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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, anti- resorptive drugs, electrical bone stimulators and low frequency ultrasound Or operative in the form of debridement of ulcer, osteotomy, 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.