Charcot Neuropathic Osteoarthropathy

Question 1

It is seen in the lower extremity and is characterized by bone and joint fragmentation of the foot and ankle in individuals with various peripheral neuropathies.

Answer 1

Charcot Neuropathic Osteoarthropathy

Question 2

Pathogenesis of this condition

Answer 2

1. Neuro-traumatic theory
2. Neurovascular theory

Question 3

Etiology

Answer 3

1. Diabetic Neuropathy
2. SCI
3. Poliomyelitis
4. Leprosis
5. Syphilis
6. Syringomyelia
7. Chronic Alcoholism

Question 4

Common classifications that map the phases of Charcot include the

Answer 4

1. Eichenholtz classification
2. Sanders and Frykberg classification.

Question 5

It describe the three stages of disease progression based on clinical and radiographic findings.

Answer 5

Eichenholtz classification

Question 6

It is used to type and class the five common anatomical locations of Charcot in the foot.

Answer 6

Sanders/Frykberg classification

Question 7

Clinically: red, hot, swollen foot. No deformity.
Radiographically: no changes yet are seen. Normal radiograph

Answer 7

Stage 0 Precharcot/Prodromal

Question 8

Clinically: Erythema, foot edema, elevated temperature, no pain
Radiographically: Boney debris at joints, fragmentation of subchondral bone, joint subluxation, and/or fracture-dislocation

Answer 8

Stage1 Development/Destruction

Question 9

Clinically: Decreased signs of inflammation

Radiographically: Worsening of stage 1 features. Absorption of boney debris with new bone formation. Coalescence of large fragments with sclerosis of bone ends. Some increased stability

Answer 9

Stage 2 Coalescence

Question 10

Clinically: Resolution of inflammation. Changes in overall foot architecture due to underlying final bony remodeling that can lead to new pressure points which are at risk of ulceration

Radiographically: Remodeling of affected bones and joints

Answer 10

Stage 3 Consolidation

Question 11

Sanders and FrykbergClassification: 15%

Answer 11

Metatarsophalengeal to interphalangeal joints

Question 12

Sanders and FrykbergClassification: 40%

Answer 12

Tarsometatarsal joints

Question 13

Sanders and FrykbergClassification; 30%

Answer 13

Naviculocuneiform joint

Question 14

Sanders and FrykbergClassification: 10%

Answer 14

Ankle and subtalar joints

Question 15

Sanders and FrykbergClassification: 5%

Answer 15

Calcaneus

Question 16

Tx of this condition

Answer 16

1. Immobilize the foot and restrict wt bearing in acute phase
2. Medication: Biphosphonates, Calcitonin, Pamidronate, Zoledronic Acid