Download PDF
CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2020; 55(04): 397-403
DOI: 10.1055/s-0039-3402460
Artigo de Atualização
Tornozelo e Pé

Diabetic Foot. Part 2: Charcot Neuroarthropathy[*]

Article in several languages: português | English
Ricardo Cardenuto Ferreira 
1   Grupo de Cirurgia do Pé e Tornozelo, Departamento de Ortopedia e Traumatologia da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Charcot neuroarthropathy (CN) is an unfortunate and common complication of patients with diabetes, most likely resulting from a lack of proper understanding of the disease, which leads to late diagnosis. It is commonly misdiagnosed as infection and treated with antibiotics and a frustrated attempt of surgical drainage, which will reveal only debris of the osteoarticular destruction. Proper education of diabetic patients and of the health care professionals involved in their treatment is essential for the recognition of the initial signs of CN. The general orthopedic surgeon is usually the first to treat these patients in the early stages of the disease and must be aware of the signs of CN in order to establish an accurate diagnosis and ensure proper treatment. In theory, this would make it possible to decrease the morbidity of this condition, as long as proper treatment is instituted early.

Keywords

diabetes - foot - arthropathy, neurogenic/complications - amputation

* Study developed at Foot and Ankle Surgery Group, Department of Orthopedics and Traumatology of Santa Casa de Misericórdia de São Paulo, SP, Brazil.




Publication History

Received: 28 June 2019

Accepted: 13 September 2019

Article published online:
27 April 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revinter Publicações Ltda
Rio de Janeiro, Brazil

 

  • Referências

  • 1 Hu FB. Globalization of diabetes: the role of diet, lifestyle, and genes. Diabetes Care 2011; 34 (06) 1249-1257
    CrossrefPubMedGoogle Scholar
  • 2 Centers for Disease Control and Prevention. National Diabetics Statistics Report 2017. Department of Health and Human Services, Center for Disease Prevention and Control; 2017
    Google Scholar
  • 3 Del Core MA, Ahn J, Lewis 3rd RB. , et al. The evaluation and treatment of diabetic foot ulcers and diabetic foot infections. Foot Ankle Int 2018; 3 (1S): 13S-23S
    Google Scholar
  • 4 Brodsky JW. The diabetic foot. In: Mann RA, Coughlin MJ. , editors. Surgery of the Foot and Ankle. 6th ed. St Louis, MO: Mosby; 1993: 278-283
    Google Scholar
  • 5 Brodsky JW. Outpatient diagnosis and care of the diabetic foot. Instr Course Lect 1993; 42: 121-139
    PubMedGoogle Scholar
  • 6 Wukich DK, Raspovic KM, Suder NC. Patients with diabetic foot disease fear major lower-extremity amputation more than death. Foot Ankle Spec 2018; 11 (01) 17-21
    CrossrefPubMedGoogle Scholar
  • 7 Peterson N, Widnall J, Evans P, Jackson G, Platt S. Diagnostic imaging of diabetic foot disorders. Foot Ankle Int 2017; 38 (01) 86-95
    CrossrefPubMedGoogle Scholar
  • 8 Gibbons GW, Habershaw GM. Diabetic foot infections. Anatomy and surgery. Infect Dis Clin North Am 1995; 9 (01) 131-142
    CrossrefPubMedGoogle Scholar
  • 9 Suder NC, Wukich DK. Prevalence of diabetic neuropathy in patients undergoing foot and ankle surgery. Foot Ankle Spec 2012; 5 (02) 97-101
    CrossrefPubMedGoogle Scholar
  • 10 Game FL, Catlow R, Jones GR. , et al. Audit of acute Charcot's disease in the UK: the CDUK study. Diabetologia 2012; 55 (01) 32-35
    CrossrefPubMedGoogle Scholar
  • 11 Gouveri E, Papanas N. Charcot osteoarthropathy in diabetes: A brief review with an emphasis on clinical practice. World J Diabetes 2011; 2 (05) 59-65
    CrossrefPubMedGoogle Scholar
  • 12 Rogers LC, Frykberg RG, Armstrong DG. , et al. The diabetic Charcot foot syndrome: a report of the joint task force on the Charcot foot by the American Diabetes Association and the American Podiatric Medical Association. Diabetes Care 2011; 34 (09) 2123-2129
    CrossrefPubMedGoogle Scholar
  • 13 Fabrin J, Larsen K, Holstein PE. Long-term follow-up in diabetic Charcot feet with spontaneous onset. Diabetes Care 2000; 23 (06) 796-800
    CrossrefPubMedGoogle Scholar
  • 14 Stuck RM, Sohn MW, Budiman-Mak E, Lee TA, Weiss KB. Charcot arthropathy risk elevation in the obese diabetic population. Am J Med 2008; 121 (11) 1008-1014
    CrossrefPubMedGoogle Scholar
  • 15 Raspovic KM, Wukich DK. Self-reported quality of life and diabetic foot infections. J Foot Ankle Surg 2014; 53 (06) 716-719
    CrossrefPubMedGoogle Scholar
  • 16 Dhawan V, Spratt KF, Pinzur MS, Baumhauer J, Rudicel S, Saltzman CL. Reliability of AOFAS diabetic foot questionnaire in Charcot arthropathy: stability, internal consistency, and measurable difference. Foot Ankle Int 2005; 26 (09) 717-731
    CrossrefPubMedGoogle Scholar
  • 17 Raspovic KM, Hobizal KB, Rosario BL, Wukich DK. Midfoot Charcot neuroarthropathy in patients with diabetes: the impact f foot ulceration on self-reported quality of life. Foot Ankle Spec 2015; 8 (04) 255-259
    CrossrefPubMedGoogle Scholar
  • 18 Pinzur MS, Evans A. Health-related quality of life in patients with Charcot foot. Am J Orthop 2003; 32 (10) 492-496
    PubMedGoogle Scholar
  • 19 van Baal J, Hubbard R, Game F, Jeffcoate W. Mortality associated with acute Charcot foot and neuropathic foot ulceration. Diabetes Care 2010; 33 (05) 1086-1089
    CrossrefPubMedGoogle Scholar
  • 20 Ferreira RC, Gonçalez DH, Filho JM, Costa MT, Santin RAL. Midfoot Charcot arthropathy in diabetic patients: complication of an epidemic disease. Rev Bras Ortop 2015; 47 (05) 616-625
    Google Scholar
  • 21 Pinzur MS. An evidence-based introduction to Charcot foot artrhopathy. Foot Ankle Int. 2018; 3 (1S): 24S-31S
    Google Scholar
  • 22 Trepman E, Nihal A, Pinzur MS. Current topics review: Charcot neuroarthropathy of the foot and ankle. Foot Ankle Int 2005; 26 (01) 46-63
    CrossrefPubMedGoogle Scholar
  • 23 Pinzur MS, Kernan-Schroeder D, Emanuele NV, Emanuel M. Development of a nurse-provided health system strategy for diabetic foot care. Foot Ankle Int 2001; 22 (09) 744-746
    CrossrefPubMedGoogle Scholar
  • 24 Myerson MS, Henderson MR, Saxby T, Short KW. Management of midfoot diabetic neuroarthropathy. Foot Ankle Int 1994; 15 (05) 233-241
    CrossrefPubMedGoogle Scholar
  • 25 Wukich DK, Sadoskas D, Vaudreuil NJ, Fourman M. Comparision of diabetic Charcot patients with and without foot wounds. Foot Ankle Int 2017; 38 (02) 140-148
    CrossrefPubMedGoogle Scholar
  • 26 Eichenholtz SN. Charcot Joints. Springfield, IL: C.C.Thomas; 1966
    Google Scholar
  • 27 Lepäntalo M, Apelqvist J, Setacci C. , et al. Chapter V: Diabetic foot. Eur J Vasc Endovasc Surg 2011; 42 (Suppl. 02) S60-S74
    CrossrefPubMedGoogle Scholar
  • 28 Maloney N, Britt RC, Rushing GD. , et al. Insulin requirements in the intensive care unit in response to infection. Am Surg 2008; 74 (09) 845-848
    CrossrefPubMedGoogle Scholar
  • 29 de Souza LJ. Charcot arthropathy and immobilization in a weight-bearing total contact cast. J Bone Joint Surg Am 2008; 90 (04) 754-759
    CrossrefPubMedGoogle Scholar
  • 30 Pinzur MS. Current concepts review: Charcot arthropathy of the foot and ankle. Foot Ankle Int 2007; 28 (08) 952-959
    CrossrefPubMedGoogle Scholar
  • 31 Johnson JE. Surgical treatment for neuropathic arthropathy of the foot and ankle. Instr Course Lect 1999; 48: 269-277
    PubMedGoogle Scholar
  • 32 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 (07) 939-950
    CrossrefPubMedGoogle Scholar
  • 33 Pinzur M. Surgical versus accommodative treatment for Charcot arthropathy of the midfoot. Foot Ankle Int 2004; 25 (08) 545-549
    CrossrefPubMedGoogle Scholar
  • 34 Pinzur MS, Gil J, Belmares J. Treatment of osteomyelitis in charcot foot with single-stage resection of infection, correction of deformity, and maintenance with ring fixation. Foot Ankle Int 2012; 33 (12) 1069-1074
    CrossrefPubMedGoogle Scholar
  • 35 Strotman PK, Reif TJ, Pinzur MS. Current concepts: Charcot arthropathy of the foot and ankle. Foot Ankle Int 2016; 37 (11) 1255-1263
    CrossrefPubMedGoogle Scholar
  • 36 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 (07) 808-811
    CrossrefPubMedGoogle Scholar
  • 37 Sammarco VJ, Sammarco GJ, Walker Jr EW, Guiao RP. Midtarsal arthrodesis in the treatment of Charcot midfoot arthropathy. J Bone Joint Surg Am 2009; 91 (01) 80-91
    CrossrefPubMedGoogle Scholar
  • 38 Schon LC, Easley ME, Weinfeld SB. Charcot neuroarthropathy of the foot and ankle. Clin Orthop Relat Res 1998; (349) 116-131
    CrossrefPubMedGoogle Scholar
  • 39 Pinzur MS. Neutral ring fixation for high-risk nonplantigrade Charcot midfoot deformity. Foot Ankle Int 2007; 28 (09) 961-966
    CrossrefPubMedGoogle Scholar
  • 40 Fonseca Filho FF, Ferreira RC, Stéfani KC, Costa MC. A haste intramedular bloqueada na fixação da artrodese tibiotalocalcânea. Rev Bras Ortop 2001; 36 (09) 352-355
    Google Scholar
  • 41 Ferreira RC, Silva AP, Costa MC. , et al. Aspectos epidemiológicos das lesões no pé e tornozelo do paciente diabético. Acta Ortop Bras 2010; 18 (03) 135-141
    CrossrefGoogle Scholar
  • 42 Schneekloth BJ, Lowery NJ, Wukich DK. Charcot neuroarthropathy in patients with diabetes: an update systematic review of surgical management. J Foot Ankle Surg 2016; 55 (03) 586-590
    CrossrefPubMedGoogle Scholar
  • 43 Ferreira RC, Mercadante MT. Artrodese do tornozelo com fixador externo de Ilizarov. Rev Bras Ortop 2004; 39 (03) 75-92
    Google Scholar
  • 44 Gershater MA, Löndahl M, Nyberg P. , et al. Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers: a cohort study. Diabetologia 2009; 52 (03) 398-407
    CrossrefPubMedGoogle Scholar
  • 45 Gil J, Schiff AP, Pinzur MS. Cost comparison: limb salvage versus amputation in diabetic patients with charcot foot. Foot Ankle Int 2013; 34 (08) 1097-1099
    CrossrefPubMedGoogle Scholar
  • 46 Robinson AH, Pasapula C, Brodsky JW. Surgical aspects of the diabetic foot. J Bone Joint Surg Br 2009; 91 (01) 1-7
    CrossrefPubMedGoogle Scholar
  • 47 Wukich DK, Ahn J, Raspovic KM, La Fontaine J, Lavery LA. Improved quality of life after transtibial amputations in patients with diabetes-related foot complications. Int J Low Extrem Wounds 2017; 16 (02) 114-121
    CrossrefPubMedGoogle Scholar
  • 48 Wukich DK, Pearson KT. Self-reported outcomes of trans-tibial amputations for non-reconstructable Charcot neuroarthropathy in patients with diabetes: a preliminary report. Diabet Med 2013; 30 (03) e87-e90
    CrossrefPubMedGoogle Scholar