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Charcot Neuroarthropathy

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Evidence-Based Podiatry

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Abstract

The objective of this chapter is to provide a critical analysis of the medical literature with respect to factors associated with the pathogenesis, evaluation, and treatment of Charcot neuroarthropathy of the foot and ankle. This includes a discussion of early diagnosis, medical management, surgical intervention, and patient expectations. The authors attempt to define limitations within the contemporary knowledge base and identify gaps which might be examined by future generations of foot and ankle surgeons.

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References

  1. Eichenholtz SN, editor. Charcot joints. Springfield: Charles C. Thomas; 1966. p. 7–8.

    Google Scholar 

  2. Brodsky J. The diabetic foot. In: Coughlin MJ, Mann RA, Saltzman CL, editors. Surgery of the foot and ankle. 8th ed. Philadelphia: Mosby Elsevier; 2007. p. 1281–368.

    Google Scholar 

  3. Frykberg RG. Charcot foot: an update on pathogenesis and management. In: Boulton AJM, Connor H, Cavanagh PR, editors. The foot in diabetes. 3rd ed. Chichester: Wiley; 2000. p. 235–60.

    Google Scholar 

  4. Sanders LE, Frykberg RG, Rogers LC. The diabetic Charcot foot: recognition, evaluation, and management. In: Armstrong DG, Lavery LA, editors. Clinical care of the diabetic foot. 2nd ed. Alexandria: American Diabetes Association; 2010. p. 79–96.

    Google Scholar 

  5. Zgonis TM, Stapleton JJ, Roukis TS. Charcot foot and ankle deformity. In: Southerland JT, Boberg JS, Downey MS, Am N, Rabjohn LV, editors. McGlamry’s comprehensive textbook of foot and ankle surgery. 4th ed. Philadelphia: Lippincott, Williams & Wilkins; 2013. p. 1008–21.

    Google Scholar 

  6. Rogers LC, Frykberg RG, Armstrong DG, Boulton AJ, Edmonds M, Van GH, Hartemann A, Game F, Jeffcoate W, Jirkovska A, Jude E, Morbach S, Morrison WB, Pinsur M, Pitocco D, Sanders L, Wukich DK, Uccioli L. The Charcot foot in diabetes. Diabetes Care. 2011;34(9):2123–9.

    PubMed  PubMed Central  Google Scholar 

  7. La Fontaine J, Lavery L, Jude E. Current concepts of Charcot foot in diabetic patients. Foot (Edinb). 2016;26:7–14.

    Google Scholar 

  8. Strotman PK, Reif TH, Pinzur MS. Charcot arthropathy of the foot and ankle. Foot Ankle Int. 2016;37(11):1255–63.

    PubMed  Google Scholar 

  9. Frykberg RG, Zgonis T, Armstrong DG, Driver VR, Giurini JM, Kravitz SR, Landsman AS, Lavery LA, Moore JC, Schuberth JM, Wukich DK, Andersen C, Vanore JV. Diabetic foot disorders. A clinical practice guideline (2006 revision). J Foot Ankle Surg. 2006;45(5 Suppl):S1–66.

    PubMed  Google Scholar 

  10. Varma AK. Charcot neuroarthropathy of the foot and ankle: a review. J Foot Ankle Surg. 2014;52(6):740–9.

    Google Scholar 

  11. Blume PA, Sumpio B, Schmidt B, Donegan R. Charcot neuroarthropathy of the foot and ankle: diagnosis and management strategies. Clin Podiatr Med Surg. 2014;31(1):151–72.

    PubMed  Google Scholar 

  12. Wukich DK, Sung W. Charcot arthropathy of the foot and ankle: modern concepts and management review. J Diabetes Complicat. 2009;23(6):409–26.

    PubMed  Google Scholar 

  13. Hyer CF, Pinzur MS, Ellington JK, Davis WH, Jones CP. Charcot arthropathy: operative and nonoperative management. Foot Ankle Spec. 2014;7(4):286–90.

    PubMed  Google Scholar 

  14. Labovitz JM, Shapiro JM, Satterfield VK, Smith NT. Excess cost and healthcare resources associated with delayed diagnosis of Charcot foot. J Foot Ankle Surg. 2018;57(5):952–6.

    PubMed  Google Scholar 

  15. Schade VL, Andersen CA. A literature-based guide to the conservative and surgical management of the acute Charcot foot and ankle. Diabet Foot Ankle. 2015;6:26627.

    PubMed  Google Scholar 

  16. Pinzur MS, Lio T, Posner M. Treatment of Eichenholtz stage 1 foot arthropathy with a weightbearing total contact cast. Foot Ankle Int. 2006;27(5):324–9.

    PubMed  Google Scholar 

  17. de Souza LJ. Charcot arthropathy and immobilization in a weight-bearing total contact cast. J Bone Joint Surg Am. 2008;90(4):754–9.

    PubMed  Google Scholar 

  18. Chantelau E. The perils of procrastination: effects of early vs. delayed detection and treatment of incipient Charcot fracture. Diabet Med. 2005;22(12):1707–12.

    CAS  PubMed  Google Scholar 

  19. Wukich D, Sung W, Wipf AM, Armstrong D. The consequences of complacency: managing the effects of unrecognized Charcot feet. Diabet Med. 2011;28:195–8.

    CAS  PubMed  Google Scholar 

  20. Hastings MK, Johnson JE, Strube MJ, Hildebolt CF, Bohnert KL, Prior FW, Sinacore DR. Progression of foot deformity in Charcot neuropathic osteoarthropathy. J Bone Joint Surg Am. 2013;95(13):1206–13.

    PubMed  PubMed Central  Google Scholar 

  21. Armstrong DG, Lavery LA, Liswood PJ, Todd WF, Tredwell JA. Infrared dermal thermometry for the high-risk diabetic foot. Phys Ther. 1997;77(2):176–7.

    Google Scholar 

  22. Moura-Neto A, Fernandes TD, Zantut-Wittman DE, Trevisan RO, Sakaki MH, Santos AL, Nery M, Parsisi MC. Charcot foot: skin temperature as a good clinical parameter for predicting disease outcome. Diabetes Res Clin Pract. 2012;96(2):e11–4.

    PubMed  Google Scholar 

  23. van Netten JJ, Prijs M, van Baal JG, Liu C, van der Jeijden F, Bus SA. Diagnostic value for skin temperature assessment to detect diabetes-related foot complications. Diabetes Technol Ther. 2014;16(11):714–21.

    PubMed  Google Scholar 

  24. Sousa P, Felizardo V, Oliveira D, Couto R, Garcia NM. A review of thermal methods and technologies for diabetic foot assessment. Expert Rev Med Devices. 2015;12(4):439–48.

    CAS  PubMed  Google Scholar 

  25. Chantelau E, Richter A, Schmidt-Grigoriadis P, Scherbaum WA. The diabetic Charcot foot: MRI discloses bone stress injury as trigger mechanism of neuroarthropathy. Exp Clin Endocrinol Diabetes. 2006;114(3):118–23.

    CAS  PubMed  Google Scholar 

  26. Peterson N, Widnall J, Evans P, Jackson G, Platt S. Diagnostic imaging of diabetic foot disorders. Foot Ankle Int. 2017;38(1):86–95.

    PubMed  Google Scholar 

  27. Rogers LC, Bevilacqua NJ. Imaging of the Charcot foot. Clin Podiatr Med Surg. 2008;25(2):263–74.

    PubMed  Google Scholar 

  28. Short DJ, Zgonis T. Medical imaging in differentiating the diabetic Charcot foot from osteomyelitis. Clin Podiatr Med Surg. 2017;34(1):914.

    Google Scholar 

  29. Schlossbauer T, Mioc T, Sommerey S, Kessler SB, Reiser SB, Pfeifer KJ. Magnetic resonance imaging in early stage Charcot arthropathy: correlation of imaging findings and clinical symptoms. Eur J Med Res. 2008;13(9):409–14.

    CAS  PubMed  Google Scholar 

  30. Pickwell KM, van Kroonenburgh MJ, Weijers RE, van Hirtum PV, Huijberts MS, Schaper NC. F-18 FDG PET/CT scanning in Charcot disease: a brief report. Clin Nucl Med. 2011;36(1):8–10.

    PubMed  Google Scholar 

  31. Commean PK, Smith KE, Hildebolt CF, Bohnert KL, Sinacore DR, Prior FW. A candidate imaging marker for early detection of Charcot neuroarthropathy. J Clin Densitom. 2017;21:485.

    PubMed  PubMed Central  Google Scholar 

  32. Mabilleau G, Petrova N, Edmonds ME, Sabokbar A. Number of circulating CD14-positive cells and the serum levels of TNF-alpha are raised in acute Charcot foot. Diabetes Care. 2011;34(3):33.

    Google Scholar 

  33. Petrova NL, Dew TK, Musto RL, Sherwood RA, Bates M, Moniz CF, Edmonds ME. Inflammatory and bone turnover markers in a cross-sectional and prospective study of acute Charcot osteoarthropathy. Diabet Med. 2015;32(2):267–73.

    CAS  PubMed  Google Scholar 

  34. Jansen RB, Christensen TM, Bulow J, Rordam L, Jorgensen NR, Svendsen OL. Markers of local inflammation and bone resorption in the acute diabetic Charcot foot. J Diabetes Res. 2018;208:5647981.

    Google Scholar 

  35. Jansen RB, Christensen TM, Bulow J, Rordam L, Jorgensen NR, Svendsen OL. Bone mineral density and markers of bone turnover and inflammation in diabetes patients with or without a Charcot foot: an 8.5-year prospective case-control study. J Diabetes Complicat. 2018;32(2):164–70.

    PubMed  Google Scholar 

  36. Gough A, Abraha H, Li F, Purewal TS, Foster AV, Watkins PJ, Moniz C, Edmonds ME. Measurement of markers of osteoclast and osteoblast activity in patients with acute and chronic diabetic Charcot neuroarthropathy. Diabet Med. 1997;14(7):527–31.

    CAS  PubMed  Google Scholar 

  37. Yu GV, Hudson JR. Evaluation and treatment of stage 0 Charcot’s neuroarthropathy of the foot and ankle. J Am Podiatr Med Assoc. 2002;92(4):210–20.

    PubMed  Google Scholar 

  38. Shibata T, Tada K, Hashizume C. The results of arthrodesis of the ankle for leprotic neuroarthropathy. J Bone Joint Surg Am. 1990;72(5):749–56.

    CAS  PubMed  Google Scholar 

  39. Sella EJ, Barrette C. Staging of Charcot neuroarthropathy along the medial column of the foot in the diabetic patient. J Foot Ankle Surg. 1999;38(1):34–40.

    CAS  PubMed  Google Scholar 

  40. Holmes C, Schmidt B, Munson M, Wrobel JS. Charcot stage 0: a review and considerations for making the correct diagnosis early. Clin Diabetes Endocrinol. 2015;18(1):18.

    Google Scholar 

  41. Rogers LC, Frykberg RG. The Charcot foot. Med Clin North Am. 2013;97(5):847–56.

    PubMed  Google Scholar 

  42. Schon LC, Easley ME, Weinfeld SB. Charcot neuroarthropathy of the foot and ankle. Clin Orthop Relat Res. 1998;349:116–31.

    Google Scholar 

  43. Sammarco VJ. Superconstructs in the treatment of Charcot foot deformity: plantar plating, locked plating and axial screw fixation. Foot Ankle Clin. 2009;14(3):393–407.

    PubMed  Google Scholar 

  44. Harris JF, Brand PW. Patterns of disintegration of the tarsus in the anaesthetic foot. J Bone Joint Surg Br. 1996;48(1):4–16.

    Google Scholar 

  45. Pinzur MS, Schiff AP. Deformity and clinical outcomes following operative of Charcot foot: a new classification with implications for treatment. Foot Ankle Int. 2018;39(3):265–70.

    PubMed  Google Scholar 

  46. Wukich DK, Sadoskas D, Vaudreuil NJ, Fourman M. Comparison of diabetic Charcot patients with and without foot wounds. Foot Ankle Int. 2017;38(2):140–8.

    PubMed  Google Scholar 

  47. Sinacore DR. Healing times of diabetic ulcers in the presence of fixed deformities of the foot using total contact casting. Foot Ankle Int. 1998;19(9):613–8.

    CAS  PubMed  Google Scholar 

  48. Sinacore DR. Acute Charcot arthropathy in patients with diabetes mellitus: healing times by foot location. J Diabetes Complicat. 1998;12(5):287–93.

    CAS  PubMed  Google Scholar 

  49. Bevan WP, Tomlinson MP. Radiographic measures as a predictor of ulcer formation in diabetic charcot midfoot. Foot Ankle Int. 2008;29(6):568–73.

    PubMed  Google Scholar 

  50. Wukich DK, Raspovic KM, Hobizal KB, Rosario B. Radiographic analysis of diabetic midfoot charcot neuroarthropathy with and without midfoot ulceration. Foot Ankle Int. 2014;35(11):1108–15.

    PubMed  PubMed Central  Google Scholar 

  51. Schon LC, Weinfeld SB, Horton GA, Resch S. Radiographic and clinical classification of acquired midtarsus deformities. Foot Ankle Int. 1998;19(6):394–404.

    CAS  PubMed  Google Scholar 

  52. Meyr AJ, Sebag JA. Relationship of cuboid height to plantar ulceration and other radiographic parameters in midfoot Charcot neuroarthropathy. J Foot Ankle Surg. 2017;56(4):748–55.

    PubMed  Google Scholar 

  53. Game FL, Catlow R, Jones GR, Edmonds ME, Jude EB, Rayman G, Jeffcoate WJ. Audit of acute Charcot’s disease in the UK: the CDUK study. Diabetologia. 2012;55(1):32–5.

    CAS  PubMed  Google Scholar 

  54. Richard JL, Almasri M, Schuldiner S. Treatment of acute Charcot foot with bisphosphonates: a systematic review of the literature. Diabetologia. 2012;55(5):1258–64.

    CAS  PubMed  Google Scholar 

  55. Jude EB, Selby PL, Burgess J, Lilleystone P, Mawer EB, Page SR, Donohue M, Foster AV, Edmonds ME, Boulton AJ. Bisphosphonates in the treatment of Charcot neuroarthrpathy: a double-blind randomized controlled trial. Diabetologia. 2001;44(11):2032–7.

    CAS  PubMed  Google Scholar 

  56. Parkarinen TK, Laine HJ, Maenpaa H, Kahonen M, Mattila P, Lahtela J. Effect of immobilization, off-loading and zoledronic acid on bone mineral density in patients with acute Charcot neuroarthropathy: a prospective randomized trial. Foot Ankle Surg. 2013;19(2):121–4.

    Google Scholar 

  57. Petrova NL, Edmonds ME. Medical management of Charcot arthropathy. Diabetes Obes Metab. 2013;15(3):193–7.

    CAS  PubMed  Google Scholar 

  58. Smith C, Kumar S, Causby R. The effectiveness of non-surgical interventions in the treatment of Charcot foot. JBI Libr Syst Rev. 2007;5(10):558–76.

    PubMed  Google Scholar 

  59. Schneekloth BJ, Lowery NJ, Wukich DK. Charcot neuroarthropathy in patients with diabetes: an updated systematic review of surgical management. J Foot Ankle Surg. 2016;55(3):586–90.

    PubMed  Google Scholar 

  60. Burns PR, Wukich DK. Surgical reconstruction of the Charcot rearfoot and ankle. Clin Podiatr Med Surg. 2008;25(1):95–120.

    PubMed  Google Scholar 

  61. Simon SR, Tejwani SG, Wilson DL, Santner TJ, Denniston NL. Arthrodesis as an early alternative to nonoperative management of Charcot arthropathy of the diabetic foot. J Bone Joint Surg Am. 2000;82-A(7):939–50.

    CAS  PubMed  Google Scholar 

  62. Wukich DK, Crim BE, Frykberg RG, Rosario BL. Neuropathy and poorly controlled diabetes increase the rate of surgical site infection after foot and ankle surgery. J Bone Joint Surg Am. 2014;96(10):832–9.

    PubMed  PubMed Central  Google Scholar 

  63. Brodsky JW, Rouse AM. Exostectomy for symptomatic bony prominences in diabetic Charcot feet. Clin Orthop Relat Res. 1993;296:21–6.

    Google Scholar 

  64. Marks RM, Parks BG, Schon LC. Midfoot fusion technique for neuroarthropathic feet: biomechanical analysis and rationale. Foot Ankle Int. 1998;19(8):507–10.

    CAS  PubMed  Google Scholar 

  65. Dayton P, Feilmeier M, Thompson M, Whitehouse P, Reimer RA. Comparison of complications for internal and external fixation for Charcot reconstruction: a systematic review. J Foot Ankle Surg. 2015;54(6):1072–5.

    PubMed  Google Scholar 

  66. Zgonis T, Roukis TS, Lamm BM. Charcot foot and ankle reconstruction: current thinking and surgical approaches. Clin Podiatr Med Surg. 2007;24(3):505–17.

    PubMed  Google Scholar 

  67. Lamm BM, Gottlieb HD, Paley D. A two-stage percutaneous approach to Charcot diabetic foot reconstruction. J Foot Ankle Surg. 2010;49(6):517–22.

    PubMed  Google Scholar 

  68. Lamm BM, Siddiqui NA, Nair AK, LaPorta G. Intramedullary foot fixation for midfoot Charcot neuroarthropathy. J Foot Ankle Surg. 2012;51(4):531–6.

    PubMed  Google Scholar 

  69. Kann JN, Parks BG, Schon LC. Biomechanical evaluation of two different screw positions for fusion of the calcaneocuboid joint. Foot Ankle Int. 1999;20:33–6.

    CAS  PubMed  Google Scholar 

  70. Bosco JA 3rd, Sachdev R, Shapiro LA, Stein SM, Zuckerman JD. Measuring quality in orthopaedic surgery: the use of metrics in quality management. Instr Course Lect. 2014;63:473–85.

    PubMed  Google Scholar 

  71. Katz G, Ong C, Hutzler L, Zuckerman JD, Bosco JA 3rd. Applying quality principles to orthopaedic surgery. Instr Course Lect. 2014;63:465–72.

    PubMed  Google Scholar 

  72. Snyder CF, Aaronson NK. Use of patient-reported outcomes in clinical practice. Lancet. 2009;374(9687):369–70.

    PubMed  Google Scholar 

  73. Walijee JF, Nellans K. Quality assessment in hand surgery. Hand Clin. 2014;30(3):259–68.

    Google Scholar 

  74. Andrawis JP, Chenok KE, Bozic KJ. Health policy implications of outcomes measurement in orthopaedics. Clin Orthop Relat Res. 2013;471(11):3475–81.

    PubMed  PubMed Central  Google Scholar 

  75. Kroin E, Schiff A, Pinzur MS, Davis ES, Chaharbakhshi E, DiSilvio FA Jr. Functional impairment of patients undergoing surgical correction for Charcot foot Arthropathy. Foot Ankle Int. 2017;38(7):705–9.

    PubMed  Google Scholar 

  76. Pinzur MS, Evans A. Health-related quality of life in patients with Charcot foot. Am J Orthop (Belle Mead NJ). 2003;32(10):492–6.

    Google Scholar 

  77. Sochocki MP, Verity S, Atherton PJ, Huntington JL, Sloan JA, Embil JM, Trepman E. Health related quality of life in patients with Charcot arthropathy of the foot and ankle. Foot Ankle Surg. 2008;14(1):11–5.

    PubMed  Google Scholar 

  78. Raspovic KM, Wukich DK. Self-reported quality of life in patients with diabetes: a comparison of patients with and without Charcot neuroarthropathy. Foot Ankle Int. 2014;35(3):195–200.

    PubMed  Google Scholar 

  79. Raspovic KM, Hobizal KB, Rosario BL, Wukich DK. Midfoot Charcot neuroarthropathy in patients with diabetes: the impact of foot ulceration on self-reported quality of life. Foot Ankle Spec. 2015;8(4):255–9.

    PubMed  PubMed Central  Google Scholar 

  80. Wukich DK, Raspovic KM, Suder NC. Patients with diabetic foot disease fear major lower-extremity amputation more than death. Foot Ankle Spec. 2018;11(1):17–21.

    PubMed  Google Scholar 

  81. Saltzman CL, Hagy ML, Zimmerman B, Estin M, Cooper R. How effective is intensive nonoperative initial treatment of patients with diabetes and Charcot arthropathy of the feet? Clin Orthop Relat Res. 2005;435:185–90.

    Google Scholar 

  82. Sohn MW, Lee TA, Stuck RM, Frykberg RG, Budiman-Mak E. Mortality risk of Charcot arthropathy compared with that of diabetic foot ulcer and diabetes alone. Diabetes Care. 2009;32(5):816–21.

    PubMed  PubMed Central  Google Scholar 

  83. Pakarinen TK, Laine HJ, Maenpaa H, Mattila P, Lahtela J. Long-term outcome and quality of life in patients with Charcot foot. Foot Ankle Surg. 2009;15(4):187–91.

    PubMed  Google Scholar 

  84. Kroin E, Chaharbakhshi EO, Schiff A, Pinzur MS. Improvement in quality of life following operative correction of midtarsal Charcot foot deformity. Foot Ankle Int. 2018;39(7):808–11.

    PubMed  Google Scholar 

  85. Eschler A, Gradl G, Wussow A, Mittlmeier T. Prediction of complications in a high-risk cohort of patients undergoing corrective arthrodesis of late stage Charcot deformity based on the PEDIS score. BMC Musculoskeletal Disord. 2015;16:349.

    Google Scholar 

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  1. Department of Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA, USA

    Andrew J. Meyr & Kwasi Y. Kwaadu

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  1. Andrew J. Meyr
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Correspondence to Andrew J. Meyr .

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  1. American Podiatric Medical Association, Bethesda, MD, USA

    Dyane E. Tower

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Meyr, A.J., Kwaadu, K.Y. (2020). Charcot Neuroarthropathy. In: Tower, D.E. (eds) Evidence-Based Podiatry. Springer, Cham. https://doi.org/10.1007/978-3-030-50853-1_10

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  • DOI: https://doi.org/10.1007/978-3-030-50853-1_10

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