Neuropathic arthropathy

Neuropathic arthropathy (also known as Charcot neuroarthropathy or diabetic arthropathy), refers to a progressive fragmentation of bones and joints in the presence of neuropathy. It can occur in any joint where denervation is present, although it most frequently presents in the foot and ankle (Charcot's foot, the term was coined by Ralph H. Major in 1928). Charcot's foot develops from an unnoticed trivial bone injury, which will extend with continuing load bearing and, hence, progessing reactive inflammation. This process can be halted (while neuropathy continues) by appropriate unloading, preferably before any significant joint damage has occurred. If not, joint coalescence, stiffness and deformity will result, associated with severely impaired foot function. Such a ruined foot will cause considerable morbidity and mortality due to ulceration, infection and amputation.

The diagnosis of Charcot neuroarthropathy should be considered whenever a patient presents with warmth and swelling around a joint in the presence of neuropathy with impaired nociception. Although counterintuitive, deep dull pain may be present upon load bearing in many cases despite the neuropathy. Some sort of trauma or microtrauma is thought to initiate the cycle but often patients will not remember because of numbness. Misdiagnosis is common.

The goal of treatment is to avoid foot deformity, ulceration, create joint stability, and to maintain a plantigrade foot. Early recognition, patient education, and protection of joints through various offloading methods is important in treating this disorder. Corrective surgery can be considered in cases of advanced joint destruction.