Key Considerations In Managing The Charcot Foot

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A 58-year-old patient with longstanding diabetes and a previous history of ulceration and neuropathy presented with increasing redness and swelling to his right foot (as shown above).
Radiographs (like the one shown above) revealed dorsal dislocation at the tarsometatarsal joint, resulting in a divergence of the joint complex.
Here one can see a plantigrade foot five weeks after the patient underwent surgical arthrodesis.
Key Considerations In Managing The Charcot Foot
27
Author(s): 
By Suhad A. Hadi, DPM

Dr. Steinberg (pictured) is an Assistant Professor in the Department of Surgery at the Georgetown University School of Medicine in Washington, D.C.




References:

1. Armstrong DG, Lavery LA, Harkless LB: Treatment based classification system for assessment and care of diabetic feet. Clin. Pod. Med. Surg. 15(1):11-19, 1998.
2. Shapiro, SA, et al: Normal blood flow response and vasomotion in the diabetic Charcot foot. J Diab Comp. 12:147-153, 1998
3. Gough A, et al: Measurement of markers of osteoclast and osteoblast activity in patients with acute and chronic diabetic Charcot neuroarthropathy. Diabetic Medicine 14:527-531, 1997.
4. Armstrong DG, Todd WF, Lavery LA, Harkless LB, Bushman TR: The natural history of acute Charcot's arthropathy in a diabetic foot specialty clinic. Diabet Med 14:357-363, 1997.
5. Selby PL, Young MJ, Boulton AM: Bisphosphonates: A new treatment for diabetic Charcot neuroarthropathy? Diabetic Medicine 11:28-31, 1994.
6. Fabrin J. et al. Long-term flow-up in diabetic Charcot feet with spontaneous onset. Diabetes Care 23(6):796-800, 2000.
7. Pinzur MS, et al. A treatment algorithm for neuropathy (Charcot) midfoot deformity. Foot & Ankle 14(4):189-197, 1993.
8. Brodsky JW, Rouse AM. Exostectomy for symptomatic bony prominences in diabetic Charcot feet. Clinical Orthopaedics 296:21-26, 1993.
9. Simon SR, et al. Arthrodesis as an early alternative to nonoperative management of Charcot arthropathy of the diabetic foot. JBJS 82-A(7):939-944, 2000.
10. Wang JC, Le AW, Tsukuda RK. A new technique for Charcot's foot reconstruction. JAPMA 92(8):429-436, 2002.
11. Sticha RS, Frascone ST, Wertheimer SJ: Major arthrodesis in patients with neuropathic arthropathy. JFAS 35(6):560-566, 1996.
12. Grady JF, et al: Use of electrostimulation in the treatment of diabetic neuroarthropathy. JAPMA 90(6):287-294, 2000.
Additional Reference
13. Sims DS, Cavanagh PR, Ulbrecht JS. Risk factors in the diabetic foot. Physical Therapy 68(12):1887-1902, 1988.












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