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Charcot neuroarthropathy in diabetes mellitus.
Diabetologia. 2002 Aug; 45(8):1085-96.D

Abstract

Charcot neuroarthropathy has been recognised for over 130 years and yet it remains a major cause of morbidity for patients with diabetes mellitus and a continuing challenge for physicians. It is rare but it seems to be increasing in prevalence and this provides hope that with larger studies it will soon be possible to clarify the natural history and optimal treatment regimens. The underlying cause is thought to be trauma in a neuropathic foot that leads to a complex series of pathological processes culminating in bone and joint destruction and subsequent deformity. The acute reaction is often misdiagnosed and many patients present late with established deformity. Even when the diagnosis is considered at an early stage there are no definitive criteria or tests to confirm charcot neuroarthropathy and a high index of suspicion is necessary in any diabetic patient with a swollen warm foot in the presence of somatic or autonomic neuropathy. Treatment has traditionally involved the use of various methods to avoid weight bearing but recent work has begun to suggest that bisphosphonates might be able to arrest the acute process. In the long term, treatment involves a multidisciplinary approach aimed at providing appropriate footwear to reduce plantar pressures and avoid foot ulceration; in some circumstances this involves surgical correction of deformities before adequate footwear can be supplied. Further studies of the emerging treatments for Charcot neuroarthropathy are needed to provide long-term outcome data on morbidity and deformity.

Authors+Show Affiliations

Rajbhandari SM
Chorley and South Ribble Hospital, Lancashire, UK.
Jenkins RC
No affiliation info available
Davies C
No affiliation info available
Tesfaye S
No affiliation info available

MeSH

Arthropathy, NeurogenicDiabetes ComplicationsDiabetic NeuropathiesHumans

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

12189438

Citation

Rajbhandari, S M., et al. "Charcot Neuroarthropathy in Diabetes Mellitus." Diabetologia, vol. 45, no. 8, 2002, pp. 1085-96.
Rajbhandari SM, Jenkins RC, Davies C, et al. Charcot neuroarthropathy in diabetes mellitus. Diabetologia. 2002;45(8):1085-96.
Rajbhandari, S. M., Jenkins, R. C., Davies, C., & Tesfaye, S. (2002). Charcot neuroarthropathy in diabetes mellitus. Diabetologia, 45(8), 1085-96.
Rajbhandari SM, et al. Charcot Neuroarthropathy in Diabetes Mellitus. Diabetologia. 2002;45(8):1085-96. PubMed PMID: 12189438.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Charcot neuroarthropathy in diabetes mellitus. AU - Rajbhandari,S M, AU - Jenkins,R C, AU - Davies,C, AU - Tesfaye,S, Y1 - 2002/07/11/ PY - 2001/11/01/received PY - 2002/05/02/revised PY - 2002/8/22/pubmed PY - 2003/2/26/medline PY - 2002/8/22/entrez SP - 1085 EP - 96 JF - Diabetologia JO - Diabetologia VL - 45 IS - 8 N2 - Charcot neuroarthropathy has been recognised for over 130 years and yet it remains a major cause of morbidity for patients with diabetes mellitus and a continuing challenge for physicians. It is rare but it seems to be increasing in prevalence and this provides hope that with larger studies it will soon be possible to clarify the natural history and optimal treatment regimens. The underlying cause is thought to be trauma in a neuropathic foot that leads to a complex series of pathological processes culminating in bone and joint destruction and subsequent deformity. The acute reaction is often misdiagnosed and many patients present late with established deformity. Even when the diagnosis is considered at an early stage there are no definitive criteria or tests to confirm charcot neuroarthropathy and a high index of suspicion is necessary in any diabetic patient with a swollen warm foot in the presence of somatic or autonomic neuropathy. Treatment has traditionally involved the use of various methods to avoid weight bearing but recent work has begun to suggest that bisphosphonates might be able to arrest the acute process. In the long term, treatment involves a multidisciplinary approach aimed at providing appropriate footwear to reduce plantar pressures and avoid foot ulceration; in some circumstances this involves surgical correction of deformities before adequate footwear can be supplied. Further studies of the emerging treatments for Charcot neuroarthropathy are needed to provide long-term outcome data on morbidity and deformity. SN - 0012-186X UR - https://www.unboundmedicine.com/medline/citation/12189438/Charcot_neuroarthropathy_in_diabetes_mellitus_ DB - PRIME DP - Unbound Medicine ER -