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Charcot Arthropathy .

Charcot Arthropathy. Hanan El-Soutouhy Gawish. Prof Int Med, Diabetes Unit,Mansoura University International Working Group of Diabetic Foot Egypt Representative. History. Mitchell,1831: The first association between joints and neurological diseases.

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Charcot Arthropathy .

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

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

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

  4. Charcot Arthropathy

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

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  9. Epidemiology • Incidence : 0.1 – 0.5 % . Increased in patients with neuropathy. • Common in the 4th or 5th decades of life. • Bilateral in 30 % of patients. • Sex difference : No • Type 1 or type 2: Both are at risk. • Majority: in the mid foot but any bone or joint in the foot or ankle can be affected. Charcot Arthropathy

  10. Clinical Features and Diagnosis Acute Charcot • Warm, inflamed and swollen. • Misdiagnosed as cellulitis, osteomyelitis or inflammatory arthropathy as gouty or septic. • Although sensory neuropathy, pain is common feature followed by discomfort. • Diagnosis by exclusion as investigations in early stages are negative. Charcot Arthropathy

  11. Clinical Features and Diagnosis High index of suspicion is necessary so that appropriate treatment is immediately instituted to prevent severe deformity! Charcot Arthropathy

  12. Clinical Features and Diagnosis Chronic Charcot, may be months, painless, without temperature difference and deformed. • Reactivation by further trauma is frequent. • Patients are at high risk of ulceration and amputation, so long term follow up is recommended. Charcot Arthropathy

  13. Investigations • X-ray : Early; absent or subtle finding. Late; bone and joint destruction, fragmentation. • Tc bisphosphonate bone scan: Increased bone uptake. • In labeled leucocytes scan to differentiate from osteomyelitis. • MRI: Bone marrow oedema is the earliest sign. Charcot Arthropathy

  14. Treatment • Immobilization • Radiotherapy and Ultrasound. • Pharmacological Treatment. • Surgical Treatment. Charcot Arthropathy

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

  16. Removable Cast Walker Charcot Arthropathy

  17. Treatment • Immobilization: Almost 16 weeks (3-6 months) but may be more. (temp gradient less than 1 on 2 occasions or radiology). Charcot Arthropathy

  18. Treatment • Radiotherapy and Ultrasound: May be useful in conjunction to offloading but only few small studies. Charcot Arthropathy

  19. Treatment 3. Pharmacological Treatment. • Pilot study first using pamidronate,1994. Other Bisphosphonates were used to decrease disease activity and bone turnover markers. • Calcitonin were also used. • Given for 12 weeks or till temp gradient is less than 2 on 2 consecutive visits. Charcot Arthropathy

  20. Treatment • Surgical treatment: No role in acute. Later may be to remove bony deformities or constructive surgeries to achieve a stable shape. Techniques include; Arthrodesis, exostectomies, reconstruction and Achilles tendon lengthening. Charcot Arthropathy

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  25. Conclusion • High degree of suspicion to diagnose acute Charcot arthropathy. • High risk categorization. • Immobilization and Bisphosphonate. Charcot Arthropathy

  26. Thank You Charcot Arthropathy

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