A Closer Look At Redefining Charcot

By Molly Judge, DPM

   For foot and ankle specialists, the diagnosis and complete management of neuropathic arthropathy ranks among the most daunting challenges. Currently, one makes the clinical diagnosis when there is a compilation of clinical and radiographic findings suspicious for the condition. The diagnosis relies upon the histopathology to identify the neuropathic joint destruction.    Once one makes a diagnosis, either definitively or clinically, the treatment approach remains the discretion of the physician. Those best trained for treating this condition rely on the literature completed by some of the world’s most renowned authorities in the fields of diabetes research and foot and ankle surgery.1 Although there are numerous articles on managing the condition, many are case reports and isolated accounts of individual experience.2 The traditional academic approach considers the etiology of Charcot neuroarthropathy, possible triggers of the disease process and focuses on arresting the acute, destructive phase of this condition.    While there are numerous conditions that lend themselves to the development of neuroarthropathy, the prevailing thinking is there are at least two essential components that incite neuropathic joint destruction: a significant sensory nerve deficit (somatic and autonomic); and trauma (trivial or otherwise).3

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