[Diabetic neuroarthropathy in acute phase: a diagnostic dilemma. Two cases and bibliographic review]. / Neuroartropatía diabética en fase aguda: un dilema diagnóstico. A propósito de dos casos y revisión de la bibliografía.

INTRODUCTION: Charcot's neuroarthropathy is a progressive deterioration of bones and joints, mainly the ankle and foot of the diabetic patients suffering severe neuropathy. Its pathogeny is not well known, although mechanical, vascular and neurological factors are thought to be involved, generally with a precipitating minor traumatic even. Charcot's foot acute phase is inflammatory, and it is often confused with other diseases such as arthritis, cellulitis and deep venous thrombosis (DVT). This leads to delays or errors in the diagnosis, the patient coming to the hospital too late with severe foot deformation. OBJECTIVE: Thus, it must always be posed as differential diagnosis in a diabetic patient who comes with a warm and inflamed foot, generally without fever, even more if he has a severe autonomic or somatic neuropathy. In the acute onset, the only treatment has been complete and long term off-loading with a total contact cast that should be initiated immediately after diagnosis. More recent studies show promising results with biphosphonates to decrease bone turnover in acute phase. CONCLUSION: We present two cases of acute Charcot's foot and we briefly review the bibliography.

Neuroartropatía diabética en fase aguda: un dilema diagnóstico. A propósito de dos casos y revisión de la bibliografía / Diabetic neuroarthropathy in acute phase: a diagnostic dilemma. Two cases and bibliographic review

Introducción. La neuroartropatía de Charcot consiste en un progresivo deterioro de los huesos y articulaciones, principalmente del tobillo y pie, de pacientes diabéticos afectos de una neuropatía grave. Su patogenia no es bien conocida, aunque se consideran implicados factores mecánicos, vasculares y neurológicos, precipitados generalmente por un traumatismo. La fase inflamatoria aguda pasa a menudo inadvertida o se confunde con patologías como artritis, celulitis o trombosis venosa profunda (TVP), lo que determina retraso o errores en el diagnóstico, presentándose el paciente en la consulta ya con deformidad en el pie. Objetivo. Así, ha de plantearse siempre como diagnóstico diferencial ante un paciente diabético que acude con un pie caliente e inflamado habitualmente sin fiebre, sobre una neuropatía grave somática y/o autonómica. En esta fase precoz el único tratamiento que ha demostrado una clara ventaja es la descarga completa y prolongada del pie mediante prótesis que debería iniciarse inmediatamente después del diagnóstico. Estudios más recientes muestran resultados positivos con la administración de bifosfonatos que logran frenar la reacción inflamatoria propia de esta fase aguda. Conclusión. A continuación se describen dos casos de neuroartropatía de Charcot en fase aguda y se realiza una revisión de la bibliografía

Introduction. Charcot's neuroarthropathy is a progressive deterioration of bones and joints, mainly the ankle and foot of the diabetic patients suffering severe neuropathy. Its pathogeny is not well known, although mechanical, vascular and neurological factors are thought to be involved, generally with a precipitating minor traumatic even. Charcot's foot acute phase is inflammatory, and it is often confused with other diseases such as arthritis, cellulitis and deep venous thrombosis (DVT). This leads to delays or errors in the diagnosis, the patient coming to the hospital too late with severe foot deformation. Objective. Thus, it must always be posed as differential diagnosis in a diabetic patient who comes with a warm and inflamed foot, generally without fever, even more if he has a severe autonomic or somatic neuropathy. In the acute onset, the only treatment has been complete and long term off-loading with a total contact cast that should be initiated immediately after diagnosis. More recent studies show promising results with biphosphonates to decrease bone turnover in acute phase