Definition
Charcot's joint; neuropathic arthritis; neuropathic
arthropathy; ;destructive joint disease caused by diminished
proprioceptive sensation, with gradual destruction of the joint by
repeated subliminal injury, commonly associated with tabes dorsalis
or diabetic neuropathy. Subsequent damage results because the
patient is unable to sense the position of the joint in space and
therefore cannot protect it as they walk,
Jean-Martin Charcot
French neurologist, born November 29, 1825 Paris;
died August 16, 1893, Lac des Settons, Nièvre.
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Radiographic Appearance
Usually in the feet but occasionally seen elsewhere e.g..
elbow.
At presentation the X-ray appearance of Charcot's joint may be
normal or show a minor fracture but may already show quite gross
bone destruction.
Stage I is the destructive phase, and is characterized by fracture
as a result of repetitive trauma without splinting or allowing for
repair. As the acute inflammatory response ensues, mechanical
destruction. Stage II is characterized by persistent hyperemia and
chronic inflammation that leads to progressive loss of bone
strength. Further mechanical destruction in the desensitized joint
can result in a cycle of destruction and failed attempts at
biological repair that characterizes the final Stage III. Johnson
observed that for treatment to be successful, the destructive phase
must be halted with immobilization. Healing can then occur in an
orderly fashion.
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Pathology
Originally described in patients with syphilis but more common in
diabetic patients
A degenerative disease with progressive destruction of the bones and
joints within the foot, resulting from neurological disorders,
including tabes dorsalis, leprosy, diabetic neuropathy, alcoholic
neuropathy, syringomyelia, or other conditions involving disease or
injury to the spinal cord. The condition is characterized by hyper
mobility and instability of the joint. Decalcification of bone on
joint surfaces accompanied by overgrowth of bone, intraarticular
fractures and loose bodies, dislocations, knock knees, bone
fragmentation, and osteophytic formations are among the usual
findings. Pain is usually absent although there are sometimes
painful joint swellings.
The condition is constantly aggravated by the loss of pain and hyper
mobility of the joints, which deprive the affected organ of natural
protection from injuries. In the early phases of the disease
process, the foot may look normal. As it develops, the foot will
present with significant amounts of soft tissue swelling and colour
changes. There is usually no arch remaining and the foot will tend
to have a prominent bulge in the arch area. The foot is hot, swollen
and non-painful. Prevalent in males; onset usually after 40 years of
age; usually, insidious onset.
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Treatment:
Management of acute Charcot's arthropathy
There is no proven specific pharmacological treatment for Charcot's
arthropathy. There has been a report that a group of drugs known as
the biphosphonates may be useful. These are currently undergoing
clinical trials
Prevention of further destruction and deformity of the foot at the
acute phase is the primary goal of treatment. It is therefore
essential to prevent the patient walking on the fragile bones until
they have a chance to heal. The mainstay of current treatment is
placing the foot in a well moulded contact cast to relieve pressure
and to preserve foot shape. Patients remain in the contact cast
until there is no major difference in the temperature and swelling
between the affected and unaffected feet. This usually takes between
6-9 months. |
Image 1
Charcot Joint 2nd proximal metatarsal
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Useful Link
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