From the Research
Charcot joint, also known as neuropathic arthropathy, is a progressive degenerative condition affecting joints due to loss of sensation, most commonly occurring in people with diabetic neuropathy, affecting the feet and ankles. The condition develops when repeated trauma to insensate joints leads to progressive destruction, deformity, and instability. Early signs include redness, warmth, and swelling that may be mistaken for infection or gout.
Key Characteristics
- The condition is often mistaken for cellulitis or deep vein thrombosis and may result in significant foot or ankle deformities 1.
- It may be present in up to 35% of patients with diabetic neuropathy 2.
- Charcot joint should be considered in patients with a unilateral, warm, erythematous, swollen foot without other systemic symptoms 2.
Treatment
- Treatment primarily involves immobilization with total contact casting or a removable walking boot for 3-6 months until the acute phase resolves 2, 1.
- Weight-bearing should be restricted during this period.
- Custom orthotic footwear is essential after healing to prevent recurrence and ulceration.
- Surgical intervention may be necessary for severe deformities or instability.
Prevention
- Prevention focuses on tight glycemic control in diabetic patients, regular foot examinations, and prompt treatment of any foot injuries.
- The pathophysiology involves neurovascular dysfunction where loss of protective sensation allows repetitive trauma, while autonomic neuropathy causes increased blood flow and bone resorption.
- Early recognition is crucial as delayed diagnosis can lead to permanent deformity, ulceration, and potentially amputation.
Additional Considerations
- Bisphosphonates, such as pamidronate, may be a useful treatment for Charcot neuroarthropathy, as they have been shown to improve symptoms and reduce bone turnover 3, 4.
- However, the most recent and highest quality study on this topic is from 2002, which emphasizes the importance of early recognition and immobilization in the treatment of Charcot joint 2.