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Acute charcot foot

David R Sinacore, Kathryn L Bohnert, Kirk E Smith, Mary K Hastings, Paul K Commean, David J Gutekunst, Jeffrey E Johnson, Fred W Prior
AIMS: To determine local and systemic markers of inflammation and bone mineral density (BMD) in the foot and central sites in participants with diabetes mellitus and peripheral neuropathy (DMPN) with and without acute Charcot neuropathic osteoarthropathy (CN). METHODS: Eighteen participants with DMPN and CN and 19 participants without CN had foot temperature assessments, serum markers of inflammation [C-reactive protein, (CRP) and erythrocyte sedimentation rate, (ESR)] and BMD of the foot, hip and lumbar spine at baseline and 1year follow-up...
June 2017: Journal of Diabetes and its Complications
Niklas Renner, Stephan Hermann Wirth, Georg Osterhoff, Thomas Böni, Martin Berli
BACKGROUND: Charcot neuropathic arthropathy (CN) is a chronic, progressive, destructive, non-infectious process that most frequently affects the bone architecture of the foot in patients with sensory neuropathy. We evaluated the outcome of protected weightbearing treatment of CN in unilaterally and bilaterally affected patients and secondarily compared outcomes in protected versus unprotected weightbearing treatment. METHODS: Patient records and radiographs from 2002 to 2012 were retrospectively analyzed...
December 29, 2016: BMC Musculoskeletal Disorders
Claire M Capobianco, Thomas Zgonis
Foot and ankle ulcerations in patients with diabetic Charcot neuroarthropathy (DCN) occur frequently and can be challenging to address surgically when conservative care fails. Patients with acute or chronic diabetic foot ulcers (DFU) are at continued risk for development of osteomyelitis, septic arthritis, gas gangrene, and potential lower extremity amputation. Concurrent vasculopathy and peripheral neuropathy as well as uncontrolled medical comorbidities complicate the treatment approach. In addition, pathomechanical forces left untreated may contribute to DFU recurrence in this patient population...
January 2017: Clinics in Podiatric Medicine and Surgery
A O'Loughlin, E Kellegher, C McCusker, R Canavan
BACKGROUND: Diabetic Charcot neuroarthropathy (DCN) is a devastating complication for people with diabetes mellitus. The failure to diagnose DCN and institute treatment in the acute phase leads to permanent deformity and significant morbidity. There is a paucity of data on the prevalence and characteristics of patients who have developed this complication of diabetes. AIMS: To determine the prevalence, clinical characteristics and outcomes of patients with DCN from 2006 to 2012...
February 2017: Irish Journal of Medical Science
Rasmus Bo Jansen, Ole Lander Svendsen, Klaus Kirketerp-Møller
INTRODUCTION: Charcot foot is a severe complication to diabetes mellitus and treatment involves several different clinical specialities. Our objective was to describe the current awareness, knowledge and treatment practices of Charcot foot among doctors who handle diabetic foot disorders. METHODS: This study is based on a questionnaire survey sent out to healthcare professionals, primarily doctors, working with diabetic foot ulcers and Charcot feet in the public sector of the Danish healthcare system...
October 2016: Danish Medical Journal
K Schara, R Štukelj, J L Krek, K Lakota, S Sodin-Šemrl, A J M Boulton, V Kralj-Iglič
It was the aim of this work to determine whether the plasma concentration of extracellular vesicles (EVs) in active diabetic Charcot neuroarthropathy (CN) is connected to the inflammatory markers, temperature elevation in the affected foot and concentration of soluble receptor for advanced glycation end products (RAGE). EVs were isolated from peripheral blood of 35 patients with active CN. EVs were counted after repetitive centrifugation and washing of samples, by flow cytometry. Foot temperature was measured by infrared thermometer...
February 15, 2017: European Journal of Pharmaceutical Sciences
Andreas M Hingsammer, David Bauer, Niklas Renner, Paul Borbas, Thomas Boeni, Martin Berli
BACKGROUND: Charcot osteoarthropathy (COA) is characterized by a progressive destruction of bone and joint associated with neuropathy and is most common in the foot and ankle. Clinical manifestation of COA is frequently indistinguishable from other causes of pain, swelling, and erythema of the affected extremity, in particular, infection. Diagnosis of COA can be challenging in particular in early stages where radiographic changes are sparse. The presence of elevated systemic inflammatory parameters in the context of suspected infection may delay early diagnosis and treatment of COA...
September 2016: Foot & Ankle International
Anne M Foley
The clinical findings of the acute Charcot process includes a swollen, warm, and erythematous foot; although pain may be present, it is often mild and out of proportion to the clinical examination. The diagnosis is confirmed by radiologic imaging, and the diagnosis must be considered in any patient with diabetic neuropathy and unilateral foot swelling. Initial treatment calls for immediate immobilization of the foot. Failure to do so can lead to further foot damage, destruction, and possibly amputation. The patient with acute CN requires referral to a multidisciplinary team experienced in the care of the diabetic patient with this devastating condition...
March 2016: Journal of Vascular Nursing: Official Publication of the Society for Peripheral Vascular Nursing
Javier La Fontaine, Lawrence Lavery, Edward Jude
The Charcot foot is an uncommon complication of neuropathy in diabetes. It is a disabling and devastating condition. The etiology of the Charcot foot is unknown, but it is characterized by acute inflammation with collapse of the foot and/or the ankle. Although the cause of this potentially debilitating condition is not known, it is generally accepted that the components of neuropathy that lead to foot complications must exist. When it is not detected early, a severe deformity will result in a secondary ulceration, infection, and amputation...
March 2016: Foot
Olivier Lidove, Valérie Zeller, Valérie Chicheportiche, Vanina Meyssonnier, Thomas Sené, Sophie Godot, Jean-Marc Ziza
OBJECTIVES: Fabry disease is a rare X-linked metabolic disorder characterized by a deficiency in the enzyme alpha-galactosidase A. Both males and females can be affected. The main presenting symptom is pain in the extremities, whereas at a more advanced stage, the manifestations include hypertrophic cardiomyopathy, cardiac dysrhythmia, proteinuria, chronic kidney dysfunction, stroke, and hearing loss. When not diagnosed and treated, Fabry disease causes early death. No studies specifically designed to describe the musculoskeletal manifestations of Fabry disease are available...
July 2016: Joint, Bone, Spine: Revue du Rhumatisme
Agnetha Folestad, Martin Ålund, Susanne Asteberg, Jesper Fowelin, Ylva Aurell, Jan Göthlin, Jean Cassuto
BACKGROUND: Proinflammatory cytokines are an integral part of the osteolytic activity of Charcot arthropathy but are also central to normal bone healing. As there are no previous longitudinal studies investigating their role during the recovery phase of Charcot, we set out to monitor systemic levels of proinflammatory cytokines from Charcot presentation until a clinically and radiographically documented chronic state has been reached. METHODS: Twenty-eight consecutive Charcot patients were monitored during 2 years by repeated foot radiographs, MRI and plasma levels of interleukin [IL]-6, IL-8, IL-1β, Tumor Necrosis Factor [TNF]-α, and IL-1 receptor antibody (IL-1RA)...
2015: Journal of Foot and Ankle Research
Parinita A Dherange, Sarah Patel, Evbu Enakpene, Prakash Suryanarayana
We report a case of a 55-year-old woman with a history of type 2 diabetes mellitus, Charcot arthropathy and end-stage renal disease, who presented with a syncopal episode after undergoing haemodialysis. She had a history of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia from an unknown source 3 months earlier, which was treated with an 8-week course of intravenous antibiotics. At the time of presentation to the emergency room, she was found to be in refractory shock. Bedside echocardiogram was performed, which showed moderate pericardial effusion...
December 7, 2015: BMJ Case Reports
N L Petrova, M E Edmonds
Charcot neuro-osteoarthropathy (CN) is one of the most challenging foot complications in diabetes. Common predisposing and precipitating factors include neuropathy and increased mechanical forces, fracture and bone resorption, trauma and inflammation. In the last 15 years, considerable progress has been made in the early recognition of the acute Charcot foot when the X ray is still negative (stage 0 or incipient Charcot foot). Recent advances in imaging modalities have enabled the detection of initial signs of inflammation and underlying bone damage before overt bone and joint destruction has occurred...
January 2016: Diabetes/metabolism Research and Reviews
Tomáš Kučera, Jaromír Šrot, Josef Roubal, Pavel Šponer
The basic prerequisite for the successful treatment of the diabetic foot is a multidisciplinary approach. Ideally, the diagnosis and treatment is managed by a podiatrist, who is also responsible for a cost-effective and well-managed setting. General concern of diabetics is the fear of losing a limb. On the basis of multidisciplinary approach is pos-sible to prevent major amputations in many cases, or in case of them to ensure the prosthetic and rehabilitation care. New possibilities of revascularization and cooperation with antibiotic centers increase the success of surgical treatment of diabetic foot syndrome...
June 2015: Vnitr̆ní Lékar̆ství
Marta Barreto de Medeiros Nóbrega, Roque Aras, Eduardo Martins Netto, Ricardo David Couto, Alexandre Magno da Nóbrega Marinho, João Luís da Silva, Víctor Nóbrega Quintas Colares, Priscilla Leite Campelo, Marcos André Lima Nunes
OBJECTIVE: Diabetes mellitus is the main cause of Charcot neuroarthropathy and is clinically classified as follows: Charcot foot, acute Charcot foot (ACF) when there is inflammation, and inactive Charcot foot when inflammatory signs are absent. The aim of this study was to identify the risk factors for ACF in patients with type 2 diabetes mellitus. MATERIALS AND METHODS: A matched case-control study was conducted to assess the factors associated with acute Charcot foot from February 2000 until September 2012...
June 2015: Archives of Endocrinology and Metabolism
M Fosbøl, S Reving, E H Petersen, P Rossing, M Lajer, B Zerahn
AIM: To investigate whether inclusion of quantitative data on blood flow distribution compared with visual qualitative evaluation improve the reliability and diagnostic performance of (99 m) Tc-hydroxymethylene diphosphate three-phase bone scintigraphy (TPBS) in patients suspected for charcot neuropathic osteoarthropathy (CNO) of the foot. METHOD: A retrospective cohort study of TPBS performed on 148 patients with suspected acute CNO referred from a single specialized diabetes care centre...
January 2017: Clinical Physiology and Functional Imaging
Fernando García Barrado, Dirk R Kuypers, Giovanni A Matricali
We retrospectively analyzed outcome and risk factors of developing Charcot foot (CF) in 100 patients with type 1 diabetes mellitus who underwent a simultaneous pancreas-kidney (SPK) transplantation. Patients who developed CF after SPK transplantation had significantly higher mortality (56% vs. 18%) and more frequently graft failure (44% vs. 13%). Recipients with CF also experienced acute rejections more frequently (78% vs. 41%). They furthermore had higher pre-transplant values of HbA1c , received cyclosporine and azathioprine more often, and had significantly higher cumulative corticosteroid use...
August 2015: Clinical Transplantation
J von Recum
BACKGROUND: Involvement of the ankle joint in Charcot osteoarthropathy is most often associated with severe instability and fracture or collapse of the talus. Caused by malalignment, ulcerations over both malleoli are associated with increased risk of major amputation. OBJECTIVE: The goal of the operation is to realign the hind foot, gain a stable osteosynthesis, and prevent major amputation. INDICATIONS: Charcot osteoarthropathy of the ankle joint with instability, with or without soft tissue involvement, failure of the primary arthrodesis of the ankle or subtalar joint...
April 2015: Operative Orthopädie und Traumatologie
Valerie L Schade, Charles A Andersen
Acute Charcot neuroarthropathy of the foot and ankle presents with the insidious onset of a unilateral acutely edematous, erythematous, and warm lower extremity. The acute stages are typically defined as Eichenholtz Stage 1, or Stage 0, which was first described by Shibata et al. in 1990. The ultimate goal of treatment is maintenance of a stable, plantigrade foot which can be easily shod, minimizing the risk of callus, ulceration, infection, and amputation. The gold standard of treatment is non-weight-bearing immobilization in a total contact cast...
2015: Diabetic Foot & Ankle
Osaretin B Idusuyi
BACKGROUND: Charcot neuroarthropathy is one of the more devastating complications of diabetes. It is a progressive, destructive condition that is characterized by acute fracture, dislocation, and joint destruction in weight-bearing neuropathic foot. In its acute phase, it is often misdiagnosed and can lead to several deformities such as ulcerations and amputation. Early diagnosis and management is, therefore, imperative to avoid rapid progression. OBJECTIVES: Review current literature on the diagnosis and management of diabetic patients with Charcot neuroarthropathy...
February 2015: Prosthetics and Orthotics International
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