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Neuropathic or Diabeticfoot (Charcot Joint) Deformities

Neuropathic arthropathy, also known as Charcot Joint (often “Charcot foot”), refers to progressive degeneration of a weight bearingjoint, a process marked by bony destruction, bone resorption, and eventual deformity.
Diabetes is the foremost cause in the world today for neuropathic joint disease and the foot is the most affected region. In those with foot deformity, approximately 60% are in the tarsometatarsal joints (medial joints affected more than lateral), 30% Metatarsophalangeal joints and 10% have ankle disease. Other less common causes include syphilis,spinal cord injury,leprosy and alcoholic neuropathy.
With diabetes affecting increasing number of people, number of diabetic foot problems are also on the rise. Most of these include intractable foot ulcers with joint destruction leading to severe foot and ankle deformities. The rationale for operative treatment is to decrease the deformity and thereby minimize the likelihood of complications of deformity including infection and amputation.

Clinical Findings

Clinical findings include erythema, edema and increased temperature in the affected joint. In neuropathic foot joints, plantar ulcers may be present.

swallen_inflamed_foot
SWOLLEN & INFALMED FOOT IN CHARCOT ARTHROPATHY

x_rayX RAY APPEARANCE OF CHARCOT FOOT

Surgical Indications

Decision for surgical intervention in a neuropathic foot is not as clear cut as in normal feet. Conservative modality is encouraged as long as the patent can manage to wear custom shoes and orthotics. Patient compliance, bodyweight, skin condition, family support, condition of the other limb etc have to be taken into consideration before proposing surgery.However if the foot is warm, surgery should be deferred as warmth is an indicator of bone activity and periosteal new bone formation. Broadly, the indications are-

  • Acute or frank dislocation of the midfoot
  • Ulceration & infection in a chronic neuropathic foot

A wide variety of surgeries are carried out in a neuropathic foot but the most common ones are-

  • Ostectomy of bony prominences
  • Midfoot arthodesis
  • Hindfoot arthrodesis

hindfoot_arthrodesis
HINDFOOT ARTHRODESIS IN CHARCOT ARTHOPATHY