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By Rafi Mahandaru \ 212
CHARCOT FOOT
By Rafi Mahandaru \ 212
CHARCOT FOOT
Jean-Marie Charcot• 29 November 1825 – 16 August 1893
• The father of neurology
• Charcot triad-1 MS• Charcot triad-2 AC• Charcot joint, known
as Charcot neuroarthropathy (CNA)/charcot osteoarthropathy (COA) / charcot foot/ neuropathic joint
DEFINITION
Charcot footCharcot foot can be defined as a relatively painless, progressive and degenerative
arthropathy of single or multiple joints caused by an underlying neurological deficit.
It was a limbthreatening condition, wich can lead to amputation
ETIOLOGY
Firstly describes 1868Tabes Dorsalis late manifestation of shypilis
Bilateral degeneration of axons in BOTH dorsal columns• Pain, parestethic, sensory loss• Muscle stretch reflex also messed up
because the sensory input to those reflexes have been lesioned
• usually occurs at lumbar levels
Recent common cause
• Complication of diabetes melitus
• is estimated to affectbetween 1-2.5% of people with diabetes (2003)
• It is estimated to affect 0.8%-8% of diabetic populations (2011)
• At least 10 years suffer
Another rare cause
PATHOPHYSIOLOGY
French Theory• Charcot 1868 neurovascular theory• “…the arthropathy of ataxic patients seems to
always start after the sclerotic changes have taken place in the spinal cord.”
• Spinal cord lesion autonomic neuropathy arterious venous shunting increase blood flow increase osteoclast activity bone resorption and mechanical weakening fractures and deformity
• Increase blood flow warmth foot and dilated veins
German theory (1946)
• Volkman and Virchow neurotraumatic theory• “ peripheral neuropathy leading to loss of
protective sensation may render the foot susceptible to injury from either repeated or acute trauma “
• Insensitive joint• Allow mechanical trauma normaly prevented by
pain• Spontaneous fracture, subluxation and dislocation
Other Contributed Factor
• Bone pathology• Atypical neuropathy• Non-enzymatic collagen glycation• Increased plantar pressures• Excessive local inflammation
Acute Charcot Foot
Acute Charcot Foot
• H : Hminor trauma• L : Swollen, erythem,
deform• F : Warmth – hot• M : Crepitation• Discomfort
considerably less than might be expected from the pathology seen
Chronic Charcot foot
Chronic Charcot foot• L : pemanent deform,
no erythem, reducing swollen
• F : warmth or hot temp., subside
• M : no crepitation, gait tabes dorsalis,
• Sometimes with unoticed ulcer
Clinical Course• People risk for Charcot foot stage 0• Acute Charcot foot stage I Dev-fragmentation
– Swollen, hyperemia, bone fragmentation, join dislocation and destruction
– Radiological still looks normal, bone debris, joint subluxation and dislocation subsequently develop
• Chronic Charcot foot stage II coalescence– Decreasing erythem, hot, swelling– X-Ray :absorption of fine debris,formation of new bone,
coalescence of larger fragments and sclerosis of bone ends– Decrease joint mobility
Clinical Course
• Stage III reconstruction - consolidation– edema, erythema and warmth are not present,– unless fractures have not healed– Ulcers may develop at– sites of residual deformity, while X-rays reveal
bony remodeling,– rounding of bone ends and decreased sclerosis
Diagnose
Clinically
• Have been describe above• Investigation should be make on early stage
and to differentiate between another disease like Osteomyelitis, Gout, Arthritis– History – Predisposising factor– Physical Examination– Complication
X - Ray• Atrophic changes :
“pencil pointing or sucked candy “
X-Ray• Hypertropic
changes :– Bone proliferation– Bone destruction– Subcondral sclerosis
and– Osteophtes may be
seen
Treatment
Conservative
Immobilization and off loading• Reducing swelling and mechanical stress
elevation, bed rest, whell chair• TCC Total Contact Cast
Conservative
• Biphosphonat inhibit Osteoclastic activity– N-Containing
• Sodium alendronat (fosamax)• Riserdonat (actonel)
– Non N-Containing• Etidronat (didronel)• Tiludronic (skelid)
INTRANASAL CALCITONIN
Surgery
• Acute Charcot Foot Contraindicated• Chronic Ulcerated and fixed deformity
indication of surgery remove bony prominent and correct the deformity– Exostectomy– Arthrodesis– Tendon Lengthening
THANX … !