La Lettre de médecine physique et de réadaptation

, Volume 25, Issue 4, pp 195–199

Le pied de Charcot: quelle prise en charge proposer ?

Article de Synthèse
  • 154 Downloads

Résumé

Le diagnostic précoce d’une neuroarthropathie diabétique de Charcot est certainement le moyen le plus sûr d’en éviter ses sévères complications. Ainsi, ce diagnostic doit être suspecté chez tout patient neuropathique présentant un pied chaud, rouge, gonflé. En effet, les problèmes sont différents au stade précoce de résorption osseuse où l’objectif du traitement sera d’éviter autant que possible, par la mise en décharge, l’aggravation des déformations en attendant la consolidation ou l’ankylose fibreuse, alors qu’au stade tardif, la mise en place d’une chaussure thérapeutique sur mesure avec orthèse plantaire thermomoulée sur positif aura pour objectif principal la prévention de l’apparition d’ulcérations cutanées. Quant au traitement chirurgical, il interviendra, lui aussi, au stade chronique.

Mots clés

Maladie de Charcot Prise en charge Traitement 

Management of diabetic neuropathy in Charcot’s disease

Abstract

Early diagnosis of diabetic neuropathy in Charcot’s disease is undoubtedly the best way of avoiding the severe complications associated with such neuropathy. This form of diabetic neuropathy should be suspected in all patients presenting with a warm, red, swollen foot. Indeed, the problems encountered are different in an early-stage in bone reduction during which treatment is aimed at preventing the worsening of deformities through rest, while waiting for consolidation or fibrous ankylosis to occur. In later stages, a therapeutic customized shoe fitted with a heat moulded plantar orthopaedic brace can be used, primarily with a view to preventing skin ulcers. Surgical treatment is also used, at a chronic stage.

Keywords

Charcot’s disease Management Treatment 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Références

  1. 1.
    Armstrong DG, Nguyen HC, Lavery LA, et al. (2001) Offloading the diabetic foot wound: a randomised clinical trial. Diabetes Care 24:1019–1022CrossRefPubMedGoogle Scholar
  2. 2.
    Armstrong DG, Lavery LA, Wu S, Boulton AJ (2005) Evaluation of removable and irremovable cast walkers in the healing of diabetic foot wounds: a randomised controlled trial. Diabetes Care 28:551–554CrossRefPubMedGoogle Scholar
  3. 3.
    Averous C (2004) Le traitement des maux perforants plantaires chez le diabétique par botte plâtrée. Lett Med Phys Readapt 72:13–14Google Scholar
  4. 4.
    Brunon A, Vannereau D, Latour P (2004) Dispositif transitoire d’aide à la cicatrisation du pied. Lett Med Phys Readapt 72:29Google Scholar
  5. 5.
    Chantelau E, Spraul M (1999) Amputation ? Nein Danke. Neuer Merkur Verlag et communication orale CPC Paris 07-2004Google Scholar
  6. 6.
    Coeper S, Schaffer M, Witte M, Becker HD (1999) Wundbehandlung beim diabetischen Fussulkus. Orthopaedie Schuhtechnik 2:52–55Google Scholar
  7. 7.
    Ehrler S, Wieser R (2004) Mise en décharge du pied diabétique. Lett Med Phys Readapt 72:25–28Google Scholar
  8. 8.
    Ehrler S, Guillot-Masanovic M (2005) Mise en décharge du pied diabétique ouvert. JPC 48:414Google Scholar
  9. 9.
    Ha Van G, Siney H, Hartmann-Heurtier A, et al. (2003) Nonremovable, windowed, fibreglass cast boot in the treatment of diabetic plantar ulcers: efficacy, safety and compliance. Diabetes Care 26:2848–2852CrossRefPubMedGoogle Scholar
  10. 10.
    Jeffcoate William Foot Ulcer Trials Unit, City Hospital, Nottingham, UK, Diabetologia 2004; Lancet 2005Google Scholar
  11. 11.
    Jude Edward B (2006) Charcot Foot: what’s new in pathogenis and medical management, chap 22, pp. 265–273, the Foot in Diabetes th edition Editions Andrew JM Boulton, Peter R. Cavanagh and Gery RaymanGoogle Scholar
  12. 12.
    Kelikian AS (1999) Operative treatment of the foot and ankle. Conn: Appleton et Lange, Stamford 153Google Scholar
  13. 13.
    Katz IA, Harlan A, Miranda-Palma B, et al. (2005) A randomised trial of two irremovable off-loading devices in the management of plantar neuropathic diabetic foot ulcers. Diabetes Care 28:555–559CrossRefPubMedGoogle Scholar
  14. 14.
    Knowles EA, Boulton AJ (1996) Do people with diabetes wear their prescribed footwear? Diabet Med 13:1064–1068CrossRefPubMedGoogle Scholar
  15. 15.
    Litzeman DK, Marriott DJ, Vinicor F (1997) The role of footwear in the prevention of foot lesions in patients with NIDDM. Conventional wisdom or evidence-based practice? Diabetes Care 20:156–162CrossRefGoogle Scholar
  16. 16.
    McCrory JL, Morag E, Norkitis AJ, et al. (1998) Healing of Charcot fractures: skin temperature and radiographic correlates. Foot 8:158–165CrossRefGoogle Scholar
  17. 17.
    Pollo FE, Brodsky JW, Crenshaw SJ, Kirksey C (2003) Plantar pressures in fibreglass contact casts vs a new diabetic walking boot. Foot Ankle Int 24:45–49PubMedGoogle Scholar
  18. 18.
    Sanders Lee J, Frykberg Robert G. Charcot Neuroarthropathy of the Foot, Chap 21, pp. 439–66, The Diabetic Foot. Bowker John H, Pfeiffe Michael A, Levin and O’Neals. The Diabetic Foot, sixth edition, MosbyGoogle Scholar

Copyright information

© Springer-Verlag France 2009

Authors and Affiliations

  1. 1.MPRCHR Félix-GuyonSaint-Denis, La RéunionFrance
  2. 2.MPRCRF ClémenceauStrasbourgFrance
  3. 3.Clinique de l’OrangerieStrasbourg cedexFrance

Personalised recommendations