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Abstract Charcot foot refers to an inflammatory pedal disease based on polyneuropathy; the detailed pathomechanism of the disease is still unclear. Since the most common cause of polyneuropathy in industrialized countries is diabetes mellitus, the prevalence in this risk group is very high, up to 35%. Patients with Charcot foot typically present in...
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... stages ( Fig. 1) [7,8], resembling active and inactive disease phases: inflammation, fragmentation, coalescence, consolidation. The disease is normally limited to a single-run through these different disease stages. The active phase is characterized by a hot, red, and swollen foot (inflammation), often without pain, due to the polyneuropathy (Fig. 2) [1]. In the active phase, the bone gets fragile due to temporary osteopenia leading to fractures, joint destructions (often Lisfranc's joint) and collapse of the longitudinal arch of the foot [2,8,9]. During the less active or inactive phase, the foot is not red any more, but some soft tissue and bone marrow edema may last. Prominent ...
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... Charcot foot, the cuboid bone typically becomes the most inferior bone in the foot [3] (Fig. 20). Due to the resulting changes in pedal shape, the foot is prone to extensive callus formation, blisters, and ulcerations, especially plantar to the cuboid bone (Fig. 20c). This may lead to soft tissue infections and osteomyelitis (Fig. 20a, b) [2]. MRI has a high diagnostic accuracy in diagnosing osteomyelitis of the foot, with a high ...
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... Charcot foot, the cuboid bone typically becomes the most inferior bone in the foot [3] (Fig. 20). Due to the resulting changes in pedal shape, the foot is prone to extensive callus formation, blisters, and ulcerations, especially plantar to the cuboid bone (Fig. 20c). This may lead to soft tissue infections and osteomyelitis (Fig. 20a, b) [2]. MRI has a high diagnostic accuracy in diagnosing osteomyelitis of the foot, with a high sensitivity (77-100%) and a high specificity (80-100%) [24]. MRI has a very high negative predictive value (98%): if there are no signs of osteomyelitis on MRI, ...
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... Charcot foot, the cuboid bone typically becomes the most inferior bone in the foot [3] (Fig. 20). Due to the resulting changes in pedal shape, the foot is prone to extensive callus formation, blisters, and ulcerations, especially plantar to the cuboid bone (Fig. 20c). This may lead to soft tissue infections and osteomyelitis (Fig. 20a, b) [2]. MRI has a high diagnostic accuracy in diagnosing osteomyelitis of the foot, with a high sensitivity (77-100%) and a high specificity (80-100%) [24]. MRI has a very high negative predictive value (98%): if there are no signs of osteomyelitis on MRI, osteomyelitis can practically be excluded [28]. However, discriminating an active ...
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... arrow heads) and soft tissue edema (white arrows) (a). Also note the subluxation at the Chopard's joint with downward tilt of the talar head (b) 7 months after a consequent offloading therapy with a total contact cast: note the almost complete disappearance of bone marrow edema (white arrow heads) and soft tissue edema on sagittal STIR sequence Fig. 20 Patient with ulceration (a) at the sole of the foot directly beneath the cuboid bone as a typical complication of rocker-bottom deformity of the foot. MRI with sagittal STIR sequence (b) demonstrates contiguous spread of infection from the skin, forming a sinus tract (red arrow) to the cuboid bone (asterisk) and bone marrow edema due ...
Similar publications
Diabetic related Foot deformity prevalence,risk factors and patient knowledge and practice of foot care
Citations
... the initial form of imaging and classifications systems such as the Brodsky and Eichenholtz classification are based on plain radiographs [10][11][12][13]. One of the key findings indicating inflammation due to active CN is bone marrow edema (BME) [14,15]. The location and distribution of BME can aid in differentiating CN from other diseases such as osteomyelitis [12]. ...
Objective
This study aimed to quantitatively assess the diagnostic value of bone marrow edema (BME) detection on virtual non-calcium (VNCa) images calculated from dual-energy CT (DECT) in people with diabetes mellitus and suspected Charcot neuro-osteoarthropathy (CN).
Materials and Methods
People with diabetes mellitus and suspected CN who underwent DECT of the feet (80kVp/Sn150kVp) were included retrospectively. Two blinded observers independently measured CT values on VNCa images using circular regions of interest in five locations in the midfoot (cuneiforms, cuboid and navicular) and the calcaneus of the contralateral or (if one foot was available) the ipsilateral foot. Two clinical groups were formed, one with active CN and one without active CN (no-CN), based on the clinical diagnosis.
Results
Thirty-two people with diabetes mellitus and suspected CN were included. Eleven had clinically active CN. The mean CT value in the midfoot was significantly higher in the CN group (-55.6 ± 18.7 HU) compared to the no-CN group (-94.4 ± 23.5 HU; p < 0.001). In the CN group, the difference in CT value between the midfoot and calcaneus was statistically significant ( p = 0.003); this was not the case in the no-CN group ( p = 0.357). The overall observer agreement was good for the midfoot (ICC = 0.804) and moderate for the calcaneus (ICC = 0.712). Sensitivity was 100.0% and specificity was 71.4% using a cutoff value of -87.6 HU.
Conclusion
The detection of BME on VNCa images has a potential value in people with diabetes mellitus and suspected active CN.
... Most commonly, CN is seen in association with diabetes mellitus. Other associated conditions include syphilis and spinal cord 2,3 . The consequences of delayed diagnosis of this arthropathy become evident when the outcomes of patients with CN related to diabetic neuropathy are assessed. ...
Increasingly Charcot neuroarthropathy (CN) is being recognized in patients with Charcot-Marie-Tooth (CMT) disease. In this report, we describe a case of CN in a CMT patient, adding to the very scarce literature describing this association. We additionally report his unique evaluation with fluorodeoxyglucose (FDG) and sodium fluoride (NaF) positron emission tomography/computed tomography (PET/CT) scanning, the study of which is limited in CN despite its promising role. A 54-year-old known case of CMT, presented with left foot pain, and swelling for 4 months. Weakness and sensory deficits as a result of CMT were evident in both lower and upper limbs. His x-ray was suggestive of CN. Both FDG and NaF PET/CT scanning demonstrated increased tracer uptake in the first tarsometatarsal joint (TMTJ), in keeping with CN. Recognition of the association of CMT with CN is of vital importance as early diagnosis relies on high clinical suspicion. Characterizing risk factors of CN in CMT patients is still under study. Moreover, there is lack of data evaluating the role of PET/CT in CN and specifically in the context of CMT.
... Evre 3 ise rekonstrüksiyon evresidir ve klinik bulgular ortadan kalkmakla birlikte deformite rijid bir hal almıştır. Bu evrede Lisfranc ligamentinin hasar görmesi ile birlikte metatarsal dislokasyon gelişir, ayak arkı çöker ve tipik "beşik ayak" deformitesi ortaya çıkar (200). Bu hastalarda mevcut deformiteye ek olarak infeksiyon nedeniyle yapılan debridmanın yol açtığı hasar da eklendiğinde, rekonstrüksiyonun daha sorunlu ve başarısının da düşük olması beklenir. ...
... 4 However, early diagnosis is difficult since it might be normal in the inflammatory stage of the Eichen Holtz classification (Figure 2), therefore, MRI could be done for early diagnosis (bone marrow and soft tissue oedema, joint effusion and microfractures), monitoring disease progression and complications. 6,15 As an alternative, CT and PET-CT can be used if MRI is contraindicated. 6,15 Charcot foot is often misdiagnosed as an infection, gout or deep vein thrombosis 1,3,5-7 and thus wrongly treated. ...
... 6,15 As an alternative, CT and PET-CT can be used if MRI is contraindicated. 6,15 Charcot foot is often misdiagnosed as an infection, gout or deep vein thrombosis 1,3,5-7 and thus wrongly treated. ...
... First line of treatment of active Charcot foot consists of offloading, with complete immobilization or protected weight-bearing in a total contact casting in order to prevent more trauma and it may take 3 to 18 months long. 1,[4][5][6][7][8] In the inactive phase, the foot should be accommodated into custom-made insole with therapeutic footwear adjusted to the deformities. 1,5,14 Corrective surgery might be considered to improve patient ambulation and quality of life. ...
A 55-year-old Caucasian female presented with one year old oedema of the right foot, flattened, and deformed with no scratch, wound or ulcer. There was no difference in temperature between the feet and it was not painful. The left foot had previously presented two episodes of diabetic ulcers which were treated successfully. The patient had a history of type 2 Diabetes mellitus with need of insulin therapy and associated organ damage. Foot radiography demonstrated and confirmed inactive consolidated Charcot neuroarthropathy. Comfortable custom-made footwear was advised by Orthopedics. No other follow-up was arranged. In Portugal, Charcot foot is not readily recognized, and its management is far from the recommended by the present literature. There are almost no published article about Portuguese Charcot neuroarthropathy cases. Therefore, it is important to showcase Charcot feet in order to make clinicians aware of its existence and their appropriate treatment.
... Ref.[22]: Weight bearing x-ray in dorsal plantar projection. Fractures, subchondral cysts, erosions and luxation of Lisfranc's joint (white arrows) developed 5 months post baseline (b). ...
... Ref.[22]: Eichenholtz stage 1 ( fragmentation) of CNO showing gross cortical fractures of the second to fifth metatarsals (white arrows) on MRI (a) and x-ray (b). ...
This chapter aims to explore the clinical features and effective management strategies for diabetic foot ulcers (DFUs), which, if not appropriately treated, can lead to serious consequences and ultimately require amputation. It is crucial to adopt a comprehensive approach that encompasses accurate diagnosis and effective treatment plans. These ulcers have a multifactorial etiology and a wide range of clinical features that can be attributed to the ulcers themselves, the underlying causes contributing to their development, or their complications, particularly infections. However, timely and accurate diagnosis can be challenging due to a lack of sensation, making risk factor assessments and severity assessments through various classification systems necessary. Managing DFUs effectively requires a multidisciplinary approach that includes optimum glycemic control, performing wound debridement, relieving pressure from the affected area, controlling infections, and utilizing appropriate dressings.
... Post-contrast imaging may be helpful for demonstrating superimposed osteomyelitis, particularly when there is low T1 signal on pre-contrast images with poor definition of the bones ("disappeared") that then "reappear" after contrast administration, also known as the "ghost sign" [20]. Advanced techniques such as diffusion-weighted imaging (osteomyelitis demonstrates restricted diffusion while bone marrow edema does not) and dynamic contrast enhancement (DCE) (which may show different perfusion patterns between osteomyelitis and osteoarthropathy) may increase specificity [21,22]. 1 Fifty-five-year-old woman with poorly controlled type 2 diabetes mellitus with right thigh pain. ...
Imaging evaluation for lower extremity infections can be complicated, especially in the setting of underlying conditions and with atypical infections. Predisposing conditions are discussed, including diabetes mellitus, peripheral arterial disease, neuropathic arthropathy, and intravenous drug abuse, as well as differentiating features of infectious versus non-infectious disease. Atypical infections such as viral, mycobacterial, fungal, and parasitic infections and their imaging features are also reviewed. Potential mimics of lower extremity infection including chronic nonbacterial osteomyelitis, foreign body granuloma, gout, inflammatory arthropathies, lymphedema, and Morel-Lavallée lesions, and their differentiating features are also explored.
... Plain radiographs, such as Xrays, play a fundamental role in diagnosing CN. They actively reveal structural changes within the affected foot, such as fractures, bone resorption, and joint dislocations [23]. Infrared thermography is a non-invasive procedure used to measure temperature differences between the two feet. ...
... Rosskopf AB, et al. [23] 2019 ...
Charcot Neuroarthropathy (CN) is a complex and incapacitating disorder characterized by neuropathy, progressive deformity, and joint destruction. It is of substantial interest within the diabetic population as this ailment chiefly affects individuals with diabetes. The pathophysiology of CN is multidimensional, connecting peripheral neuropathy, repetitive trauma, and autonomic dysfunction. The review analyses the mechanisms directing the development of CN, emphasizing the influence of diabetes in individuals who lean toward this condition. Clinical presentation and diagnosis of CN in diabetic patients present unique challenges. Complex clinical features have also been discussed, including joint deformities, insidious onset, and painless swelling, which mimic other musculoskeletal conditions. The diagnostic approaches, involving clinical examination and radiological imaging, are analyzed for early and accurate diagnosis. Risk factors and epidemiology emphasize the prevalence of CN within the diabetic population and draw attention to common risk factors contributing to its development. Significant factors such as glycemic control, duration of the disease, and type of diabetes are important in estimating an individual's risk for CN. Complications, such as foot ulcers and amputations, provide an understanding of the severe outcome of this condition on patients' quality of life. Management approaches and treatment involving conservative and surgical approaches are reviewed in depth. A multidisciplinary approach to patient care is emphasized, given the complex nature of CN and the comorbidities existing in diabetic individuals. Prognosis and prevention comprise approaches for mitigating the risk of CN in diabetic patients, such as glycemic control, regular foot examinations, and patient education. This thorough review aims to outline the intricate relationship between CN and diabetes, offering an understanding of pathophysiology, clinical complexities, diagnostic nuances, treatment modalities, and prevention strategies.
... 1 It is estimated to affect between 0.1 and 7.5 % of the general diabetic population, affecting exclusively patients who have peripheral neuropathy, although the difficulty in its diagnosis may underestimate its prevalence. 2 Charcot foot results in a poorer quality of life, poorer mental and physical health and increased risk of significant morbidity and mortality. 1,3,4 Although the exact pathophysiology is unclear, it is understood a combination of loss of protective sensation and gradual wasting of musculature leads to repetitive microtrauma to the foot and ankle. ...
... Nonsurgical methods are used in acute disease and include total contact casting or protective footwear. 15 However, in the coalescence phase and in a setting of a hallux valgus deformity, there is little role for conservative management. Surgical treatment includes cheilectomy, resection arthroplasty, and arthrodesis. ...
... Relying on these clinical signs has been associated with a certain degree of reactivation, and some have suggested relying on the resolution of changes on magnetic resonance imaging to discontinue offloading. 8,20,21 Mehta et al. described three factors to determine when to shift from a TCC to a CROW walker-(1) decrease in pain to the point where only occasional analgesics were required; (2) reduction of swelling to a stable level and no further fluctuation in swelling for were included for each modality of treatment. Although each method of conservative management revolved around a central theme, there were few additions in many papers discussing newer modifications and pharmacological therapy. ...
