diabetes diagnosed as having CA. Cases of CA were classified based on the Brodsky anatomical classification into five types according to location and involved joints. RESULTS The mean ± SD age of the studied cohort was 56.7 ± 11 years, with a mean ± SD diabetes duration of 21.2 ± 7.0 years. The CA cohort had poorly controlled diabetes and a high rate of neuropathy and retinopathy. The most frequent type of CA was type 4, with multiple regions involved at a rate of 56.4%, followed by type 1, with midfoot involvement at 34.5%. A total of 47.7% of the patients had bilateral CA. Complications affected 220 limbs, of which 67.7% had foot ulceration. With respect to foot deformity, hammertoe affected all of the patients; hallux valgus, 59.5%; and flatfoot, 21.8%. CONCLUSIONS There is a high rate of bilateral CA, mainly type 4, which could be attributed to cultural habits in Saudi Arabia, including footwear. This finding warrants increasing awareness of the importance of maintaining proper footwear to avoid such complications. Implementation of preventive measures for CA is urgently needed.
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Abstract
With worsening diet and increasing prevalence of diabetes, patient encounters with Charcot neuropathic arthropathy (CNA) are expected to increase. Without intervention, the pathology progresses with further subluxation/dislocation and fracture, placing soft tissues at risk of preulceration or formal ulceration, infection, and potentially major amputation. The need to avoid amputation is of paramount importance. Although a formal single eradicating tool for CNA is lacking, there is capacity to intervene in ways that may curtail the pace of destruction. This article reviews understanding of the disease process and provides guidance to surgical reconstruction of the deformity.
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Affiliation(s)
- Kwasi Y Kwaadu
- Department of Surgery, Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA.
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Dardari D, Penfornis A, Amadou C, Phan F, Bourron O, Davaine JM, Foufelle F, Jaisser F, Laborne FX, Hartemann A. Multifocal (tarsus and knee) activation of neuroarthropathy following rapid glycaemic correction. J Diabetes Complications 2019; 33:107438. [PMID: 31668589 DOI: 10.1016/j.jdiacomp.2019.107438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 08/21/2019] [Accepted: 08/25/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To report a case of neuroarthropathy in the tarsus and knee following rapid glycaemic normalisation in a female patient with type I diabetes. METHODS A retrospective review of case notes. RESULTS We describe the case of a female patient with type I diabetes who had developed a multifocal neuroarthropathy in only six months, probably due to a rapid glycaemic normalisation. The onset of this neuroarthropathy was not only fast but mostly multifocal affecting two levels of joints. CONCLUSION The link between the onset of multifocal neuroarthropathy and the rapid correction of chronic hyperglycaemia is probably proven in our case. Patients with chronic hyperglycaemia with sensitive neuropathy should benefit from a gradual correction of their glycaemic imbalance in order to avoid the apparition of neuroarthropathy.
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Affiliation(s)
- Dured Dardari
- Diabetology Department, Centre Hopitalier Sud Francilien, Corbeil Essonnes, France; Centre de recherche des Cordeliers INSERM U1138 Team "Diabetes, metabolic diseases and comorbidities", 15 rue de l'Ecole de Médecine, 75270 Paris cedex 06, France; Sorbonne Université, 15 rue de l'Ecole de Médecine, 75006 Paris, France.
| | - Alfred Penfornis
- Diabetology Department, Centre Hopitalier Sud Francilien, Corbeil Essonnes, France
| | - Coralie Amadou
- Diabetology Department, Centre Hopitalier Sud Francilien, Corbeil Essonnes, France
| | - Franck Phan
- Diabetology Department, AP-HP, Hôpital Pitié-Salpêtrière, F-75013 Paris, France; Centre de recherche des Cordeliers INSERM U1138 Team "Diabetes, metabolic diseases and comorbidities", 15 rue de l'Ecole de Médecine, 75270 Paris cedex 06, France; Sorbonne Université, 15 rue de l'Ecole de Médecine, 75006 Paris, France
| | - Olivier Bourron
- Diabetology Department, AP-HP, Hôpital Pitié-Salpêtrière, F-75013 Paris, France; Centre de recherche des Cordeliers INSERM U1138 Team "Diabetes, metabolic diseases and comorbidities", 15 rue de l'Ecole de Médecine, 75270 Paris cedex 06, France; Sorbonne Université, 15 rue de l'Ecole de Médecine, 75006 Paris, France
| | - Jean Michel Davaine
- Centre de recherche des Cordeliers INSERM U1138 Team "Diabetes, metabolic diseases and comorbidities", 15 rue de l'Ecole de Médecine, 75270 Paris cedex 06, France; Vascular Surgery Department AP-HP, Hôpital Pitié-Salpêtrière, F-75013 Paris, France; Sorbonne Université, 15 rue de l'Ecole de Médecine, 75006 Paris, France
| | - Fabienne Foufelle
- Centre de recherche des Cordeliers INSERM U1138 Team "Diabetes, metabolic diseases and comorbidities", 15 rue de l'Ecole de Médecine, 75270 Paris cedex 06, France
| | - Frédéric Jaisser
- Centre de recherche des Cordeliers INSERM U1138 Team "Diabetes, metabolic diseases and comorbidities", 15 rue de l'Ecole de Médecine, 75270 Paris cedex 06, France
| | - Francois-Xavier Laborne
- Clinical Research Unit centre hospitalier sud Francilien, 40 Avenue Serge Dassault, 91100 Corbeil-Essonnes, France
| | - Agnes Hartemann
- Diabetology Department, AP-HP, Hôpital Pitié-Salpêtrière, F-75013 Paris, France; Centre de recherche des Cordeliers INSERM U1138 Team "Diabetes, metabolic diseases and comorbidities", 15 rue de l'Ecole de Médecine, 75270 Paris cedex 06, France; Sorbonne Université, 15 rue de l'Ecole de Médecine, 75006 Paris, France
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Vora D, Schlaff CD, Rosner MK. Surgical management of a complex case of Charcot arthropathy of the spine: a case report. Spinal Cord Ser Cases 2019; 5:73. [PMID: 31632731 PMCID: PMC6786288 DOI: 10.1038/s41394-019-0217-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction The authors present a case of a 55-year-old male with T10 complete paraplegia diagnosed with Charcot arthropathy of the spine (CAS). Case presentation He presented to an outside institution with vomiting and productive cough with subsequent computed tomography (CT) and MRI imaging revealing L5 osteomyelitis and a paraspinal abscess. Given the patient's inability to remain in good posture in his wheelchair he underwent a multilevel vertebrectomy and thoracolumbar fusion. Due to multiple co-morbidities, surgical recovery was complex, ultimately requiring revision circumferential fixation. Discussion CAS is an uncommon, long-term complication of traumatic spinal cord injury (SCI). Surgical management is often complex and associated with significant complications. Currently, a consensus on CAS prevention, specific surgical fixation techniques and post-surgical nursing care management is lacking. In this case report we provide our experience in the management of a complex case of CAS to aid in decision making for future neurosurgeons who encounter this sequela of traumatic SCI.
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Affiliation(s)
- Darshan Vora
- Department of Neurological Surgery, The George Washington University Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, WA 20037 United States
| | - Cody D. Schlaff
- Department of Neurological Surgery, The George Washington University Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, WA 20037 United States
| | - Michael K. Rosner
- Department of Neurological Surgery, The George Washington University Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, WA 20037 United States
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Wang X, Li Y, Gao J, Wang T, Li Z. Charcot arthropathy of the shoulder joint as a presenting feature of basilar impression with syringomyelia: A case report and literature review. Medicine (Baltimore) 2018; 97:e11391. [PMID: 29995782 PMCID: PMC6076164 DOI: 10.1097/md.0000000000011391] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
RATIONALE Charcot arthropathy, also known as Neuropathic arthropathy (NA), is an unusual chronic degenerative disease. To date, there exists a paucity of research on NA caused by syringomyelia. PATIENTS CONCERNS A 52-year-old non-diabetic female presented with progressive swelling, pain and limited movement in her left shoulder joint combined with asthenia of her left upper extremity for three months. DIAGNOSES Neuropathic arthropathy of the shoulder associated with the cervicothoracic syrinx and basilar impressions was diagnosed. INTERVENTIONS The treatment is directed to its potential cause to cease its progression. A posterior fossa decompression (PFD) was conducted for this patient. OUTCOMES Postoperatively, the patient's symptoms were relieved and the size of syrinx was reduced at the 6-month follow-up. LESSONS Taken together with 34 previous reports identified from a PubMed search, an analysis of 35 cases of Charcot arthropathy was conducted. Surgical decompression is an effective treatment, but the optimal treatment remains controversial. Thus, the aim of this literature review was to remind us to diagnose the potential cause as early as possible and we should spare no efforts on the exploration of etiology and adjuvant therapy for this disease.
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Marmolejo VS, Arnold JF, Ponticello M, Anderson CA. Charcot Foot: Clinical Clues, Diagnostic Strategies, and Treatment Principles. Am Fam Physician 2018; 97:594-599. [PMID: 29763252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Acute Charcot neuroarthropathy of the foot and ankle is often difficult to diagnose because of limited findings in the patient history, physical examination, imaging, and laboratory studies. Delay in treatment results in the development of rigid foot and ankle deformities, increasing the risk of ulceration, infection, and major lower extremity amputation. Acute Charcot neuroarthropathy should be suspected in any patient 40 years or older with obesity and peripheral neuropathy who presents with an acutely swollen foot following minimal or no recalled trauma and who reports minimal to no pain, particularly if radiography and laboratory markers of infection are normal. Magnetic resonance imaging or computed tomography should be performed in these cases. If changes consistent with acute Charcot neuroarthropathy are observed, prompt immobilization and/or referral to a foot and ankle subspecialist is needed to minimize sequelae. Immobilization should continue until lower extremity edema and warmth resolve, and serial radiography shows evidence of osseous consolidation. Intranasal calcitonin salmon may have a role as adjunctive therapy. Although controversial, surgery may be indicated if there is severe dislocation or instability, concern for skin breakdown, or failure of conservative treatment to obtain a stable, plantigrade foot.
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Affiliation(s)
| | - Jonathan F Arnold
- Great River Wound and Hyperbaric Medicine Clinic, West Burlington, IA, USA
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Dixon J, Coulter J, Garrett M, Cutfield R. A retrospective audit of the characteristics and treatment outcomes in patients with diabetes-related charcot neuropathic osteoarthropathy. N Z Med J 2017; 130:62-67. [PMID: 29240741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIMS To review the characteristics, management and outcomes one year after diagnosis in patients with diabetes related charcot neuropathic osteoarthropathy (CN) treated at the Diabetes Podiatry service, Waitemata District Health Board (WDHB) between 2000-2014. METHODS Patients with diabetes and recorded diagnosis of CN were identified from the podiatry service records. Clinical details were retrospectively obtained from WDHB databases and patient medical records. RESULTS Forty-one patients were included, 31 had type 2 diabetes, 10 had type 1 diabetes. At presentation, the median duration of all-type diabetes was 15 years. The median time from symptom onset to diagnosis was 17 weeks. Symptoms at presentation were: oedema (49%), warmth (73%), erythema (17%), swelling (90%) and pain (60%). Concomitant ulcers were present in 32%, deformities 83%, osteomyelitis 2% and septic arthritis 2%. Mean time to ambulation in modified shoes was 21.3 weeks (±11.5). Complication rates one year from diagnosis for ulcers, osteomyelitis, amputations and all-cause mortality were 34%, 2%, 2% and 5% respectively. CONCLUSION Time to diagnosis of CN was shorter than previously reported, though the high rate of deformities still suggests a significant delay in diagnosis. Increased education of healthcare professionals and people with diabetes-related neuropathy is important to ensure early diagnosis and appropriate management to reduce deformities and complications.
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Affiliation(s)
- Joanne Dixon
- Endocrinology Registrar, Endocrinology and Diabetes Department, Waitemata District Health Board, Auckland
| | | | - Michele Garrett
- Podiatrist, Endocrinology and Diabetes Department, Waitemata District Health Board, Auckland
| | - Rick Cutfield
- Endocrinologist, Endocrinology and Diabetes Department, Waitemata District Health Board, Auckland
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Rizzo P, Pitocco D, Zaccardi F, Di Stasio E, Strollo R, Rizzi A, Scavone G, Costantini F, Galli M, Tinelli G, Flex A, Caputo S, Pozzilli P, Landolfi R, Ghirlanda G, Nissim A. Autoantibodies to post-translationally modified type I and II collagen in Charcot neuroarthropathy in subjects with type 2 diabetes mellitus. Diabetes Metab Res Rev 2017; 33. [PMID: 27454862 DOI: 10.1002/dmrr.2839] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 07/05/2016] [Accepted: 07/18/2016] [Indexed: 11/07/2022]
Abstract
AIMS Charcot neuroarthropathy (CN) is a disabling complication, culminating in bone destruction and involving joints and articular cartilage with high inflammatory environment. Its real pathogenesis is as yet unknown. In autoinflammatory diseases, such as rheumatoid arthritis, characterized by inflammation and joint involvement, autoantibodies against oxidative post-translationally modified (oxPTM) collagen type I (CI) and type II (CII) were detected. Therefore, the aim of our study was to assess the potential involvement of autoimmunity in charcot neuroarthropathy, investigating the presence of autoantibodies oxPTM-CI and oxPTM-CII, in participants with charcot neuroarthropathy. METHODS In this case-control study, we enrolled 124 participants with type 2 diabetes mellitus (47 with charcot neuroarthropathy, 37 with diabetic peripheral neuropathy without charcot neuroarthropathy, and 40 with uncomplicated diabetes), and 32 healthy controls. The CI and CII were modified with ribose and other oxidant species, and the modifications were evaluated with sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Binding of sera from the participants was analyzed with enzyme-linked immunosorbent assay. RESULTS Age, body mass index, waist and hip circumferences, and lipid profile were similar across the 4 groups, as well as glycated hemoglobin and duration of diabetes among people with diabetes. An increased binding to both native and all oxidation-modified forms of CII was found in participants with CN and diabetic neuropathy. Conversely, for CI, an aspecific increased reactivity was noted. CONCLUSIONS Our results detected the presence of autoantibodies against oxidative post-translational modified collagen, particularly type 2 collagen, in participants with charcot neuroarthropathy and diabetic neuropathy, suggesting the possible involvement of autoimmunity. Further studies are required to understand the role of autoimmunity in the pathogenesis of charcot neuroarthropathy.
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Affiliation(s)
- Paola Rizzo
- Diabetes Care Unit, Internal Medicine, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
- Centre for Biochemical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Dario Pitocco
- Diabetes Care Unit, Internal Medicine, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Zaccardi
- Diabetes Care Unit, Internal Medicine, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Enrico Di Stasio
- Institute of Biochemistry, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Rocky Strollo
- Centre for Biochemical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, UK
- Department of Endocrinology & Diabetes, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Alessandro Rizzi
- Diabetes Care Unit, Internal Medicine, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Scavone
- Diabetes Care Unit, Internal Medicine, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Federica Costantini
- Diabetes Care Unit, Internal Medicine, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Marco Galli
- Institute of Orthopedic Surgery, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Tinelli
- Department of Vascular Surgery, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Andrea Flex
- Institute of Internal Medicine, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Salvatore Caputo
- Diabetes Care Unit, Internal Medicine, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Paolo Pozzilli
- Department of Endocrinology & Diabetes, Campus Bio-Medico, University of Rome, Rome, Italy
- Centre for Diabetes, Queen Mary University of London, London, UK
| | - Raffaele Landolfi
- Institute of Internal Medicine, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Ghirlanda
- Diabetes Care Unit, Internal Medicine, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Ahuva Nissim
- Centre for Biochemical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, UK
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Abstract
Internal and external fixation techniques have been described for realignment and arthrodesis of Charcot midfoot deformity. There currently is no consensus on the optimal method of surgical reconstruction. This systematic review compared the clinical results of surgical realignment with internal and external fixation, specifically in regard to return to functional ambulation, ulcer occurrence, nonunion, extremity amputation, unplanned further surgery, deep infection, wound healing problems, peri- or intraoperative fractures, and total cases with any complication. A search of multiple databases for all relevant articles published from January 1, 1990, to March 22, 2014, was performed. A logistic regression model evaluated each of the outcomes and its association with the type of fixation method. The odds of returning to functional ambulation were 25% higher for internal fixation (odds ratio [OR], 1.259). Internal fixation had a 42% reduced rate of ulcer occurrence (OR, 0.578). External fixation was 8 times more likely to develop radiographic nonunion than internal fixation (OR, 8.2). Internal fixation resulted in a 1.5-fold increase in extremity amputation (OR, 1.488), a 2-fold increase in deep infection (OR, 2.068), a 3.4-fold increase in wound healing complications (OR, 3.405), and a 1.5-fold increase in the total number of cases experiencing any complication (OR, 1.525). This was associated with a 20% increase in the need for unplanned further surgery with internal fixation (OR, 1.221). Although internal fixation may decrease the risk of nonunion and increase return to functional ambulation, it had a higher rate of overall complications than external fixation for realignment and arthrodesis of Charcot midfoot deformity. [Orthopedics. 2016; 39(4):e595-e601.].
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Abstract
Simultaneous pancreas-kidney transplant (SPKT) is an accepted approach and the treatment of choice in patients with type 1 diabetes with accompanying end-stage renal disease. Charcot's neuroarthropathy of the foot (CN) is a fairly common and devastating complication found in patients with long-standing, mostly uncontrolled, diabetes. However, CN has also been identified as a posttransplant consequence of SPKT. Traditional postoperative immunosuppressive therapy, particularly the use of corticosteroids, is acknowledged as an additional risk factor for the development of de novo CN after SPKT. This article describes an unusual case of a patient who presented with full-blown CN deformity after SPKT.
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Abstract
UNLABELLED Background Treatment of Charcot arthopathy of the foot can be challenging. The goal of this investigation was to determine whether primary gastrocnemius-soleus recession could decrease rate of new ulcers, progression of deformity, and amputation in patients with Charcot arthropathy of the midfoot.Methods A retrospective chart review revealed 28 feet in 24 diabetic patients with radiographic evidence of Charcot arthropathy of the midfoot. They were treated with primary gastrocnemius-soleus recession. Eleven feet in 11 patients had concurrent plantar midfoot ulcers. Three feet in 3 patients were lost to follow-up. Twenty-five feet in 21 patients were followed for an average of 37 months postoperatively (range = 18-79).Results A favorable outcome was defined as healing of existing ulcers, no new ulcers, no obvious progression of deformity, and no amputation. Favorable outcomes were obtained in 22 of 25 feet (18 of 21 patients). Only one patient had a persistent ulcer after gastrocnemius-soleus recession. The other 10 patients with preexisting ulcers healed. Deformity of midfoot progressed in one patient, leading ultimately to transtibial amputation. Another patient developed a knee joint infection and had a transfemoral amputation at another institution.Discussion These preliminary data suggest that primary gastrocnemius-soleus recession is followed by a much lower rate of persistent, recurrent, and new ulceration than previously reported studies. Gastrocnemius-soleus recession seems to aid in the treatment of Charcot arthropathy of the midfoot. LEVELS OF EVIDENCE Level IV.
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Affiliation(s)
- J Monroe Laborde
- Touro Infirmary, New Orleans, Louisiana (JML)Westerville Medical Campus, Westerville, Ohio (TMP, JD)Beaumont Army Medical Center, El Paso, Texas (PJC)
| | - Terrence M Philbin
- Touro Infirmary, New Orleans, Louisiana (JML)Westerville Medical Campus, Westerville, Ohio (TMP, JD)Beaumont Army Medical Center, El Paso, Texas (PJC)
| | - Philip J Chandler
- Touro Infirmary, New Orleans, Louisiana (JML)Westerville Medical Campus, Westerville, Ohio (TMP, JD)Beaumont Army Medical Center, El Paso, Texas (PJC)
| | - Justin Daigre
- Touro Infirmary, New Orleans, Louisiana (JML)Westerville Medical Campus, Westerville, Ohio (TMP, JD)Beaumont Army Medical Center, El Paso, Texas (PJC)
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39
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Abstract
The Charcot foot is an uncommon complication of neuropathy in diabetes. It is a disabling and devastating condition. The etiology of the Charcot foot is unknown, but it is characterized by acute inflammation with collapse of the foot and/or the ankle. Although the cause of this potentially debilitating condition is not known, it is generally accepted that the components of neuropathy that lead to foot complications must exist. When it is not detected early, a severe deformity will result in a secondary ulceration, infection, and amputation. Immobilization in the early stages is the key for success, but severe deformity may still develop. When severe deformity is present, bracing may be attempted but often patients will need surgical intervention. Good success has been shown with internal and external fixation. In patients with concomitant osteomyelitis, severe deformity, and/or soft tissue infection, a high amputation may be the best treatment of choice.
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Affiliation(s)
- Javier La Fontaine
- UT Southwestern Medical Center, Department of Plastic Surgery, Dallas, TX, USA.
| | - Lawrence Lavery
- UT Southwestern Medical Center, Department of Plastic Surgery, Dallas, TX, USA
| | - Edward Jude
- Tameside Hospital NHS Foundation Trust, Lancashire, UK
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40
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Ouhadi L, Gaudreault M, Mottard S, Gillet P. [A DESTRUCTIVE SHOULDER ARTHROPATHY]. Rev Med Liege 2016; 71:71-77. [PMID: 27141649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Charcot arthropathy is a progressive, chronic and degenerative destruction of one or several joints caused by a central or peripheral neurological disorder. Approximately 25 % of the patients with syringomyelia develop this arthropathy located in the upper limb in 80 % of the cases. An early etiological diagnosis is essential to begin the treatment of the underlying neurological disorder. Afterwards, a conservative treatment of the arthropathy is preferred. We report the story of a patient with an arthropathy of the left shoulder due to Arnold-Chiari's malformation of type I with syringomyelia.
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41
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Abstract
Charcot's arthropathy or neuropathic osteoarthropathy is a form of destructive arthropathy associated with decreased sensory innervation. We present an unusual case of a patient referred to oncology clinic for further evaluation of a spindle cell neoplasm of the humerus concerning for malignancy. The mass presented as a lytic lesion associated with a right humerus fracture. This was later diagnosed as Charcot's shoulder secondary to cervical syringomyelia. A detailed case report and discussion are presented here.
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Affiliation(s)
- Jingdong Su
- Department of Hematology and Oncology, Louisiana State University Health, Shreveport, Louisiana, USA
| | - Firas Al-Delfi
- Department of Pathology, Louisiana State University Health, Shreveport, Louisiana, USA
| | - Glenn Mills
- Department of Hematology and Oncology, Louisiana State University Health, Shreveport, Louisiana, USA
| | - Prakash Peddi
- Department of Hematology and Oncology, Louisiana State University Health, Shreveport, Louisiana, USA
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Allo Miguel G, García Fernández E, Hawkins Carranza F. Diabetic Charcot neuroarthropathy of the knee in a patient with type-1 diabetes mellitus. Endocrine 2015; 49:863-4. [PMID: 25351369 DOI: 10.1007/s12020-014-0466-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 10/23/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Gonzalo Allo Miguel
- Endocrinology Service, 12 de Octubre University Hospital, UCM, Avenida Córdoba S/N, 28026, Madrid, Spain,
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Abstract
Charcot foot syndrome is an uncommon complication of diabetes but is potentially devastating in its consequences. Outcome is made worse by widespread professional ignorance leading to delayed diagnosis, but it is also hampered by lack of understanding of its causes and lack of treatments with proven effectiveness, other than offloading. There remains a desperate need for studies into its causes as well as comparative audit and trials designed to determine the best treatment for this difficult condition. Such work can probably only be effectively carried out through the establishment of multicentre networks. Nevertheless, improved understanding in recent years of the likely role of inflammatory pathways has raised awareness of the multiple ways in which the effects of neuropathy may be manifest in the development of the Charcot foot. This awareness is also leading to the realization that similar processes may conceivably contribute to the refractoriness of other foot diseases in diabetes, including both chronic unhealing ulcers and osteomyelitis.
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Affiliation(s)
- W J Jeffcoate
- Foot Ulcer Trials Unit, Department of Diabetes and Endocrinology, Nottingham University Hospitals Trust, Nottingham, UK
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44
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Petrova NL, Petrov PK, Edmonds ME, Shanahan CM. Inhibition of TNF-α Reverses the Pathological Resorption Pit Profile of Osteoclasts from Patients with Acute Charcot Osteoarthropathy. J Diabetes Res 2015; 2015:917945. [PMID: 26137498 PMCID: PMC4468294 DOI: 10.1155/2015/917945] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/23/2015] [Accepted: 04/23/2015] [Indexed: 02/01/2023] Open
Abstract
We hypothesised that tumour necrosis factor-α (TNF-α) may enhance receptor activator of nuclear factor-κβ ligand- (RANKL-) mediated osteoclastogenesis in acute Charcot osteoarthropathy. Peripheral blood monocytes were isolated from 10 acute Charcot patients, 8 diabetic patients, and 9 healthy control subjects and cultured in vitro on plastic and bone discs. Osteoclast formation and resorption were assessed after treatment with (1) macrophage-colony stimulating factor (M-CSF) and RANKL and (2) M-CSF, RANKL, and neutralising antibody to TNF-α (anti-TNF-α). Resorption was measured on the surface of bone discs by image analysis and under the surface using surface profilometry. Although osteoclast formation was similar in M-CSF + RANKL-treated cultures between the groups (p > 0.05), there was a significant increase in the area of resorption on the surface (p < 0.01) and under the surface (p < 0.01) in Charcot patients compared with diabetic patients and control subjects. The addition of anti-TNF-α resulted in a significant reduction in the area of resorption on the surface (p < 0.05) and under the surface (p < 0.05) only in Charcot patients as well as a normalisation of the aberrant erosion profile. We conclude that TNF-α modulates RANKL-mediated osteoclastic resorption in vitro in patients with acute Charcot osteoarthropathy.
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Affiliation(s)
- Nina L. Petrova
- Diabetic Foot Clinic, King's College Hospital, London SE5 9RS, UK
- *Nina L. Petrova:
| | - Peter K. Petrov
- Department of Materials, Imperial College London, London SW7 2AZ, UK
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45
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Abstract
We report a case of Charcot spinal arthropathy in a diabetic patient and emphasize the clinical reasoning leading to the diagnosis, discuss the differential diagnosis, and insist on the crucial role of the radiologist and pathologist which allows the distinction between Charcot spinal arthropathy and infectious or tumoural disorders of the spine.
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46
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Cps S, Pandey V, Acharya KV. Charcot's Elbow Following Syringomyelia: Revisited. JNMA J Nepal Med Assoc 2014; 52:822-824. [PMID: 26905711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Neuropathic arthropathy of the elbow joint is uncommon with a reported incidence of 3-8%only. The natural history, pathogenesis and management approaches are debatable with an absence of clear guidelines. We report two cases of Charcot's elbow following syringomyelia with ulnar nerve manifestations. One patient required debulkingsynovectomy and ulnar nerve decompression while the other was managed conservatively. The article aims to enrich the limited knowledge of managing Charcot's elbow.
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Affiliation(s)
- S Cps
- Department of Orthopaedics, Kasturba Medical College and Hospital, Manipal University, Manipal, Udupi District, Karnataka, India
| | - V Pandey
- Department of Orthopaedics, Kasturba Medical College and Hospital, Manipal University, Manipal, Udupi District, Karnataka, India
| | - K V Acharya
- Department of Orthopaedics, Kasturba Medical College and Hospital, Manipal University, Manipal, Udupi District, Karnataka, India
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Abstract
Emerging evidence from the last two decades has shown that vascular calcification (VC) is a regulated, cell-mediated process orchestrated by vascular smooth muscle cells (VSMCs) and that this process bears many similarities to bone mineralization. While many of the mechanisms driving VSMC calcification have been well established, it remains unclear what factors in specific disease states act to promote vascular calcification and in parallel, bone loss. Diabetes is a condition most commonly associated with VC and bone abnormalities. In this review, we describe how factors associated with the diabetic milieu impact on VSMCs, focusing on the role of oxidative stress, inflammation, impairment of the advanced glycation end product (AGE)/receptor for AGE system and, importantly, diabetic neuropathy. We also explore the link between bone and VC in diabetes with a specific emphasis on the receptor activator of nuclear factor κβ ligand/osteoprotegerin system. Finally, we describe what insights can be gleaned from studying Charcot osteoarthropathy, a rare complication of diabetic neuropathy, in which the occurrence of VC is frequent and where bone lysis is extreme.
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Affiliation(s)
- N L Petrova
- Diabetic Foot Clinic, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
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Chamberlain MC, Chang E, Maravilla KR. Lumbar spine neuroarthropathy (Charcot joint) caused by a myxopapillary ependymoma. J Neurooncol 2014; 117:375-6. [PMID: 24477624 DOI: 10.1007/s11060-014-1384-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 01/20/2014] [Indexed: 11/24/2022]
Affiliation(s)
- Marc C Chamberlain
- Department of Neurology, Seattle Cancer Care Alliance, Fred Hutchison Cancer Research Center, University of Washington, 825 Eastlake Ave East, MS G4940, Box 19023, Seattle, WA, 98109, USA,
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Munson ME, Wrobel JS, Holmes CM, Hanauer DA. Data mining for identifying novel associations and temporal relationships with Charcot foot. J Diabetes Res 2014; 2014:214353. [PMID: 24868558 PMCID: PMC4020407 DOI: 10.1155/2014/214353] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 03/28/2014] [Accepted: 03/28/2014] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION. Charcot foot is a rare and devastating complication of diabetes. While some risk factors are known, debate continues regarding etiology. Elucidating other associated disorders and their temporal occurrence could lead to a better understanding of its pathogenesis. We applied a large data mining approach to Charcot foot for elucidating novel associations. METHODS. We conducted an association analysis using ICD-9 diagnosis codes for every patient in our health system (n = 1.6 million with 41.2 million time-stamped ICD-9 codes). For the current analysis, we focused on the 388 patients with Charcot foot (ICD-9 713.5). RESULTS. We found 710 associations, 676 (95.2%) of which had a P value for the association less than 1.0 × 10⁻⁵ and 603 (84.9%) of which had an odds ratio > 5.0. There were 111 (15.6%) associations with a significant temporal relationship (P < 1.0 × 10⁻³). The three novel associations with the strongest temporal component were cardiac dysrhythmia, pulmonary eosinophilia, and volume depletion disorder. CONCLUSION. We identified novel associations with Charcot foot in the context of pathogenesis models that include neurotrophic, neurovascular, and microtraumatic factors mediated through inflammatory cytokines. Future work should focus on confirmatory analyses. These novel areas of investigation could lead to prevention or earlier diagnosis.
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Affiliation(s)
- Michael E. Munson
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, 24 Frank Lloyd Wright Drive, Lobby C, Suite 1300, Ann Arbor, MI 48106, USA
- *Michael E. Munson:
| | - James S. Wrobel
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, 24 Frank Lloyd Wright Drive, Lobby C, Suite 1300, Ann Arbor, MI 48106, USA
| | - Crystal M. Holmes
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, 24 Frank Lloyd Wright Drive, Lobby C, Suite 1300, Ann Arbor, MI 48106, USA
| | - David A. Hanauer
- Department of Pediatrics, University of Michigan Medical School, 5312 CC, SPC 5940, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA
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50
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Abstract
This article reviews current literature discussing the etiology, pathophysiology, diagnosis and imaging, and conservative and surgical treatment of Charcot osteoarthropathy. The treatment of Charcot osteoarthropathy with concurrent osteomyelitis is also discussed.
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Affiliation(s)
- Peter A Blume
- Orthopedics and Rehabilitation, and Anesthesia, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA.
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