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Background of Charcot Foot:DFAN/one step:"In 1868 a French neurologist, Charcot, noticed a bizarre pattern of bone destruction in some of his patients. This destruction was occurring with no apparent pain. By 1966 Charcot's disease was reported among diabetic patients, as well as others. Today it is found most often among diabetic patients. Charcot Foot (Charcot Joint, Charcot Fracture) is a foot condition that affects people with diabetes. It is a serious condition since the diabetic can lose some of the feeling in their feet due to neuropathy and literally crush their own joints."
http://pages.prodigy.com/dfan/charcot1.htm

The Charcot Foot: of diabetic arthropathy:Podiatry online:"Charcot's original description of neurogenic arthropathy in 1869 was limited to patients with syphilis. Since that time, conditions other than syphilis have been found to cause a "Charcot's joint." To date over twenty-four different diseases have been demonstrated to develop this condition. Today diabetes mellitus is the leading etiology for the development of a Charcot joint. The process is characterized by pathologic fractures with an exuberant repair mechanism and is associated with mixed peripheral neuropathies. The common denominator in these various conditions is that motor function is not as severely affected as are sensory modalities in the patient"
http://www.footdoc.com/footman/ribotsky.html

The Charcot Foot in Diabetes: Six Key Points:American Academy of Family Physicians:"The Charcot foot commonly goes unrecognized, particularly in the acute phase, until severe complications occur. Early recognition and diagnosis, immediate immobilization and a lifelong program of preventive care can minimize the morbidity associated with this potentially devastating complication of diabetic neuropathy. If unrecognized or improperly managed, the Charcot foot can have disastrous consequences, including amputation. The acute Charcot foot is usually painless and may mimic cellulitis or deep venous thrombosis. Although the initial radiograph may be normal, making diagnosis difficult, immediate detection and immobilization of the foot are essential in the management of the Charcot foot. A lifelong program of patient education, protective footwear and routine foot care is required to prevent complications such as foot ulceration."
http://www.aafp.org/afp/980600ap/caputo.html

Charcot Foot: The Diagnostic Dilemma:American Academy of Family Physicians:"Primary care physicians involved in the management of patients with diabetes are likely to encounter the diagnostic and treatment challenges of pedal neuropathic joint disease, also known as Charcot foot. The acute Charcot foot is characterized by erythema, edema and elevated temperature of the foot that can clinically mimic cellulitis or gout. Plain film radiographic findings can be normal in the acute phase of Charcot foot. A diagnosis of Charcot syndrome should be considered in any neuropathic patient, even those with a minor increase of heat and swelling of the foot or ankle, especially after any injury."
http://www.aafp.org/afp/20011101/1591.html

MANAGEMENT OF DIABETIC CHARCOT ARTHROPATHY:doctorbret.com:"The Charcot foot in the diabetic patient is a progressive condition that is not confined to bones but affects all of the tissues in the lower extremity. It is often confused with osteomyelitis and massive infection of the foot necessitating early identification and management to prevent amputation of the lower extremity. With the advent of advanced surgical techniques and a better understanding, the physician may be optimistic with the treatment of this condition. By thoroughly understanding the etiologic factors and deforming forces, treatment can be planned for each specific patient. The etiology of Charcot joints has been argued by many authors."
http://www.doctorbret.com/charcot.htm

Symptoms of Charcot foot:podiatrychannel:"While peripheral neuropathy develops over decades, the progression of Charcot foot (ligament tears, small fractures, subluxation, dislocation, deformity) can occur in a matter of weeks or months. A minor trauma, such as twisting the foot, can initiate the process. Increased bone resorption makes the joints in the foot susceptible to small fractures. Because of the loss of pain perception and the loss of the sense of position of the foot, joints receive repeated injuries, such as torn ligaments and bone fractures."
http://www.podiatrychannel.com/charcotfoot/

The Charcot Foot-Management:celos.psu.edu:"The Charcot foot is treated by eliminating any weight on the foot. This sometimes means strict bed rest or very strict use of crutches (remember there is insufficient pain to tell you when you are stepping on the foot and each step makes matters worse). Many physicians instead prescribe a special walking cast (a total contact cast) that relieves weight bearing on the foot."
http://www.celos.psu.edu/dfc/patients_module2.html

CARING FOR YOUR FEET/Charcot Foot:ourfootdoctor:"Symptoms & Treatments: The acute, or early symptoms of Charcot Foot are: small fractures of the bones of the foot, swelling over these areas, and later the entire foot may become swollen and inflammed. There is little, if any pain during this stage. Treatment during this stage is imperative, and includes: complete rest of the foot by using a non-weightbearing cast, crutches, and bed rest. If treatment is not initiated, this disease progresses to its chronic stage. During this stage the following symptoms may be present: a foot which is deformed, and noticebly different then the other foot; a collapsed arch; bones which abnormally protrude against the skin, possibly causing the skin to breakdown and ulcerate; swelling and inflammation of the foot; and there may be no pain present, or in some patients the pain is intense, due to the amount of bone and joint destruction present. Treatment during this stage involves non-weightbearing casts until the swelling subsides, physical therapy, and custom-made shoes and orthotics."
http://www.ourfootdoctor.com/yourfeet_charcot.shtml

Charcot foot (Neuropathic osteoarthopathy):gentili.net:"Secondary signs of osteomyelitis should be searched for on both conventional radiographs and MR images. These include the following: Ulcer formation at new pressure points. The medial aspect of the navicular bone and the inferior aspect of the cuboid bone frequently become new areas of pressure as the foot collapses. Inappropriate fitting shoes will wear at these areas and cause skin breakdown. Sinus tract formation may extend from the ulcer deep into the soft tissues. Focal bone destruction adjacent to ulcers and sinus tracts. Large joint fluid collections. MR imaging helps to localize larger fluid collections which can then be aspirated for laboratory analysis."
http://www.gentili.net/diabeticfoot/charcot.htm

Charcot's Arthropathy - The swollen foot:diabetes.usyd.edu.au:"What is it and why is it important ? Charcot's arthropathy is a complication of diabetic neuropathy. Due to the neuropathy, the bones in the foot become weakened and fractured without major trauma. As the patient notices little pain (a result of the neuropathy), he/she continues to walk on it. This leads to severe deformities of the foot, intractable ulceration, culminating in the need for amputation. It is therefore most important to make the diagnosis early at the acute phase of Charcot's arthropathy because appropriate treatment at this stage can minimise deformities and reduce associated morbidity."
http://www.diabetes.usyd.edu.au/foot/Charcot1.html



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Last updated by Andrew Lopez, RN on Wednesday, September 29, 2010


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