الفهرس 
PATHOPHYSIOLOGY OF charCOT
RISK FACTORSOnly 14 pages are availabe for public view
 |  | from | 16 |  |  |
| | | from | 16 | | |
Abstract
Charcot neuroarthropathy is a non-infective, destructive
process occurring in patients rendered insensate peripheral
neuropathy which is caused mainly by diabetes.
Repetitive trauma from standing and walking provides a
neuro-traumatic stimulus that leads to dislocation, peri-articular
fracture, or both within the ankle.
The joints most frequently affected by charcot
arthropathy in order of frequency are the tarso-metatarsal joints,
the transverse tarsal joint and the ankle joint.
The charcot arthropathy process can take up to 2 years to
run its course. Primary care physicians must consider the
diagnosis of charcot arthropathy in any neuropathic patient
presented with erythema, edema and warmth regardless of local
or systemic signs of infection. This stage is sometimes
confused with osteomyelitis of the ankle; however it can be
differentiated on clinical grounds by the absence of wound
breakdown (portal of entry) and the failure to manifest clinical
and laboratory signs of a significant infection. In the patient
with diabetes and lower extremity neuropathy, any minor injury
requires careful observation because of the tendency of the limb
to proceed to a charcot process. Early identification and
treatment of the charcot arthropathy helps prevent deformity and decreased function of the lower extremity, as well as
subsequent amputation.
Treatment modalities either non operative in the form of
TCC, Prefabricated Pneumatic Walking Brace, CROW, antiresorptive drugs, electrical bone stimulators and low frequency
ultrasound Or operative in the form of debridement of ulcer,
ostectomy, arthrodesis either with internal or external fixation
and unfortunately amputation.
Physicians should continually educate their patient about
the proper care of a neuropathic ankle and the use of orthotic
devices and custom footwear. The patient with a history of
Charcot process should be seen regularly, with close attention
given to erythema, edema and elevated temperature in the foot
or ankle.
Conclusion
66
CONCLUSION
According to this systematic review of clinical results of
the charcot arthropathy of ankle joint, the active process of
Charcot neuro-arthropathy can be delayed with non-surgical
technique. It also appears that the severe joint instability found
in charcot neuro-arthropathy of ankle can be treated
successfully with intramedullary nail fixation and external
fixation, yielding a high rate of limb salvage. However, future
long-term, prospective randomized studies are needed and more
non-surgical, surgical technique and outcomes measures
needed.