Skip to main content
SpringerLink
Log in

Charcot-Fuß

Eine Standortbestimmung und Perspektiven

Charcot foot

Current situation and outlook

  • Leitthema
  • Published:
Der Unfallchirurg Aims and scope Submit manuscript

Zusammenfassung

Eine Neuroosteoarthropathie geht mit einer schmerzarmen oder schmerzlosen Destruktion einzelner oder multipler Gelenke einher. Hauptrisikopatienten sind Diabetiker mit Polyneuropathie, der Hauptmanifestationsort ist der Fuß und die Sprunggelenksregion (Charcot-Fuß). Für die Entstehung sind insbesondere unbemerkte oder repetitive Traumata entscheidend. Unerkannt und unbehandelt können Frakturen, Dislokationen, erhebliche Fehlstellungen, Instabilitäten und Ulzerationen resultieren, die das Risiko eines konsekutiven Extremitätenverlusts durch die Notwendigkeit zur Amputation, in jedem Fall aber einer funktionellen Beschränkung erheblich steigern. Der frühen Diagnostik in der Akutphase kommt somit entscheidende prognostische Bedeutung zu. Die Primärbehandlung besteht aus vollständiger Druckentlastung und Ruhigstellung des Fußes bzw. der betroffenen Extremität, gefolgt von einer stadiengerechten Wiederaufnahme der Belastung bis zur Heilung. Die chirurgische Therapie ist als essenzieller Baustein bei der Behandlung von Komplikationen in jedem Stadium des Charcot-Fußes in das Gesamtbehandlungskonzept zu integrieren. Hauptindikationen einer chirurgischen extremitätenerhaltenden Therapie sind anderweitig nicht behandelbare Instabilitäten oder Deformitäten mit Weichteilproblemen im chronischen Stadium des Charcot-Fußes. Korrektureingriffe können somit einen relevanten Beitrag zum langfristigen Extremitätenerhalt und zur Mobilität und Lebensqualität des Patienten leisten.

Abstract

Neuro-osteoarthropathy is accompanied by the destruction of single or multiple joints involving little or no pain. Diabetic patients suffering from symmetric distal polyneuropathy are the main risk group. The main location is the foot (Charcot foot). Inadvertent or repetitive trauma appears to be the main trigger mechanism for Charcot foot. Undiagnosed and untreated fractures and dislocations, foot and ankle deformities and instabilities with consecutive ulcerations may be the consequence, which again may increase the risk for later extremity loss due to the need for amputation or at least functional deterioration. Early diagnosis in the acute phase is of the utmost importance for the patient’s prognosis. The primary strategy consists of unloading and immobilizing the foot and the corresponding extremity followed by stage-related protected remobilization until definite healing occurs. Surgical intervention is a key-stone in the treatment of complications at any stage. Surgery is an essential part of treatment and should be integrated into the overall treatment plan. The main indications for orthopedic reconstruction are non-plantigrade foot and ankle deformities or instabilities with concomitant ulcers that cannot be adequately addressed by non-operative measures, mainly in the chronic stage of Charcot foot. As such, surgical reconstruction can contribute to the long-term preservation of the affected foot and help to maintain or improve the patient’s mobility and quality of life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8
Abb. 9
Abb. 10
Abb. 11

Literatur

  1. Armstrong DG, Todd WF, Lavery LA et al. (1997) The natural history of acute Charcot’s arthropathy in a diabetic foot specialty clinic. J Am Podiatr Med Assoc 87: 272–278

    PubMed  CAS  Google Scholar 

  2. Armstrong DG, Lavery LA (1998) Elevated peak plantar pressures in patients who have Charcot arthropathy. J Bone Joint Surg 80-A: 365–369

    Google Scholar 

  3. Armstrong DG, Lavery LA, Harkless LB (1998) Who is at risk for diabetic foot ulceration? Clin Podiatr Med Surg 15: 11–19

    PubMed  CAS  Google Scholar 

  4. Baumgartner R, Botta P (2008) Amputation und Prothesenversorgung, 3. Aufl. Stuttgart, G. Thieme, Stuttgart, S 27–31

  5. Baravarian B, Van Gils CC (2004) Arthrodesis of the Charcot foot and ankle. Clin Podiatr Med Surg 21: 271–289

    Article  PubMed  Google Scholar 

  6. Cavanagh PR, Ulbrecht JS, Caputo GM (2000) New developments in the biomechanics of the diabetic foot. Diabetes Metab Res Rev 16 (Suppl 1): S6–10

    Article  PubMed  Google Scholar 

  7. Chantelau E (2005) The perils of procrastination: effects of early vs. delayed detection and treatment of incipient Charcot fracture. Diabet Med 22: 1707–1712

    Article  PubMed  CAS  Google Scholar 

  8. Chantelau E, Onvlee GJ (2006) Charcot foot in diabetes: farewell to the neurotrophic theory. Horm Metab Res 38: 361–367

    Article  PubMed  CAS  Google Scholar 

  9. Chantelau E, Poll LW (2006) Evaluation of the diabetic Charcot foot by MR Imaging or plain radiography. Exp Clin Endocrinol Diabetes 114: 428–431

    Article  PubMed  CAS  Google Scholar 

  10. Chantelau E, Richter A, Ghassem-Zadeh N, Poll LW (2007) „Silent“ bone stress injuries in the feet of diabetic patients with polyneuropathy: a report on 12 cases. Arch Orthop Trauma Surg 127: 171–177

    Article  PubMed  CAS  Google Scholar 

  11. Chantelau E, Kimmerle R, Poll LW (2007) Nonoperative treatment of neuro-osteoarthropathy of the foot: do we need new criteria? Clin Podiatr Med Surg 24: 483–503

    Article  PubMed  Google Scholar 

  12. Clohisy DR, Thompson Jr RC (1988) Fractures associated with neuropathic arthropathy in adults who have juvenile-onset diabetes. J Bone Joint Surg 70-A: 1192–1200

    Google Scholar 

  13. Dellon AL (2004) Diabetic neuropathy: review of a surgical approach to restore sensation, relive pain, and prevent ulceration and amputation. Foot Ankle Int 25: 749–755

    PubMed  Google Scholar 

  14. Drerup B, Kolling C, Koller A, Wetz HH (2004) Verringerung des plantaren Spitzendrucks beim Diabetiker durch Verkürzung der Schrittlänge. Orthopäde 33: 1013–1019

    Article  PubMed  CAS  Google Scholar 

  15. Eckardt A, Lobmann R (2005) Der diabetische Fuß. Springer, Berlin Heidelberg New York Tokyo

  16. Fishco WD (2001) Surgically induced Charcot’s foot. J Am Podiatr Med Assoc 91: 388–393

    PubMed  CAS  Google Scholar 

  17. Garapati R, Weinfeld SB (2004) Complex reconstruction of the diabetic foot and ankle. Am J Surg 187: 81S–86S

    Article  PubMed  Google Scholar 

  18. Hartemann-Heurtier A, Van GH, Grimaldi A (2002) The Charcot foot. Lancet 360: 1776–1779

    Article  PubMed  Google Scholar 

  19. Herbst SA (2004) External fixation of Charcot arthropathy. Foot Ankle Clin 9: 595–609

    Article  PubMed  Google Scholar 

  20. Höpfner S, Krolak C, Kessler S, Tiling R et al. (2004) Preoperative imaging of Charcot neuropathy in diabetic patients: comparison of ring PET, hybrid PET, and magnetic resonance imaging. Foot Ankle Int 25: 890–895

    PubMed  Google Scholar 

  21. Hyer CF, Lee TH, Philbin M, Berlet GC (2004) Diabetic neuropathy: the painful foot. Foot Ankle Clin N Am 9: 221–237

    Article  Google Scholar 

  22. Jeffcoate WJ (2005) Abnormalities of vasomotor regulation in the pathogenesis of the acute Charcot foot of diabetes mellitus. Int J Low Extrem Wounds 4: 133–137

    Article  PubMed  Google Scholar 

  23. Jolly GP, Zgonis T, Polyzois V (2003) External fixation in the management of Charcot neuroarthropathy. Clin Podiatr Med Surg 20: 741–756

    Article  PubMed  Google Scholar 

  24. Kessler SB, Kalteis TA, Botzlar A (1999) Prinzipien der chirurgischen Behandlung bei diabetisch-neuropathischer Osteoarthropathie. Internist 40: 1029–1035

    Article  PubMed  CAS  Google Scholar 

  25. Kimmerle R, Chantelau E (2007) Weight-bearing intensity produces Charcot deformity in injured neuropathic feet in diabetes. Exp Clin Endocrinol Diabetes 115: 360–364

    Article  PubMed  CAS  Google Scholar 

  26. Köck FX, Koester B (2007) Diabetisches Fußsyndrom. G. Thieme, Stuttgart

  27. Koller A, Fiedler R, Wetz HH (2001) Der Fixateur externe zur Rekonstruktion der Fußstatik bei neurogener Osteoarthropathie. Orthopäde 30: 226–230

    Article  PubMed  Google Scholar 

  28. Koller A, Fühner J, Wetz HH (2004) Radiologische und klinische Aspekte der diabetisch-neuropathischen Osteoarthropathie. Orthopäde 33: 972–982

    PubMed  CAS  Google Scholar 

  29. Koller A, Hafkemeyer U, Fiedler R, Wetz HH (2004) Rekonstruktive Fußchirurgie bei diabetisch-neuropathischer Osteoarthropathie. Orthopäde 33: 983–991

    PubMed  CAS  Google Scholar 

  30. Marks RM, Parks BG, Schon LC (1998) Midfoot fusion technique for neuropathic feet: biomechanical analysis and rationale. Foot Ankle Int 19: 507–510

    PubMed  CAS  Google Scholar 

  31. Morbach S, Müller E, Reike H et al. (2007) Diabetisches Fußsyndrom. Diabetologie 2 (Suppl 2): S191–196

    Article  Google Scholar 

  32. Myerson MS, Henderson MR, Saxby T, Short KW (1994) Management of midfoot diabetic neuropathy. Foot Ankle Int 15: 233–241

    PubMed  CAS  Google Scholar 

  33. Pakarinen TK, Laine HJ, Honkonen SE et al. (2002) Charcot arthropathy of the diabetic foot. Current concepts and review of 36 cases. Scand J Surg 91: 195–201

    PubMed  CAS  Google Scholar 

  34. Papa J, Myerson M, Girard P (1993) Salvage with arthrodesis in intractable diabetic neuropathic arthropathy of the foot and ankle. J Bone Joint Surg 75-A: 1056–1066

    Google Scholar 

  35. Perry JE, Hall JO, Davis BL (2002) Simultaneous measurement of plantar pressure and shear forces in diabetic individuals. Gait Posture 15: 101–107

    Article  PubMed  Google Scholar 

  36. Pinzur MS (2000) Charcot’s foot. Foot Ankle Clin 5: 897–912

    PubMed  CAS  Google Scholar 

  37. Pinzur M (2004) Surgical versus accommodative treatment for Charcot arthropathy of the midfoot. Foot Ankle Int 25: 545–549

    PubMed  Google Scholar 

  38. Pinzur MS, Noonan T (2006) Ankle arthrodesis with a retrograde femoral nail for Charcot ankle arthropathy. Foot Ankle Int 26: 545–549

    Google Scholar 

  39. Pinzur MS (2007) Current concepts review: Charcot arthropathy of the foot and ankle. Foot Ankle Int 28: 952–959

    Article  PubMed  Google Scholar 

  40. Pinzur MS, Sostak J (2007) Surgical stabilization of nonplantigrade Charcot arthropathy of the midfoot. Am J Orthop 36: 361–365

    PubMed  Google Scholar 

  41. Resch S (2004) Corrective surgery in diabetic foot deformity. Diabetes Metab Res Rev 20 (Suppl 1): S34–36

    Article  PubMed  Google Scholar 

  42. Rosenblum BI, Giurini JM, Miller LB et al. (1997) Neuropathic ulcerations plantar to the lateral column in patients with Charcot foot deformity: a flexible approach to limb salvage. J Foot Ankle Surg 36: 360–363

    Article  PubMed  CAS  Google Scholar 

  43. Saltzman CL, Hagy ML, Zimmerman B et al. (2005) How effective is intensive nonoperative initial treatment of patients with diabetes and Charcot arthropathy of the feet? Clin Orthop 435: 185–190

    PubMed  Google Scholar 

  44. Sanders LJ, Frykberg RG (1991) Diabetic neuropathic osteoarthropathy: the Charcot foot. In: RG Frykberg (ed) The high risk foot in diabetes mellitus. Churchill Livingstone, New York, pp 297–338

  45. Schon LC, Marks RM (1995) The management of neuroarthropathic fracture-dislocations in the diabetic patient. Orthop Clin North Am 26: 375–392

    PubMed  CAS  Google Scholar 

  46. Schon LC, Easley ME, Weinfeld SB (1998) Charcot neuroarthropathy of the foot and ankle. Clin Orthop 349: 116–131

    Article  PubMed  Google Scholar 

  47. Shaw JE, van Schie CH, Carringtom AL et al. (1998) An analysis of dynamic forces transmitted through the foot in diabetic neuropathy. Diabetes Care 21: 1955–1959

    Article  PubMed  CAS  Google Scholar 

  48. Simon SR, Tejwani SG, Wilson DL et al. (2000) Arthrodesis as an early alternative to nonoperative management of Charcot arthropathy of the diabetic foot. J Bone Joint Surg 82-A: 939–950

    Google Scholar 

  49. Smith DG, Barnes BC, Sands AK et al. (1997) Prevalence of radiographic foot abnormalities in patients with diabetes. Foot Ankle Int 6: 342–346

    Google Scholar 

  50. Spraul M (1999) Internationaler Konsensus über den Diabetischen Fuß/Internationale Arbeitsgruppe über den Diabetischen Fuß. Verlag Kirchheim, Main

  51. Stone NC, Daniels TR (2000) Midfoot and hindfoot arthrodeses in diabetic Charcot arthropathy. Can J Surgery 43: 449–455

    CAS  Google Scholar 

  52. Wang JC, Lee AW, Tsukuda RK (2002) A new technique for Charcot’s foot reconstruction. J Am Podiatr Med Assoc 92: 429–436

    PubMed  Google Scholar 

  53. Yu GV, Hudson JR (2002) Evaluation and treatment of stage 0 Charcot’s neuroarthropathy of the foot and ankle. J Am Podiatr Med Assoc 92: 120–220

    Google Scholar 

  54. Zgonis T, Roukis TS, Lamm BM (2007) Charcot foot and ankle reconstruction: current thinking and surgical approaches. Clin Podiatr Med Surg 24: 505–517

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Abteilung für Unfall- und Wiederherstellungschirurgie, Chirurgische Klinik und Poliklinik der Universität Rostock, Schillingallee 35, 18055, Rostock, Deutschland

    T. Mittlmeier, P. Haar & M. Beck

  2. Reparto di chirurgia ortopedica, Sede Moncucco, Clinica Luganese, Lugano, Schweiz

    K. Klaue

Authors
  1. T. Mittlmeier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. Klaue
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Haar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Beck
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Mittlmeier.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mittlmeier, T., Klaue, K., Haar, P. et al. Charcot-Fuß. Unfallchirurg 111, 218–231 (2008). https://doi.org/10.1007/s00113-008-1431-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00113-008-1431-y

Schlüsselwörter

Keywords

Search

Navigation