Charcot joint; Charcot foot; Charcot arthropathy

Introduction

A severe form of osteoarthritis (joint degeneration) from loss of pain sensation &/or proprioception.

Etiology

• diabetes mellitus
• tabes dorsalis (syphilis)
• syringomyelia
• meningomyelocele
• leprosy
• congenital indifference to pain
• frequent, repeated corticosteroid injections

Pathology

• repeated trauma to joint
• progressive cartilage damage
• resorption (demineralization) of tarsals, metatarsals & phalanges in diabetics
• demineralization leads to fracture, subluxation, & dislocation
• bony overgrowth
• synovial effusion

Clinical manifestations

• relatively painless
  • painless swelling of the foot & lower leg
  • pain suggests neuropathy
• severe deformity
  • Charcot foot unlikely if foot not structurally abnormal
  • foot may not yet be deformed in early stage
  • collapsed arch pes planus in later stage
  • appearance of a rocker bottom plantar foot in chronic phase
• joint instability
• hypermobility of joint
• crepitus
• skin temperature may be higher on affected side
• no erythema
• loose bodies may be palpated in joint cavity
• generally begins in a single joint & extends to involve other joints
• may evolve rapidly to totally disorganized joint in weeks to months
• distribution of joint involvement
  • diabetes mellitus
    • tarsal & tarsometatarsal joints
  • syringomyelia
    • glenohumeral, elbow, wrist
  • tabes dorsalis
    • knees, hips, ankles

Laboratory

• synovial fluid is generally non-inflammatory

Radiology

• typical features of osteoarthritis early in the disease
• marked joint destruction & hypertrophic changes occur as disease progresses
• large, bizarre osteophytes
• intra-articular bone fragments
• osteopenia
• may be difficult to distinguish from osteomyelitis
  • sharp cortical margins in Charcot's disease
  • bone margins less distinct in osteomyelitis Compllications:
    • often the first outward evidence is formation of a pressure injury over a new plantar prominence
    • pressure injury complicates diagnosis & management because of a potential for soft tissue infection, skin infection or osteomyelitis

Management

• non-weight-bearing for 8 weeks (Charcot's foot in a diabetic)
• shoe care
• pain control
• surgery

More general terms

• osteoarthritis (OA)
• neurogenic arthritis (neurogenic arthropathy)

Additional terms

• Charcot, J.M.