Abstract
Introduction
Charcot neuropathic osteoarthropathy (CN) is a progressive disease affecting the bones, joints and soft tissue of the foot and ankle, most commonly associated with diabetic peripheral neuropathy. Delay in the diagnosis of CN can lead to disruption of the bony architecture of the foot, deformity, recurrent foot ulceration, cellulitis, osteomyelitis (OM) and, ultimately, amputation.
1 Furthermore, patients with diabetes complicated by Charcot foot have especially high morbidity, frequency of hospitalisation and therefore, significant utilisation of expensive medical resources.
2 Mortality has also been reported to be higher in patients presenting with acute Charcot neuropathic Osteoarthropathy than diabetes alone.
3 the prevalence in this risk group is very high, up to 35%. Patients with Charcot foot typically present in their fifties or sixties and most of them have had diabetes mellitus for at least 10 years.
References
- Armstrong DG; Todd WF; Lavery LA; Harkless LB; Bushman TR; (n.d.). The natural history of Acute Charcot’s arthropathy in a diabetic foot specialty clinic. Diabetic medicine : a journal of the British Diabetic Association. https://pubmed.ncbi.nlm.nih.gov/9171250/
- B;, C. A. R. (n.d.). Ostectomy for diabetic neuroarthropathy involving the Midfoot. The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons. https://pubmed.ncbi.nlm.nih.gov/11055020
- Jeffcoate WJ, Game F, Cavanagh PR. The role of proinflammatory cytokines in the cause of neuropathic osteoarthropathy (acute Charcot foot) in diabetes. Lancet 2005;366:2058–2061 [PubMed] [Google Scholar
- Boyce BF, Xing L. Functions of RANKL/RANK/OPG in bone modeling and remodeling. Arch Biochem Biophys 2008;473:139–146 [PMC free article] [PubMed] [Google Scholar]
- Uccioli L, Sinistro A, Almerighi C, et al. Proinflammatory modulation of the surface and cytokine phenotype of monocytes in patients with acute Charcot foot. Diabetes Care 2010;33:350–355 [PMC free article] [PubMed] [Google Scholar]
- Mabilleau G, Petrova NL, Edmonds ME, Sabokbar A. Increased osteoclastic activity in acute Charcot’s osteoarthropathy: the role of receptor activator of nuclear factor-kappaB ligand. Diabetologia 2008;51:1035–1040 [PMC free article] [PubMed] [Google Scholar]
- Stevens MJ, Edmonds ME, Foster AV, Watkins PJ. Selective neuropathy and preserved vascular responses in the diabetic Charcot foot. Diabetologia 1992;35:148–154 [PubMed] [Google Scholar]
- Young MJ, Marshall A, Adams JE, Selby PL, Boulton AJ. Osteopenia, neurological dysfunction, and the development of Charcot neuroarthropathy. Diabetes Care 1995;18:34–38 [PubMed] [Google Scholar]
- Veves A, Akbari CM, Primavera J, et al. Endothelial dysfunction and the expression of endothelial nitric oxide synthetase in diabetic neuropathy, vascular disease, and foot ulceration. Diabetes 1998;47:457–463 [PubMed] [Google Scholar]
- Shapiro SA, Stansberry KB, Hill MA, et al. Normal blood flow response and vasomotion in the diabetic Charcot foot. J Diabetes Complications 1998;12:147–153 [PubMed] [Google Scholar]
- Baker N, Green A, Krishnan S, Rayman G. Microvascular and C-fiber function in diabetic Charcot neuroarthropathy and diabetic peripheral neuropathy. Diabetes Care 2007;30:3077–3079 [PubMed] [Google Scholar]
- Jeffcoate WJ, Game FL. New theories on the causes of the Charcot foot in diabetes. In The Diabetic Charcot Foot: Principles and Management. Frykberg RG, Ed. Brooklandville, MD, Data Trace Publishing Company, 2010, p. 29–44 [Google Scholar]
Corresponding Author
Dr Vani Raj I
Junior resident, Department of General Medicine, Govt. T.D Medical College, Alappuzha, Kerala, India