Charcot joint in a diabetic patient: an overlooked diagnosis

ABSTRACT

Charcot joint is a destructive bone and joint disorder of the foot associated with decreased sensory innervation of the involved joint, usually ending in a state of disability and amputation. In the past, tabes dorsalis was the most common cause However, with the increasing prevalence of diabetes mellitus, diabetes is now believed to be the most common cause of charcot joint. It was believed that charcot joint is rare in diabetic patieits; this could be true for the advanced stage but charcot joint is common in the early stage; however, it is usually overlooked or misdiagnosed. Diagnosis of early charcot joint requires a high index of suspicion in a neuropathic diabetic foot with a history of trauma supported by the radiological findings. Treatment is difficult and far from satisfactory in the advanced stage but if applied early it may reduce its disabling consequences. This review article describes the etiology, pathophysiology, clinical and radiological features, and treatment of charcot joint and demonstrates that a better understanding of the charcot process offers new hope for preventing the progression of this distressing diabetic complication. Therefore it is important to emphasize that early recognition and treatment of charcot joint in a diabetic patient by the physician is necessary to avoid this disabling complication and its consequences