- Mid-term follow-up of patients with hindfoot arthrodesis with retrograde compression intramedullary nail in Charcot neuroarthropathy of the hindfoot. [Journal Article]
- BJBone Joint J 2018; 100-B(2):190-196
- CONCLUSIONS: The use of retrograde intramedullary compression nail results in good rates of limb salvage when used for hindfoot reconstruction in patients with Charcot arthropathy. Cite this article:Bone Joint J2018;100-B:190-6.
- A retrospective audit of the characteristics and treatment outcomes in patients with diabetes-related charcot neuropathic osteoarthropathy. [Journal Article]
- NZN Z Med J 2017 Dec 15; 130(1467):62-67
- CONCLUSIONS: Time to diagnosis of CN was shorter than previously reported, though the high rate of deformities still suggests a significant delay in diagnosis. Increased education of healthcare professionals and people with diabetes-related neuropathy is important to ensure early diagnosis and appropriate management to reduce deformities and complications.
- Advanced MR Imaging Techniques for Differentiation of Neuropathic Arthropathy and Osteomyelitis in the Diabetic Foot. [Review]
- RRadiographics 2017 Jul-Aug; 37(4):1161-1180
- Diagnosis and treatment of foot disease in patients with diabetes is a common clinical-radiologic challenge, particularly the differentiation of neuropathic arthropathy from osteomyelitis. Convention...
Diagnosis and treatment of foot disease in patients with diabetes is a common clinical-radiologic challenge, particularly the differentiation of neuropathic arthropathy from osteomyelitis. Conventional clinical tests and imaging techniques have limited accuracy for evaluation of the diabetic foot. The introduction of morphologic magnetic resonance (MR) imaging in these patients has provided a qualitative leap in diagnosis. The characteristics of soft-tissue and bone marrow edema and their patterns of distribution throughout the foot allow discrimination between both entities. However, in certain scenarios, the application of MR imaging to this problem is limited because of overlapping features between the two and the coexistence of infection and neuropathic changes. Recent technical advances in MR imaging sequences have increased the capability to add functional quantitative information to structural information. Diffusion-weighted imaging is useful to determine the presence and extension of osteomyelitis. Dynamic contrast-enhanced MR imaging may help to detect differences between the vascularization patterns of neuropathic arthropathy and osteomyelitis. MR angiography (with or without contrast material) is used in clinical practice to identify candidate distal vessels for revascularization. MR neurography, and especially diffusion-tensor imaging, provides quantitative information about neural damage. These new sequences may help in assessment of the different pathophysiologic conditions that occur in the diabetic foot. The physical basis of these techniques, their limitations, and their potential applications for diabetic foot assessment are detailed in this article. The introduction of advanced MR imaging multiparametric protocols, with the aim of enhancing the overall diagnostic accuracy of MR imaging, may help in treatment decision making and lead to improved patient outcomes. © RSNA, 2017.
- Hospitalization for Charcot neuroarthropathy in diabetes: A population study in Italy. [Journal Article]
- DRDiabetes Res Clin Pract 2017; 129:25-31
- CONCLUSIONS: Over last decade, in Italy and Tuscany yearly CN incidence and hospitalization rates concerned only a small percentage of patients, remaining constant over years and declining in Tuscany in the last couple of years. CN was significantly associated to younger age, longer hospital stay and greater risk of amputations and infections while the need of revascularization was similar to that of non-Charcot diabetic foot.
- Diabetic Driving Studies-Part 1: Brake Response Time in Diabetic Drivers With Lower Extremity Neuropathy. [Journal Article]
- JFJ Foot Ankle Surg 2017 May - Jun; 56(3):568-572
- Although the effect of lower extremity pathology and surgical intervention on automobile driving function has been a topic of contemporary interest, we are unaware of any analysis of the effect of lo...
Although the effect of lower extremity pathology and surgical intervention on automobile driving function has been a topic of contemporary interest, we are unaware of any analysis of the effect of lower extremity diabetic sensorimotor neuropathy on driving performance. The objective of the present case-control investigation was to assess the mean brake response time in diabetic drivers with lower extremity neuropathy compared with that of a control group and a brake response safety threshold. The driving performances of participants were evaluated using a computerized driving simulator with specific measurement of the mean brake response time and frequency of abnormally delayed brake responses. We analyzed a control group of 25 active drivers with neither diabetes nor lower extremity neuropathy and an experimental group of 25 active drivers with type 2 diabetes and lower extremity neuropathy. The experimental group demonstrated a 37.89% slower mean brake response time (0.757 ± 0.180 versus 0.549 ± 0.076 second; p < .001), with abnormally delayed responses occurring at a greater frequency (57.5% versus 3.5%; p < .001). Independent of a comparative statistical analysis, the observed mean brake response time in the experimental group was slower than the reported safety brake response threshold of 0.70 second. The results of the present investigation provide original data with respect to abnormally delayed brake responses in diabetic patients with lower extremity neuropathy and might raise the potential for impaired driving function in this population.
- Milwaukee Shoulder Syndrome. [Journal Article]
- JSJ Surg Orthop Adv Spring 2017; 26(1):54-57
- Milwaukee shoulder syndrome (MSS) is a rare, rapidly destructive arthropathy associated with calcium hydroxyapatite crystal deposition. This condition is a combination of rotator cuff tear, osteoarth...
Milwaukee shoulder syndrome (MSS) is a rare, rapidly destructive arthropathy associated with calcium hydroxyapatite crystal deposition. This condition is a combination of rotator cuff tear, osteoarthritic changes, noninflammatory joint effusion containing crystals, synovial hyperplasia, cartilage and subchondral bone destruction, and multiple osteochondral loose bodies. This article discusses pathophysiology, clinical presentation, differential considerations, and magnetic resonance imaging findings of MSS.
- Red hot foot … keep Charcot arthropathy in mind. [Letter]
- CMAJCMAJ 2017 04 24; 189(16):E612
- Functional Impairment of Patients Undergoing Surgical Correction for Charcot Foot Arthropathy. [Journal Article]
- FAFoot Ankle Int 2017; 38(7):705-709
- CONCLUSIONS: Charcot foot severely impaired the quality of life in patients beyond the impact of morbid obesity. This impairment equally impacted all of the functional and emotional domains measured with the SMFA as compared with population norms. This investigation provides a benchmark for measuring the impact of operative correction of the deformity. In addition, the SMFA appears to be a valid tool for measuring impairment in this complex patient population.
- Charcot Arthropathy Versus Osteomyelitis: Evaluation and Management. [Review]
- OCOrthop Clin North Am 2017; 48(2):241-247
- Charcot arthropathy of the foot and ankle is a severe complication of peripheral neuropathy and is most commonly seen in the developed world in association with diabetes mellitus. Correct diagnosis a...
Charcot arthropathy of the foot and ankle is a severe complication of peripheral neuropathy and is most commonly seen in the developed world in association with diabetes mellitus. Correct diagnosis and differentiation from osteomyelitis of the foot and ankle are critical to guide treatment. It can exist concomitantly with osteomyelitis, typically in the setting of an advanced midfoot ulcer. Simple plain radiographs and contrasted MRI studies often yield inconclusive or confusing data. Correct use of imaging studies and a clinical algorithm can be effective tools to help make accurate and early diagnoses and guide clinical interventions for these conditions.
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- Diabetic Foot Complications Despite Successful Pancreas Transplantation. [Journal Article]
- FAFoot Ankle Int 2017; 38(6):656-661
- CONCLUSIONS: Complications of the foot and ankle still occurred following pancreas transplantation in patients with diabetes.