Charcot foot

2,981 views

Published on

0 Comments
10 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
2,981
On SlideShare
0
From Embeds
0
Number of Embeds
1,321
Actions
Shares
0
Downloads
178
Comments
0
Likes
10
Embeds 0
No embeds

No notes for slide

Charcot foot

  1. 1. NEUROPATHIC (CHARCOT )FOOT
  2. 2. Blood supply t  Arterial: ◦ Posterior tibial and dorsalis pedis supply the foot  Venous: ◦ Deep veins follow the arteries ◦ Superficial veins arise from dorsal venous arch
  3. 3. Nerve supply The foot is supplied by the (1) tibial, (2) deep peroneal, (3) superficial peroneal, (4)sural, and (5)saphenous
  4. 4. CHARCOT FOOT Named after Jean-Martin Charcot (1868) Charcot noted this disease process as a complication of syphillis In 1936, Charcot foot was found to be related to diabetic patients Pathophysiology: Neurotraumatic theory Neurovascular theoryNeurotraumatic theory: Unperceive trauma to insensate foot. Pt unaware of osseous destruction occur during ambulation Micro trauma leads to progressive destruction to bones and joints Neurovascular theory: Autonomic neuropathy causing extremities to receive increased bloodflow Results in mismatch in bone destruction and synthesis, leading to osteopenia
  5. 5. THE FOLLOWING ARE THE PRINCIPLE PREDISPOSING DISEASES: DIABETES SYRINGOMYELIA LEPROSY TABES DORSALIS
  6. 6. Physical 9 Physical Findings & Investigations
  7. 7. Physical 10 Physical Findings & Investigations
  8. 8. Presentation: Vary from mild swelling and no deformity to moderate deformity with significant swelling Always presents with signs of inflammation: warmth, joint effusion, erythema, bone resorption Pain occurs in > 75% of patients Instability and loss of joint function; “bags of loose bones” Amputation Risk (Usually BKA) Type 100 person-year Charcot alone 4.1 Ulcer alone 4.7 Charcot + Ulcer Up to 12 times
  9. 9. Classification Many types Based on anatomic involvement Brodsky and Rouse system
  10. 10. Schön Classification Type Pattern 1 Lisfranc (60%) 2 Cuneonavicular 3 Perinavicular (3a ankle joint, 3b posterior calcaneous) 4 Transverse tarsal (multiple joint) 5 Forefoot
  11. 11. MANAGEMENT Conservative Surgery ACUTE PHASE POST-ACUTE PHASE
  12. 12. Acute phase: Immobilization: e.g. Total contact cast (3-6 months) Reduction of stress Ideally non-weight bear PWB with crutches Post-acute phase: Patient education and foot care Consider brace e.g. Charcot restraint orthotic walker Total healing typically takes 1-2 years
  13. 13. Surgical therapy: Based on location of disease, surgeon preferences and experience with Charcot arthropathy Surgical procedure include exostosectomy of bony prominence, osteotomy, arthrodesis, screw and plate fixation, ORIF, reconstructive surgery, fusion with Achilles tendon lengthening, autologous bone grafting and amputation.
  14. 14. Location Surgery Ankle with displaced # ORIF Tibiotalar destruction Arthrodesis Avascular necrosis of talus Talectomy with tibiocalcaneal fusion Hindfoot Arthrodesis Midfoot Correction of rocker-bottom deformity and osteotomies for bony prominence Hindfoot/ankle equinus contracture Posterior release/Achilles tendon leengthening Forefoot Resection arthroplasty or cheilectomy
  15. 15. DIABETIC FOOT
  16. 16. The Diabetic Foot may be defined as a group of syndromes in which neuropathy, ischaemia, and infection lead to tissue breakdown resulting in morbidity and possible amputation ( WHO 1995 )
  17. 17. Peripheral Neuropathy Sensory Motor Autonomic
  18. 18. Precipitating Factors Trauma puncture/thermal/stress/footwear
  19. 19. MANAGEMENT
  20. 20. Thank you

×