charcot foot
Post on 19-Oct-2014
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NEUROPATHIC (CHARCOT )FOOT
Blood supplyBlood supply
t
Arterial: ◦Posterior tibial and dorsalis
pedis supply the footVenous:
◦Deep veins follow the arteries◦Superficial veins arise from
dorsal venous arch
Nerve supplyNerve supply
The foot is supplied by the (1) tibial,
(2) deep peroneal, (3) superficial
peroneal, (4)sural, and (5)saphenous
CHARCOT FOOTNamed after Jean-Martin Charcot (1868)
Charcot noted this disease process as a complication of syphillis
In 1936, Charcot foot was found to be related to diabetic patients
Pathophysiology:
Neurotraumatic theory
Neurovascular theoryNeurotraumatic theory:Unperceive trauma to insensate foot.Pt unaware of osseous destruction occur during ambulationMicro trauma leads to progressive destruction to bones and joints
Neurovascular theory:Autonomic neuropathy causing extremities to receive increased bloodflowResults in mismatch in bone destruction and synthesis, leading to osteopenia
THE FOLLOWING ARE THE PRINCIPLE
PREDISPOSING DISEASES:
DIABETES
SYRINGOMYELIA
LEPROSY
TABES DORSALIS
Physical
9
Physical Findings & Investigations
Physical
10
Physical Findings & Investigations
Presentation:
Vary from mild swelling and no deformity to moderate deformity with significant swelling
Always presents with signs of inflammation: warmth, joint effusion, erythema, bone resorption
Pain occurs in > 75% of patients
Instability and loss of joint function; “bags of loose bones”
Amputation Risk (Usually BKA)
Type 100 person-year
Charcot alone 4.1
Ulcer alone 4.7
Charcot + Ulcer Up to 12 times
Classification
Many types
Based on anatomic involvement
Brodsky and Rouse system
Schön Classification
Type Pattern
1 Lisfranc (60%)
2 Cuneonavicular
3 Perinavicular (3a ankle joint, 3b posterior calcaneous)
4 Transverse tarsal (multiple joint)
5 Forefoot
MANAGEMENT
Conservative Surgery
ACUTE PHASE
POST-ACUTE PHASE
Acute phase:
Immobilization: e.g. Total contact cast (3-6 months)
Reduction of stress
Ideally non-weight bear
PWB with crutches
Post-acute phase: Patient education and foot care
Consider brace e.g. Charcot restraint orthotic walker
Total healing typically takes 1-2 years
Surgical therapy:
Based on location of disease, surgeon preferences and experience with Charcot arthropathy
Surgical procedure include exostosectomy of bony prominence, osteotomy, arthrodesis, screw and plate fixation, ORIF, reconstructive surgery, fusion with Achilles tendon lengthening, autologous bone grafting and amputation.
Location Surgery
Ankle with displaced # ORIF
Tibiotalar destruction Arthrodesis
Avascular necrosis of talus Talectomy with tibiocalcaneal fusion
Hindfoot Arthrodesis
Midfoot Correction of rocker-bottom deformity and osteotomies for bony prominence
Hindfoot/ankle equinus contracture
Posterior release/Achilles tendon leengthening
Forefoot Resection arthroplasty or cheilectomy
DIABETIC FOOT
The Diabetic Foot may be defined as a group of syndromes in which neuropathy, ischaemia, and infection lead to tissue breakdown resulting in morbidity and possible amputation
( WHO 1995 )
Peripheral Neuropathy
Sensory
Motor
Autonomic
Precipitating
Factors
Trauma
puncture/thermal/stress/footwear
MANAGEMENT
Thank you