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Charcot arthropathy of the foot and ankle in patients with idiopathic neuropathy.
Foot Ankle Int. 2014 Oct; 35(10):996-1001.FA

Abstract

BACKGROUND

Charcot neuroarthropathy in the developed countries is primarily associated with diabetic neuropathy. This study investigated a series of patients with Charcot arthropathy associated with idiopathic peripheral neuropathy to evaluate the natural history in these patients and to evaluate the efficacy of a treatment protocol used for diabetic Charcot joints.

METHODS

The records and radiographs of patients with Charcot arthropathy of the foot and ankle treated between 1986 and 2009 were retrospectively reviewed. Patients with known causes of or risk factors for peripheral neuropathy were excluded, identifying 82 feet in 59 patients with idiopathic neuropathy. Twenty-three (39%) were bilateral. The average age was 76 years and the average follow-up was 60 months. Data were analyzed for medical history and diagnoses, medications, anatomic classification of Charcot arthropathy, history of ulcerations, ambulatory status, shoe wear and bracing, and operative interventions. Patient care was based on previous published treatment algorithms, based on conservative management with operative intervention reserved for nonhealing ulcers, infection, and/or nonplantigrade, unbraceable feet. Therapeutic success was a plantigrade foot with healed soft tissue envelope that allowed weight-bearing.

RESULTS

In all, 55% involved the midfoot (type 1), 34% the hindfoot (type 2), and 11% the ankle, (type 3A). Seventy-one of 82 feet were successfully treated at the time of last follow-up. Thirty-six feet (43%) were treated nonoperatively with success in 33 (92%). Forty-six of 82 feet required operative intervention, with success at last follow-up in 38 (83%). There were 8 operative failures resulting in 2 transtibial amputations and 6 feet with persistent ulceration.

CONCLUSIONS

This series of patients with Charcot arthropathy associated with idiopathic neuropathy demonstrated a wider spectrum of Charcot arthropathy of the foot and ankle than has been previously recognized or documented. At the present time, heightened awareness is needed to promote accurate diagnosis and appropriate treatment in nondiabetic patients with Charcot arthropathy.

LEVEL OF EVIDENCE

Level IV, retrospective case series.

Authors+Show Affiliations

Department of Orthopedics, Emory University School of Medicine, Atlanta, GA, USA.Department of Orthopedics, Baylor University Medical Center, Dallas, TX, USA.Department of Orthopedics, Brantford General Hospital, Brantford, ON, Canada.Department of Orthopedics, Baylor University Medical Center, Dallas, TX, USA james.brodsky@baylorhealth.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25104748

Citation

Bariteau, Jason T., et al. "Charcot Arthropathy of the Foot and Ankle in Patients With Idiopathic Neuropathy." Foot & Ankle International, vol. 35, no. 10, 2014, pp. 996-1001.
Bariteau JT, Tenenbaum S, Rabinovich A, et al. Charcot arthropathy of the foot and ankle in patients with idiopathic neuropathy. Foot Ankle Int. 2014;35(10):996-1001.
Bariteau, J. T., Tenenbaum, S., Rabinovich, A., & Brodsky, J. W. (2014). Charcot arthropathy of the foot and ankle in patients with idiopathic neuropathy. Foot & Ankle International, 35(10), 996-1001. https://doi.org/10.1177/1071100714543649
Bariteau JT, et al. Charcot Arthropathy of the Foot and Ankle in Patients With Idiopathic Neuropathy. Foot Ankle Int. 2014;35(10):996-1001. PubMed PMID: 25104748.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Charcot arthropathy of the foot and ankle in patients with idiopathic neuropathy. AU - Bariteau,Jason T, AU - Tenenbaum,Shay, AU - Rabinovich,Alexander, AU - Brodsky,James W, Y1 - 2014/08/07/ PY - 2014/8/9/entrez PY - 2014/8/12/pubmed PY - 2015/6/9/medline KW - Charcot arthropathy KW - idiopathic neuropathy SP - 996 EP - 1001 JF - Foot & ankle international JO - Foot Ankle Int VL - 35 IS - 10 N2 - BACKGROUND: Charcot neuroarthropathy in the developed countries is primarily associated with diabetic neuropathy. This study investigated a series of patients with Charcot arthropathy associated with idiopathic peripheral neuropathy to evaluate the natural history in these patients and to evaluate the efficacy of a treatment protocol used for diabetic Charcot joints. METHODS: The records and radiographs of patients with Charcot arthropathy of the foot and ankle treated between 1986 and 2009 were retrospectively reviewed. Patients with known causes of or risk factors for peripheral neuropathy were excluded, identifying 82 feet in 59 patients with idiopathic neuropathy. Twenty-three (39%) were bilateral. The average age was 76 years and the average follow-up was 60 months. Data were analyzed for medical history and diagnoses, medications, anatomic classification of Charcot arthropathy, history of ulcerations, ambulatory status, shoe wear and bracing, and operative interventions. Patient care was based on previous published treatment algorithms, based on conservative management with operative intervention reserved for nonhealing ulcers, infection, and/or nonplantigrade, unbraceable feet. Therapeutic success was a plantigrade foot with healed soft tissue envelope that allowed weight-bearing. RESULTS: In all, 55% involved the midfoot (type 1), 34% the hindfoot (type 2), and 11% the ankle, (type 3A). Seventy-one of 82 feet were successfully treated at the time of last follow-up. Thirty-six feet (43%) were treated nonoperatively with success in 33 (92%). Forty-six of 82 feet required operative intervention, with success at last follow-up in 38 (83%). There were 8 operative failures resulting in 2 transtibial amputations and 6 feet with persistent ulceration. CONCLUSIONS: This series of patients with Charcot arthropathy associated with idiopathic neuropathy demonstrated a wider spectrum of Charcot arthropathy of the foot and ankle than has been previously recognized or documented. At the present time, heightened awareness is needed to promote accurate diagnosis and appropriate treatment in nondiabetic patients with Charcot arthropathy. LEVEL OF EVIDENCE: Level IV, retrospective case series. SN - 1944-7876 UR - https://www.unboundmedicine.com/medline/citation/25104748/Charcot_arthropathy_of_the_foot_and_ankle_in_patients_with_idiopathic_neuropathy_ L2 - https://journals.sagepub.com/doi/10.1177/1071100714543649?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -