Charcot's Joint

A.K.A Neuropathic arthropathy

Definition

• refers to progressive degeneration of a weight bearing joint, a process marked by bony destruction, bone resorption, and eventual deformity.

• it could result in joint deformity, ulceration and/or superinfection, loss of function, and in the worst case scenario: amputation or death if unchecked earlier.

• can occur at any joint; however, it occurs most commonly in the lower extremity, at the foot and ankle

onset :insidious

Causes

any condition resulting in decreased peripheral sensation, proprioception, and fine motor control:

• Diabetes mellitus neuropathy - Related to long-term poor glucose control.(most common)
• Alcoholic neuropathy
• Cerebral palsy
• Leprosy
• Syphilis (tabes dorsalis), caused by the organism Treponema pallidum
  
• Spinal cord injury
• Myelomeningocele
• Syringomyelia
• Intra-articular steroid injections
• Congenital insensitivity to pain

Radiographic Appearance

• At presentation the X-ray appearance of Charcot's joint may be normal or show a minor fracture but may already show quite gross bone destruction.

• Stage I is the destructive phase

-characterized by fracture as a result of repetitive trauma without splinting or allowing for repair. As the acute inflammatory response ensues, mechanical destruction.

• Stage II

-characterized by persistent hyperemia and chronic inflammation that leads to progressive loss of bone strength.

• Stage III.

-characterized by further mechanical destruction in the desensitized joint can result in a cycle of destruction and failed attempts at biological repair

Differential Diagnosis

• osteomyelitis
• osteonecrosis
• advanced osteoarthritis
• stress fractures
• CPPD (Calcium Pyrophosphate Deposition Disease )

Treatment

• primary focus of treatment is to provide stabilization of the joint.Treatment of the underlying disorder, even if successful, does not usually alter the joint disease. Braces and splints are help
• In the diabetic patient, early recognition and treatment of a Charcot's foot by prohibiting weight-bearing of the foot for at least 8 weeks may possibly prevent severe disease from developing