Enfermedad de Charcot de pie y tobillo en pacientes con diabetes mellitus: análisis de las causas de re consultas en una unidad de pie diabético hospitalaria / Charcot´s disease of the foot and ankle in diabetic patients: analysis of the reasons for re admission at the hospital diabetic unity / Neuroartropatía de Charcot do pé e tornozelo em pacientes com diabetes mellitus: análise das causas das novas consultas em uma unidade de pés diabéticos do hospital

La neuroartropatia de Charcot es una complicación devastadora para los pacientes diabéticos, generando deformidades osteoarticulares con riesgo de ulceración, infección y amputación de miembros inferiores. El objetivo fue analizar en una población de pacientes diabéticos con secuela de neuroartropatía de Charcot, el motivo de re consulta y los tratamientos a los que fueron sometidos. El mismo se realizó en forma retrospectiva mediante observación de historias clínicas y estudios radiológicos de 22 pacientes tratados entre 2014 y 2018 en el Hospital Policial de Montevideo - Uruguay, con un tiempo de evolución mínimo de un año al momento de la revisión. Se contó con la aprobación del Comité de Ética de dicho hospital habiéndose completado un formulario con datos demográficos, tratamiento inicial, causas de las re consultas y tratamientos secundarios. Si bien al inicio de la enfermedad se siguieron los protocolos de tratamiento con alto nivel de recomendación, se observaron en las re consultas elevados porcentajes de re ulceración y necesidad de cirugías complementarias (59%). Se vinculan los resultados a la falta de categorización de paciente de riesgo para lograr seguimiento y captación precoz. El categorizar al paciente de riesgo permite establecer estrategias de educación y de tratamientos tendientes a disminuir porcentajes de nuevas lesiones que lleven a la necesidad de tratamientos secundarios o amputaciones.

One of the most devastating complications within diabetic patients is Diabetic Charcot neuroarthropathy. It can lead to osteoarticular deformities, with risk of ulceration, infection or even lower limb amputation. In this paper, a population of diabetic patients with Charcot neuroarthropathy sequelae was studied. Data was analyzed on the reasons for the patients re consultation, the treatments they were subjected to and the obtained results. The study was conducted retrospectively by the examination of medical records from 22 patients that were treated between 2014 and 2018, with a follow-up of at least a year, at the Hospital Policial in Montevideo, Uruguay. Furthermore, it had the hospital's Ethics Committee approval. The data analysis was conducted by the completion of a form including demographic data, initial treatment, reasons for re consultation and secondary treatments. According to the findings, even though highly recommended protocols were followed at the onset of the disease, high percentage of ulceration and complementary surgeries were observed (59%) within the patient's data. The results are linked to the lack of risk patient´s categorization in order to achieve early uptake. Categorizing the patient at risk makes it possible to establish health education and treatment strategies aimed at reducing percentages of new injuries that lead to the need for secondary treatments or amputations.

A neuroartropatia de Charcot é uma complicação devastadora para os pacientes com diabetes, gerando deformidades osteoarticulares residuais com risco de úlceras, infecção e amputação maior dos membros inferiores. O objetivo foi analisar em uma população de pacientes diabéticos com sequelas da neuroartropatia de Charcot, o motivo da nova consulta e os tratamentos a que foram submetidos, bem como os resultados obtidos. Foi realizado retrospectivamente por meio de observação de histórias clinicas e estudos radiológicos de 22 pacientes atendidos no periodo de 2014 a 2018 no Hospital da Polícia de Montevidéu - Uruguai, com tempo de evolução mínimo de um ano na época da revisão. Foi aprovado pelo Comité de Ética do referido hospital, tendo sido preenchido um formulário com dados demográficos, tratamento inicial, causas das novas consultas e tratamentos secundários. Embora protocolos de tratamento com alto nível de recomendação tenham sido seguidos no início da doença, elevados percentuais de re ulcerações e cirurgias complementares (59%) foram observados nas novas consultas. Os resultados estão ligados à falta de categorização dos pacientes de risco para obter captação precoces A categorização do paciente de risco permite estabelecer estratégias de educação e tratamento com o objetivo de reduzir os percentuais de novas lesões que levam à necessidade de tratamentos secundários ou amputações.

Recomendaciones de manejo del paciente con pie diabético. Curso de instrucción / Management recommendations for diabetic foot patients. Instructional course

El ataque de pie diabético es uno de los desenlaces más fatídicos para el paciente con diabetes, lo que demuestra la importancia del control en una enfermedad que avanza hasta presentar cambios macroscópicos importantes en el miembro inferior. Durante la progresión de la Diabetes, la enfermedad puede derivar en un aumento de la morbilidad e intervenciones invasivas y limitantes para el paciente, de ahí la importancia de la detección e intervención temprana y oportuna de la patología por parte del equipo médico. Estas recomendaciones van dirigida a médicos generales y especialistas en diversas ramas médicas, con el objetivo de enfatizar el cómo se debe realizar el abordaje integral del paciente con pie diabético. Abarcando la prevención, diagnóstico inicial, evaluación de la progresión de la patología, estratificación con las clasificaciones propuestas, y por último el tratamiento según el estadio en el que se encuentre el paciente. Esto con el fin de minimizar desenlaces, intervenciones y complicaciones derivadas de la progresión del pie diabetico. Hablamos de recomendaciones y no de guías debido a la ausencia en un gran número de oportunidades de evidencia científica debidamente estructurada (I y II). Tal vez lo más importante por recalcar en todas estas recomendaciones es recordarle al lector que en los casos de afectación de un pie diabético, siempre se debe tener en cuenta que el pie contralateral también ha estado sometido a la misma enfermedad durante el mismo tiempo y por lo tanto aunque no tenga síntomas se debe considerar igualmente enfermo y se debe examinar también.

Diabetic foot is one of the most fatal outcomes for patients with diabetes; the importance of control in a disease that progresses until presenting important macroscopic changes in the lower limb is absolutely relevant. Along diabetes progression, the disease can lead to increased morbidity and invasive and limiting interventions for the patient, hence the importance of early and timely detection and intervention of the pathology by the medical team. These recommendations are addressed to general practitioners and specialized faculty in various medical branches, emphasizing how a comprehensive approach to the patient with diabetic foot should be carried out. Covering prevention, initial diagnosis, evaluation of the progression of the pathology, stratification with the proposed classifications, and finally the treatment according to the stage in which the patients are, is actually well described herein in order to minimize unsatisfactory outcomes, interventions and complications derived from the progression of diabetic foot. We are talking about recommendations and not guidelines due to the absence in a large number of opportunities of properly structured scientific evidence (I and II). Perhaps, the most important thing to emphasize in all these recommendations is to remind the reader that in cases of treating a diabetic foot, it should always be kept in mind that the contralateral foot is not healthy because it has also been subjected to the same disease, for the same period of time and stressed equally as well. Therefore, even if the contralateral foot does not have symptoms, it should be considered equally ill and should be examined and treated likewise.

Diabetic Foot. Part 2: Charcot Neuroarthropathy / Pé diabético. Parte 2: Neuroartropatia de Charcot

Abstract Charcot neuroarthropathy (CN) is an unfortunate and common complication of patients with diabetes, most likely resulting from a lack of proper understanding of the disease, which leads to late diagnosis. It is commonly misdiagnosed as infection and treated with antibiotics and a frustrated attempt of surgical drainage, which will reveal only debris of the osteoarticular destruction. Proper education of diabetic patients and of the health care professionals involved in their treatment is essential for the recognition of the initial signs of CN. The general orthopedic surgeon is usually the first to treat these patients in the early stages of the disease and must be aware of the signs of CN in order to establish an accurate diagnosis and ensure proper treatment. In theory, this would make it possible to decrease the morbidity of this condition, as long as proper treatment is instituted early.

Resumo A neuropatia de Charcot (NC) é uma complicação lamentável e comum de pacientes com diabetes, provavelmente resutlante de uma falta de entendimento adequado dessa condição, que leva ao diagnóstico tardio.A confusão diagnóstica com quadro infeccioso contribui para que o tratamento inicialmente indicado seja equivocado ao prescrever medicação antibiótica ou, eventualmente, drenagem cirúrgica. Não é infrequente que a drenagem inadvertida do suposto abcesso revele que na verdade seu conteúdo é formado apenas de partículas provenientes da destruição osteoarticular. A educação adequada, tanto dos pacientes diabéticos quanto dos médicos responsáveis por prestar atendimento primário a estes pacientes, é fundamental para a correta compreensão das principais características relacionadas ao desenvolvimento da NC. O ortopedista geral é quem, na maioria das vezes, recebe no pronto atendimento os pacientes que se encontram na fase aguda inicial da doença. Por esta razão, esses profissionais devem estar extremamente alertas e serem capazes de identificar os primeiros sinais que permitem diagnosticar precocemente a NC. Em tese, isto possibilitaria reduzir a morbidade desta afecção na medida em que o tratamento adequado venha a ser precocemente instituído.

Results of Simple Conservative Treatment of Midfoot Charcot Arthropathy

BACKGROUND: Traditionally, conservative management with an offloading orthosis, such as total contact cast (TCC), has been the standard of care for midfoot Charcot arthropathy. Considering complications of TCC and surgery, we treated midfoot Charcot arthropathy without TCC in our patients. The purpose of this study was to report clinical and radiological outcomes of conservative management of midfoot Charcot arthropathy. METHODS: A total of 34 patients (38 feet) who were diagnosed as having midfoot Charcot arthropathy between 2006 and 2014 were included. Patients started full weight bearing ambulation in a hard-soled shoe immediately after diagnosis. Outcomes such as progression of arch collapse, bony prominence, ulcer occurrence, limb amputation, and changes in Charcot stage were evaluated. RESULTS: Of 38 feet, arch collapse was observed in four while progression of bottom bump of the midfoot was observed in five feet. Foot ulcers related to bony bumps were found in two feet. CONCLUSIONS: Conservative treatment without restriction of ambulation is recommended for midfoot Charcot arthropathy because it is rarely progressive, unlike hindfoot-ankle arthropathy. In some cases, simple bumpectomy can be required to prevent catastrophic infection.

Diagnosis and treatment of Charcot's osteoarthropathy / 中国骨伤

Charcot foot is a rare disease in clinic, its pathogenesis includes neurotrauma theory, neurovascular theory, comprehensive theory, and inflammatory factor theory. The disease is characterized by progressive joint and bone destruction of foot and ankle joint. Conventional X-ray examination is not sensitive to the early diagnosis of disease, the manifestation of CT and MRI of disease is characteristic and could be used to make a comprehensive evaluation of bone and soft tissue lesions of disease. It is not difficult to make a diagnosis based on characteristic findings of CT and MRI and clinical manifestations such as swelling, pain and skin temperature rising of foot and ankle. Charcot foot has multiple classification methods including anatomy, imaging and clinical classification. Improved Eichenholtz staging classification is most commonly used currently which could make a more comprehensive assessment of disease and guide treatment better. According to the stage of disease, treatment could be carried out including non-weight bearing and brace protection, drugs therapy and surgical treatment, etc. Early diagnosis, brace protection, could protect joint and delaying progression of deformity. There is no clear long-term and generally accepted conclusion about the efficacy of drug therapy. For advanced patients, surgical treatment must be actively performed to preserve a stable and functional ankle joint and reduce amputation rate.

Treatment algorithm for Charcot foot and surgical technique with circular external fixation / Algoritmo de tratamiento para el pie de Charcot y técnica quirúrgica con fijación externa circular

Abstract: Background: Charcot neuroarthropathy (CNA), commonly known as Charcot foot, is one of the most debilitating complications of diabetes mellitus. Patients with plantar ulcer and osteomyelitis (OM) due to Charcot foot represent a high cost for health systems and society in general. The amputation risk for ulcerated Charcot patients is 12 times higher than general population under 65 years old. Material and methods: In this article we present the CNA treatment protocol we use in our center. We also make a detailed description of the surgical technique «single stage surgery¼ with circular external fixation. Results: Our CNA treatment protocol covers the most common presentations of this severe neuropathic complication. With the «single stage surgery¼ using circular external fixation we achieve an ulcer-free foot, successful treatment of the OM, correction of the deformity, diminished the cost of treatment, avoided amputation and prevented recurrence of the ulcer. Conclusions: The use of a treatment algorithm based on the current literature, can be an invaluable tool in the treatment of these complex patients. The circular external fixation has proven to be the only reliable tool for treating complex Charcot foot in the context of poor bone stock, active ulcers, soft tissues problems and OM.

Resumen: Antecedentes: La neuroartropatía de Charcot, comúnmente llamado «pie de Charcot¼, es una de las complicaciones más incapacitantes de la diabetes mellitus. Los pacientes con úlceras plantares y osteomielitis representan un gasto elevado para los diferentes sistemas de salud y la sociedad en general. El riesgo de amputación en estos pacientes es 12 veces más elevado que en la población general menor de 65 años. Material y métodos: En el presente trabajo mostramos el algoritmo de tratamiento de nuestro centro y también presentamos de manera detallada la técnica quirúrgica de un solo tiempo con fijación externa circular. Resultados: Nuestro algoritmo de tratamiento cubre la mayor parte de las presentaciones clínicas de esta complicación. Con la cirugía en un solo tiempo y el uso de la fijación externa circular se ha logrado desaparecer las úlceras, tratar satisfactoriamente la osteomielitis, corregir la deformidad, disminuir costos, prevenir recurrencias y evitar las amputaciones. Conclusiones: El uso de un algoritmo de tratamiento basado en la literatura actual es de suma utilidad para este grupo de pacientes. La fijación externa circular ha demostrado ser una herramienta confiable en el tratamiento integral de estos casos.

Artropatía de Charcot: un método para su tratamiento. Seguimiento a cinco años / Treatment for Charcot arthropathy. Five-year follow-up

Resumen: Introducción: La artropatía de Charcot es una patología que afecta al sistema musculoesquelético al alterar la biomecánica y causar reacciones bioquímicas con alteraciones óseas y articulares. Se infiere la prevalencia de 1%. La historia natural de la enfermedad, clasificada por Eichenholtz y modificada por Simmons, consta de cuatro fases; en cuanto a la localización, Sanders describe cinco áreas afectadas en el pie. Material y métodos: Nuestro objetivo fue valorar si el método establecido para el tratamiento de esta patología es eficaz al diagnosticar cada fase y dar el tratamiento correspondiente mediante los estándares establecidos en la literatura, sin importar la localización, como lo muestra el algoritmo. Resultados: Se consideró que el tratamiento fue exitoso en los casos que presentaron alineación, consolidación total y marcha independiente con zapato comercial (85%), sin realizar amputaciones; hubo 15% de fracasos funcionales: casos no consolidados, con alineación parcial, marcha dependiente de soporte y reactivación. Conclusiones: Al no encontrar diferencias significativas entre las fases de la enfermedad y los tratamientos, inferimos que el abordaje empleado es el adecuado a cada fase; el éxito no depende de la fase en la que se diagnostique, sino del tratamiento individualizado.

Abstract: Introduction: Charcot arthropathy is a deformity which alters foot biomechanics and generate bichemical reactions that affect articular joints and bone. The natural history shown us a prevalence on 1% and is classified by Eichenholtz and Simmons modification in four stages; Sanders describe its location in 5 specific areas. Material and methods: Our goal was to evaluate the specific method of treatment depending in the different stages of the deformity according to the literature review and to our proposed algoritm. Results: A succesful treatment were based on alignment, bone healing and independent gait with regular shoes occurred in 85 % of our population. 15% were considered failures because of lack of consolidation, malalignment or use of gait aids and reactivation of the disease. Conclusions: There were no differences in the treatment regardless of the phase of the disease; it is more important the individualized treatment.

Evaluación del uso del clavo centromedular retrógrado bloqueado para artrodesis de tobillo en pacientes con neuroartropatía de Charcot / Retrograde intramedullary nail fixation for Charcot neuroarthropathy

Resumen: La artropatía de Charcot se define como un padecimiento articular degenerativo, crónico y progresivo que se caracteriza por lesiones óseas destructivas sin presencia de infección. La neuropatía está asociada directamente con la diabetes mellitus tipo 1 y 2. La cirugía está indicada cuando existe compromiso de partes blandas, inestabilidad de las articulaciones del tobillo y pie, cuando se desarrollan úlceras recurrentes o no es posible adecuar el tobillo o el pie a un calzado normal o en los pacientes que presentan deformidad severa, úlceras o dolor crónico y limitación para realizar las actividades de la vida diaria. El presente es un trabajo observacional, prospectivo, transversal y descriptivo de pacientes con diagnóstico de neuroartropatía de Charcot tipo 3a de Brodsky tratados quirúrgicamente mediante artrodesis de tobillo con clavo centromedular retrógrado bloqueado, del 1o de Enero de 2010 al 31 de Agosto de 2015. Se analizaron 16 pacientes. En el preoperatorio la media de la escala de AOFAS fue de 35.0 ± 5.2 puntos. Un seguimiento postoperatorio de cuatro años con un mínimo de siete meses. En el postoperatorio la escala de AOFAS mostró un incremento de 40 puntos hacia la mejoría (p = 0.0001). La técnica revisada logra la estabilización ósea, resultando en un pie con apoyo plantígrado que disminuye la aparición de úlceras crónicas y mejora el desarrollo en las actividades de la vida cotidiana.

Abstract: Charcot arthropathy is defined as an articular degenerative, chronic, progressive disease that affects one or more peripheral joints, develops as a result of a failure in the normal sensory perception (pain and proprioception) in the innervation of joints located in the foot and ankle, is characterized by destructive bone lesions without the presence of infection. Neuropathy is directly associated with diabetes mellitus type 1 and 2. Surgery is indicated when there is severe involvement of soft tissue, foot joints are unstable, at the presence of chronic or recurrent ulcers or when the foot and ankle can not fit to a normal shoe, and had limitation to perform activities of daily living. Material and methods: Design: observational, prospective, transversal, descriptive. Sample: patients diagnosed with Charcot neuropathy type 3a of Brodsky. Surgically treated by ankle arthrodesis with an intramedullary blocked nail, from January 2010 to August 2015. Results: 16 patients were analyzed. Preoperative AOFAS score was 35.0 ± 5.2 points. Postoperative follow-up period of 4 years to 7 months. Postoperative AOFAS scale showed an improvement of 40 points (p = 0.0001). Conclusions: The proposed treatment allows bone stabilization, resulting in a full foot plantar support and decreases the occurrence of chronic ulcers that are difficult to treat, and is an alternative method that avoids lead to amputation.

Neuroartropatia de Charcot secundária à siringomielia: relato de caso / Charcot neuroarthropathy by syringomyelia: case report

A neuroartropatia de Charcot é uma das complicações da siringomielia, podendo ocasionar deformidades osteoarticulares e incapacidade funcional, com comprometimento das atividades da vida diária. Relatamos um caso de paciente com neuroartropatia de Charcot do ombro associada a siringomielia e malformação de Arnold-Chiari tipo I, acompanhado no Instituto Nacional de Traumatologia e Orto-pedia do Rio de Janeiro, RJ, Brasil.

Charcot neuroartropathy is one of the complications of syringomyelia and can lead to joint deformity and disability, affecting patients in activities of daily living. We report a case of a patient with shoulder Charcot neuroarthropathy associated with syringomyelia and Arnold-Chiari malformation type I, from the National Institute of Traumatology and Orthopedics of Rio de Janeiro, RJ, Brazil.

La neuroartropatía de Charcot en el pie diabético / Charcot arthropathy and diabetic foot

Resumen: La diabetes mellitus es uno de los principales padecimientos crónicos-degenerativos que en la actualidad va tomando proporciones alarmantes en la población de nuestro país. La artropatía neuropática es uno de los trastornos degenerativos de las articulaciones de mayor interés, cada vez más comunes dentro de la patología ortopédica. Se define como una artropatía degenerativa, crónica y progresiva que afecta a una o más articulaciones periféricas y se desarrolla como resultado de la falta de percepción sensorial normal en la inervación de estas últimas. Como resultado las articulaciones de los pies son sometidas a traumatismos y lesiones repetitivas ocasionando un efecto neurotraumático que daña progresivamente las articulaciones del retropié, mediopié y antepié. El diagnóstico incluye una adecuada historia clínica, exploración meticulosa del miembro afectado, rayos X convencionales, gammagrafía, tomografía axial computarizada y en algunos casos resonancia magnética. El tratamiento conservador incluye el farmacológico y el médico: reposo de la extremidad y evitar deformidades mediante el uso de aparatos de yeso de contacto total, órtesis o calzado especial. El tratamiento quirúrgico depende de la etapa en la que se encuentre la enfermedad y puede requerir una o varias intervenciones quirúrgicas con el fin de lograr un pie plantígrado previniendo la formación de úlceras de difícil manejo. Una de las cirugías más frecuentes es la artrodesis de las articulaciones dañadas. La cirugía debe realizarse solamente en la fase de coalescencia de la enfermedad, puede utilizarse fijación interna, externa o ambas.

Abstract: Diabetes mellitus is a major chronic degenerative disease, which currently is taking on alarming proportions in the population of our country. Neuropathic arthropathy is one of the most interesting degenerative joint disorders and increasingly common within the orthopedic pathology. It is defined as a progressive degenerative arthropathy, chronic and affecting one or more peripheral joints, and develops as a result of the lack of sensory perception normal in the innervation of joints. As a result the joints of the feet are subjected to trauma and repetitive injury causing a neurotraumatic effect with progressive damage to the joints of the hindfoot, midfoot and forefoot. Diagnosis includes a proper medical history, careful examination of the affected limb, conventional X-ray, scintigraphy, computed tomography and magnetic resonance imaging in some cases. Conservative treatment includes: drugs, rest of the affected limb, and the use of appliances like total-contact cast, orthotics or special shoes. Surgical treatment depends on the stage of the disease, and may require one or more surgical procedures, in order to achieve a full foot plantar support to prevent ulcers. One of the surgeries performed most often is the fusion of damaged joints. Surgery must be performed only in the coalescence phase of the disease, using internal, or external fixation or both.

Risk factors of diabetic foot Charcot arthropathy: a case-control study at a Malaysian tertiary care centre

<p><b>INTRODUCTION</b>This study aimed to determine the risk factors of diabetic Charcot arthropathy of the foot among diabetic patients with and without foot problems.</p><p><b>METHODS</b>This was a case-control study involving diabetic patients attending the Diabetic Foot Care and Wound Management Clinic at University Malaya Medical Centre, Kuala Lumpur, Malaysia, from June 2010 to June 2011. Data on sociodemographic profiles, foot factors and diabetes characteristics was collected and analysed.</p><p><b>RESULTS</b>A total of 48 diabetic patients with Charcot arthropathy of the foot were identified. Data from these 48 patients was compared with those of 52 diabetic patients without foot problems. Up to 83.3% of patients with diabetic Charcot arthropathy presented with unilateral Charcot foot, most commonly located at the midfoot (45.8%). Patients with a history of foot problems, including foot ulcer, amputation, surgery or a combination of problems, had the highest (26-time) likelihood of developing Charcot arthropathy (odds ratio 26.4; 95% confidence interval 6.4-109.6). Other significant risk factors included age below 60 years, more than ten years' duration of diabetes mellitus and the presence of nephropathy.</p><p><b>CONCLUSION</b>A history of prior diabetic foot problems is the greatest risk factor for developing diabetic Charcot arthropathy, compared with other risk factors such as diabetes characteristics and sociodemographic profiles. Preventive management of diabetic foot problems in the primary care setting and multidisciplinary care are of paramount importance, especially among chronic diabetic patients.</p>

Diabetes mellitus de tipo 1 y pie de charcot en el tercer estadio de Eichenholtz / Type 1 diabetes mellitus and Charcot neuroarthropathy at Eichenholtz's stage III

El propósito de este trabajo es describir el caso de una paciente con diabetes mellitus de tipo1 con pie de Charcot, el primero registrado en el Hospital General Universitario "Guillermo Domínguez López" en Las Tunas, 2013. Se trata de una paciente blanca, de 21 años de edad que llegó al Servicio de Angiología y Cirugía Vascular del citado hospital por presentar una artropatía neuropática de Charcot, en el estadio tres de Eichenholtz, en el curso de una diabetes mellitus de tipo 1, con 12 años de evolución y un mal control metabólico, complicación rara e infrecuente en nuestro medio. Se realizó interrogatorio, examen físico, y estudios analíticos e imagenológicos y se decidió su ingreso. En el primer ingreso se logró la compensación de la diabetes, de la hipertensión arterial, y que el pie disminuyera de volumen. Después presentó múltiples ingresos por uro-sepsis y descontrol metabólico, hasta que fue incorporada a la hemodiálisis por insuficiencia renal y en su posterior evolución comenzó a presentar pericarditis urémica con fallo cardiaco y fallecimiento posterior. Ante la presencia de un aumento de volumen, edema del pie, lesión articular por la que no se siente dolor, deformidad e inestabilidad articular con neuropatía sensitiva-motora en extremidades inferiores, se debe pensar en una neuroartropatía de Charcot y así evitar su evolución hacia la última etapa de Eichenholtz. Este caso es de gran interés para la atención médica de los pacientes diabéticos por todas las especialidades médicas y dirigido especialmente a la atención primaria de salud(AU)

The objective of this paper was to describe the case of a female who suffered type 1 diabetes mellitus and Charcot neuroarthropathy, the first of this type managed in "Guillermo Dominguez Lopez" general university hospital in Las Tunas province in 2013. This patient was a 21 years-old Caucasian woman, who went to the angiology and vascular surgery service of the hospital, because she presented with Charcot neuropathic arthropathy at Eichenholtz´s stage III in the course of type 1 of diabetes mellitus of 12 years of evolution and inadequate metabolic control. This was a rare and uncommon complication in our setting. The patient was questioned about her symptoms and physically examined, then subjected to analytical and imaging studies; it was finally decided to admit her to hospital. In her first period of hospitalization, diabetes and blood hypertension were duly controlled and the foot swelling was reduced. After several admissions to hospital due to urinary sepsis and lack of metabolic control, she was accepted in the hemodyalisis treatment program due to renal failure, but later on, she began suffering uremic pericarditis, heart failure and finally died. In the face of raised volume, foot edema, painless joint injure, joint deformity and instability with sensory-motor neuropathy in lower limbs, one should think of Charcot neuroarthropathy and thus prevent the evolution into the last Eichenholtz´s stage. This is a case of great interest for the medical care of diabetic patients by all medical specialties and mainly aimed at the primary health care(AU)

Risk factors for Charcot foot

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. Four controls for each case were selected 47 cases of ACF and 188 controls without ACF were included. Cases and controls were matched by year of initialization of treatment. Conditional logistic regression was used to estimate matched odds ratios (ORs) and 95% confidence intervals (95% CIs).Results In multivariate analysis, patients having less than 55 years of age (adjusted OR = 4.10, 95% CI = 1.69 – 9.94), literate education age (adjusted OR = 3.73, 95% CI = 1.40 – 9.92), living alone (adjusted OR = 5.84, 95% CI = 1.49 – 22.86), previous ulceration (adjusted OR = 4.84, 95% CI = 1.62 – 14.51) were at increased risk of ACF. However, peripheral arterial disease (adjusted OR = 0.16, 95% CI = 0.05 – 0.52) of 6.25 (1.92 – 20.0) was a protective factor.Discussion The results suggest that PCA in type 2 diabetes primarily affects patients under 55 who live alone, are literate, and have a prior history of ulcers, and that peripheral arterial disease is a protective factor. Arch Endocrinol Metab. 2015;59(3):226-30.

Neuropathic Arthropathy of the Shoulder Associated with Cervical Syringomyelia: A Case Report

Neuropathic shoulder arthropathy or Charcot's shoulder is an extremely rare disease, and sometimes it is associated with cervical syringomyelia. Clinical symptoms of the disease include edema of the shoulder and restriction in range of motion. Radiological diagnosis can be made through plain radiography through a characteristic, atrophic destruction of the joint. We experienced a Charcot's joint of the shoulder wherein destruction of the joint progressed extremely quickly and reviewed the literature concerning this condition.

Neuropathic Arthropathy of the Shoulder Associated with Cervical Syringomyelia: A Case Report

Neuropathic shoulder arthropathy or Charcot's shoulder is an extremely rare disease, and sometimes it is associated with cervical syringomyelia. Clinical symptoms of the disease include edema of the shoulder and restriction in range of motion. Radiological diagnosis can be made through plain radiography through a characteristic, atrophic destruction of the joint. We experienced a Charcot's joint of the shoulder wherein destruction of the joint progressed extremely quickly and reviewed the literature concerning this condition.

Charcot neuroarthropathy: realignment of diabetic foot by means of osteosynthesis using intramedullary screws – case report

Diabetes mellitus is a serious disease that affects a large portion of the population. Charcot neuroarthropathy is one of its major complications and can lead to osteoarticular deformities, functional incapacity, ulcers and ankle and foot infections. Realignment of the foot by means of arthrodesis presents a high rate of implant failure due to weight-bearing on an insensitive foot. The aim of this report was to describe successful use of intramedullary osteosynthesis with compression screws to stabilize the deformed foot, in a diabetic patient with neuroarthropathy...

O diabetes mellitus é uma doença grave que afeta uma grande parcela da população. A neu-roartropatia de Charcot é uma das grandes complicações que podem levar a deformidades osteoarticulares, incapacidade funcional, úlceras e infecção no tornozelo e no pé. O realinhamento do pé por meio de artrodeses apresenta elevado índice de falha do implante por causa da descarga de peso em um pé insensível. O objetivo deste relato de caso é descrever o uso bem-sucedido de osteossíntese intramedular com parafusos de compressão para estabilização do pé com deformidade em paciente diabético com neuroartropatia...

Acquired Adult Flatfoot: Pathophysiology, Diagnosis, and Nonoperative Treatment / 대한족부족관절학회지

Acquired adult flatfoot is a deformity characterized by a decreased medial longitudinal arch and a hindfoot valgus with or without forefoot abduction. The etiologies of this deformity include posterior tibial tendon dysfunction, rheumatoid arthritis, trauma, Charcot's joint, neurologic deficit, and damage to the medial spring ligament complex or plantar fascia. Among these, posterior tibial tendon dysfunction is the most well-known cause. Although posterior tibial tendon dysfunction has been regarded as a synonym of acquired adult acquired flatfoot, failure of the ligaments supporting the arch can also result in progressive deformity even without a posterior tibial tendon problem. The authors describe the pathophysiology, diagnosis, and nonoperative treatment of acquired adult flatfoot, focusing on posterior tibial tendon dysfunction.

Management of Diabetic Foot Ulcer / 대한족부족관절학회지

In patients with diabetic foot, ulceration and amputation are the most serious consequences and can lead to morbidity and disability. Peripheral arterial sclerosis, peripheral neuropathy, and foot deformities are major causes of foot problems. Foot deformities, following autonomic and motor neuropathy, lead to development of over-pressured focal lesions causing the diabetic foot to be easily injured within the shoe while walking. Wound healing in these patients can be difficult due to impaired phagocytic activity, malnutrition, and ischemia. Correction of deformity or shoe modification to relieve the pressure of over-pressured points is necessary for ulcer management. Application of selective dressings that allow a moist environment following complete debridement of the necrotic tissue is mandatory. In the case of a large soft tissue defect, performance of a wound coverage procedure by either a distant flap operation or a skin graft is necessary. Patients with a Charcot joint should be stabilized and consolidated into a plantigrade foot. The bony prominence of a Charcot foot can be corrected by a bumpectomy in order to prevent ulceration. The most effective management of the diabetic foot is ulcer prevention: controlling blood sugar levels and neuropathic pain, smoking cessation, stretching exercises, frequent examination of the foot, and appropriate education regarding footwear.