Neuropathic arthropathy (or neuropathic osteoarthropathy), also known as Charcot joint (often Charcot foot) after the first to describe it, Jean-Martin Charcot, refers to progressive degeneration of a weight bearing joint, a process marked by bony destruction, bone resorption, and eventual deformity due to loss of sensation. Onset is usually insidious. Pathogenesis Any condition resulting in decreased peripheral sensation, proprioception, and fine motor control: Diabetes mellitus neuropathy (the most common in the U.S. today, resulting in destruction of foot and ankle joints), with Charcot joints in 1/600-700 diabetics . Related to long-term high blood glucose levels. Alcoholic neuropathy Cerebral palsy Leprosy Syphilis (tabes dorsalis), caused by the organism Treponema pallidum Spinal cord injury Myelomeningocele Syringomyelia Intra-articular steroid injections Congenital insensitivity to pain Peroneal muscular atrophy Patients with neurosyphilis tend to have knee involvement, and patients with syringomyelia of the spinal cord may demonstrate shoulder deformity.Hirsch M , et al.  Neuropathic osteoarthropathy of the shoulder secondary to syringomyelia  . URL Stage 2: Decreased local edema, with coalescence of fragments and absorption of fine bone debris  Treatment Once the process is recognized, it should be treated via the VIPs — vascular management, infection management and prevention, and pressure relief. Aggressively pursuing these three strategies will progress the healing trajectory of the wound.Snyder, R.J., et al.,  The management of diabetic foot ulcers through optimal off-loading building consensus guidelines and practical recommendations to improve outcomes . J Am Podiatr Med Assoc , 2014. 104(6): p. 555-67 . Pressure relief ( off-loading ) and immobilization with total contact casting (TCC) are critical to helping ward off further joint destruction. TCC involves encasing the patient's complete foot, including toes, and the lower leg in a specialist cast that redistributes weight and pressure in the lower leg and foot during everyday movements. This redistributes pressure from the foot into the leg, which is more able to bear weight, to protect the wound, letting it regenerate tissue and heal.Raspovic, A. and K.B. Landorf,  A survey of offloading practices for diabetes-related plantar neuropathic foot ulcers . J Foot Ankle Res , 2014. 7: p. 35. TCC also keeps the ankle from rotating during walking, which prevents shearing and twisting forces that can further damage the wound.Snyder, R.J., et al.,  The management of diabetic foot ulcers through optimal off-loading building consensus guidelines and practical recommendations to improve outcomes . J Am Podiatr Med Assoc , 2014. 104(6): p. 555-67 . TCC aids maintenance of quality of life by helping patients to remain mobile.Farid K, Farid M, Andrews CM.  Total contact casting as part of an adaptive care approach: a case study  . Ostomy Wound Manage. 2008; 54(6): 50–65. Walking braces controlled by pneumatics are also used. Surgical correction of a joint is rarely successful in the long-term in these patients . However, off-loading alone does not translate to optimal outcomes without appropriate management of vascular disease and/or infection.Snyder, R.J. , et al.,  The management of diabetic foot ulcers through optimal off-loading building consensus guidelines and practical recommendations to improve outcomes . J Am Podiatr Med Assoc , 2014. 104(6): p. 555-67 . Duration and aggressiveness of offloading (non-weight-bearing vs. weight-bearing, non-removable vs. removable device) should be guided by clinical assessment of healing of neuropathic arthropathy based on edema, erythema, and skin temperature changes.Rogers LC , et al.  The Charcot foot in diabetes  . Diabetes Care. 2011;34(9):2123–9. It can take 6–9 months for the edema and erythema of the affected joint to recede. Outcome Outcomes vary depending on the location of the disease, the degree of damage to the joint, and whether surgical repair was necessary. Average healing times vary from 55 – 97 days  depending on location. Up to 1–2 years may be required for complete healing. Further reading %DIFDELCMD < %DIFDELCMD < %%% Neuropathic osteoarthropathy by Monica Bhargava, M.D., University of Washington Department of Radiology
Neuropathic arthropathy (or neuropathic osteoarthropathy), also known as Charcot joint (often Charcot foot) after the first to describe it, Jean-Martin Charcot, refers to progressive degeneration of a weight-bearing joint, a process marked by bony destruction, bone resorption, and eventual deformity due to loss of sensation. Onset is usually insidious. Pathogenesis Any condition resulting in decreased peripheral sensation, proprioception, and fine motor control: Diabetes mellitus neuropathy (the most common in the U.S. today, resulting in destruction of foot and ankle joints), with Charcot joints in 1/600-700 diabetics ; related to long-term high blood glucose levels. Alcoholic neuropathy Cerebral palsy Leprosy Syphilis (tabes dorsalis), caused by the organism Treponema pallidum Spinal cord injury Myelomeningocele Syringomyelia Intra-articular steroid injections Congenital insensitivity to pain Peroneal muscular atrophy Patients with neurosyphilis tend to have knee involvement, and patients with syringomyelia of the spinal cord may demonstrate shoulder deformity.Hirsch M et al. , " Neuropathic osteoarthropathy of the shoulder secondary to syringomyelia " . URL Stage 2: Decreased local edema, with coalescence of fragments and absorption of fine bone debris . Treatment Once the process is recognized, it should be treated via the VIPs — vascular management, infection management and prevention, and pressure relief. Aggressively pursuing these three strategies will progress the healing trajectory of the wound.Snyder, R.J., et al., " The management of diabetic foot ulcers through optimal off-loading building consensus guidelines and practical recommendations to improve outcomes ". Journal of the American Podiatric Medical Association , 2014. 104(6): p. 555-567 . Pressure relief ( offloading ) and immobilization with total contact casting (TCC) are critical to helping ward off further joint destruction. TCC involves encasing the patient's complete foot, including toes, and the lower leg in a specialist cast that redistributes weight and pressure in the lower leg and foot during everyday movements. This redistributes pressure from the foot into the leg, which is more able to bear weight, to protect the wound, letting it regenerate tissue and heal.Raspovic, A. and K.B. Landorf, " A survey of offloading practices for diabetes-related plantar neuropathic foot ulcers ". Journal of Foot and Ankle Research , 2014. 7: p. 35. TCC also keeps the ankle from rotating during walking, which prevents shearing and twisting forces that can further damage the wound.Snyder, R.J., et al., " The management of diabetic foot ulcers through optimal off-loading building consensus guidelines and practical recommendations to improve outcomes ". Journal of the American Podiatric Medical Association , 2014. 104(6): p. 555-567 . TCC aids maintenance of quality of life by helping patients to remain mobile.Farid K, Farid M, Andrews CM. " Total contact casting as part of an adaptive care approach: a case study " . Ostomy Wound Management, 2008. 54(6): 50–65. Walking braces controlled by pneumatics are also used. In these patients, surgical correction of a joint is rarely successful in the long term . However, offloading alone does not translate to optimal outcomes without appropriate management of vascular disease and/or infection.Snyder, R.J. et al., " The management of diabetic foot ulcers through optimal off-loading building consensus guidelines and practical recommendations to improve outcomes ". Journal of the American Podiatric Medical Association , 2014. 104(6): p. 555-567 . Duration and aggressiveness of offloading (non-weight-bearing vs. weight-bearing, non-removable vs. removable device) should be guided by clinical assessment of healing of neuropathic arthropathy based on edema, erythema, and skin temperature changes.Rogers LC et al. " The Charcot foot in diabetes " . Diabetes Care. 2011;34(9):2123–9. It can take six to nine months for the edema and erythema of the affected joint to recede. Outcome Outcomes vary depending on the location of the disease, the degree of damage to the joint, and whether surgical repair was necessary. Average healing times vary from 55 to 97 days , depending on location. Up to one to two years may be required for complete healing. Further reading %DIFDELCMD < %DIFDELCMD < %%% Neuropathic osteoarthropathy by Monica Bhargava, M.D., University of Washington Department of Radiology
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