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Authors

  1. Houston, Dorothy S.
  2. Curran, Janette

Abstract

Abstract: Charcot joint is the painless, degenerative, progressive neuropathic destruction of the bony architecture of one or more joints of the feet. Diabetes mellitus is the most common cause of Charcot joint in North America, although the exact etiology is uncertain. The classic presenting complaint involves unilateral painless swelling of the lower extremity or foot. Charcot joint is often mistaken for cellulitis or deep vein thrombosis and may result in significant foot or ankle deformities. There are several treatment options for the patient presenting with Charcot joint. Medical management often includes immobilization and maintaining nonweightbearing status. Surgical intervention, often a final attempt at managing Charcot foot, involves careful patient selection and is not recommended for all patients. The postoperative phase can be challenging for both patient, nursing staff, and the surgeon.

 

Charcot joint, or neuropathic osteoarthropathy, is a term denoting a relatively painless, degenerative, progressive neuropathic destruction of the bony architecture of one or more joints. Originally, it was described in patients with tertiary syphilis, but this condition can be caused by a variety of pathologies that create neural deficits. It can occur in the presence of any disorder that reduces pain sensation, including Hansen's disease (leprosy), multiple sclerosis, polio, congenital insensitivity to pain or spinal cord lesions, steroid-induced osteoporosis, and alcoholism (Reinherz et al., 1995).

 

In North America, diabetes mellitus is the most common cause of Charcot joint (Saltzman et al., 1992). In diabetic patients, this condition usually affects the lower extremity, especially the ankle and metatarsophalangeal joints. It is usually associated with those who have moderate to severe neuropathy, and affects 1 in 700 people with diabetes (Halpin-Landry & Goldsmith, 1999). It is a condition that may have an acute or gradual onset, and in the most severe form, often results in significant foot or ankle deformities and foot ulcers.