Huguette M Disasi DPM/MSc

PGY-1
The Brooklyn Hospital Center
 A Non-infective bone and
joint destructive process
that occurs in association
with peripheral
neuropathy.
 DM Type 1& 2 leading
cause in developed world.
 First described by
Musgrave 1703
 named for Jean Martin
Charcot- 1868 I.D. in
patients with tertiary
syphilis
 Diabetes
 Hansen’s Disease
 Tabes Dorsalis (and Tertiary
Syphilis)
 Spinal Cord Tumor
 Charcot Marie Tooth Disease
 Pernicious Anemia
 Chronic Alcoholism
 Cerebral Palsy
 Hereditary Insensitivity to pain
 Myelodysplasia
 Meningomyelocele
 Poliomyelitis
 Syringomyelia
 Medications:
• Steroids, phenylbutazone,
indomethacin, vincristine
 Sensory-Motor  Other Factors
Neuropathy • Metabolic
 Autonomic Abnormalities
Neuropathy • Renal Transplant
 Minor Trauma • Immunosuppressive
treatment
• Steroid induced
osteoporosis
• Glycosylation of
collagen
 Secondary Trauma 
overactive vasomotor autonomic
neuropathy  AV shunting 
regional hyperemia  increase
osteoclast activity  bone
resorption and ligamentous
weakening  mechanical
breakdown/fractures and
deformity
 Increased blood flow  Warm
Foot & dilated veins
 Volkman and Virchow 
• “ Peripheral neuropathy
leading to loss of protective
sensation may render the
foot susceptible to injury
from either repeated or
acute trauma “
 Insensitivity to
proprioception and pain
 repetitive mechanical
macro and micro trauma
 spontaneous
fragmentation, subluxation
and dislocation of bone
 Minor trauma
 Sudden onset
edema/erythema
 Increased TG (warm –
hot)
 Pain: increased or
decreased.
 X-rays unremarkable
 Tc-99 Scan uptake all 3
phases.
 Edema, hyperemia,
increased
temperature, joint
laxity
 Radiological:
• Caspular distention
• Fragementation
• Debris
• Subluxation
 Decrease in erythema,
temperature, edema
 X-Ray :
• absorption of fine
debris
• new bone formation
• larger fragments
coalesce
• sclerosis of bone
 Decrease joint mobility
 No edema, erythema
 Ulcers may develop at
site of deformity
 X-rays:
• bony remodeling,
• decreased sclerosis
CONSERVATIVE SURGICAL

 Total contact casting (TCC)  Exostectomy

 Charcot Restraint Orthotic  Achilles Tendon lengthening
Walker (C.R.O.W.)  Correction of deformity
 Bisphosphonates and Calcitonin  Arthrodesis
 External Fixators/ ORIF
 Guven et al. “ Conservative and surgical treatment of the chronic
Charcot foot and ankle”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3733018/
Diabetic Foot and Ankle v4; 2013
 Goldfarb “The Foundation Board Certification Review 13th Ed”
2006
 Coughlin, M. J., In Saltzman, C. L., & In Anderson, R. B. (2014).
Mann's surgery of the foot and ankle.Ch: 27 Diabetes
 Charcot Foot” Rafi Mahandaru
https://www.slideshare.net/rafimahandaru/charcot-foot