This document provides information about Charcot disease (neuropathic osteoarthropathy). It begins with a brief history, noting early descriptions by Musgrave and Charcot. Charcot disease is defined as a non-infective, destructive process affecting bones and joints caused by neuropathy. Risk factors include diabetes, alcoholism, and other conditions causing neuropathy. Clinical presentation varies from swelling in acute cases to structural deformities in chronic cases. Management involves immobilization, bracing, surgery such as fusion or osteotomy to correct deformities, and sometimes amputation for severe cases. Complications can include fractures, deformities, ulcers, and infection.

1. Welcome to short note
presentation
Charcot disease
Dr. Ram kishor goit
Phase-B, Resident
ORTHOPAEDIC SURGERY

2. HISTORY
• In 1703 William Musgrave first described a neuropathic joint
as an arthralgia caused by venereal disease
• In 1868 Jean-Martin Charcot gave the first detailed
description of the neuropathic aspect. He noted this disease
process as a complication of syphilis (most common cause
until 1936 when Jordan linked it to Diabetes)

3. DEFINITION
• Neuropathic (Charcot) osteoarthropathy is a non infective, destructive,
lesion of a bone and joint resulting from a fracture or dislocation or
both in a patient who has peripheral neuropathy.
• A chronic and progressive joint disease following loss of protective
sensation and leads to destruction of joints and surrounding bony
structures. May lead to amputation if left untreated.

4. Also known as,
 Charcot arthropathy
 Charcot foot
 Neuropathic arthropathy
 Neuropathic joints
 Neuropathic osteoarthropathy

5. RISK FACTORS
 Diabetic neuropathy
 Alcoholism
 Leprosy
 Meningomyelocele
 Tabes dorsalis/syphilis
 Syringomyelia
 Any condition that causes sensory or autonomic neuropathy

6. EPIDEMIOLOGY
 In diabetic patients: 0.1-1.4%
 In diabetics with neuropathy 7.5%
 Bilateral disease occurs in <10%
 Type 1 DM: 20-25 years post diagnosis
 Type 2 DM: 5-10 years post diagnosis
 Gender : Male predominance

7. PATHOPHYSIOLOGY
Neurotraumatic theory: German theory 1946.
Peripheral neuropathy  loss of protective sensation 
increase susceptibility to injuries (repeated minor or acute)
 progressive destruction and damage to bone and joints.
Neurovascular theory: French theory 1868.
Spinal cord lesion  autonomic neuropathy  AV shunting
 increased blood flow (warm foot and dilated veins)  Increased
osteoclast activity  bone resorption and mechanical weakening 
fractures and deformity

8. Symptoms
• Swelling foot and ankle
• Pain 50%
• Loss of function
Acute Charcot
• Swelling
• Warmth (3.3° warmer)
• Erythema (will decrease with Charcot but not with infection on elevation)
Chronic Charcot
• Structurally deformed foot
• Rocker bottom deformity
• Collapsed medial arch
CLINICAL PRESENTATION

9. CLINICAL PRESENTATION
Acute Charcot
 Swelling
 Warmth
 Erythema
Chronic Charcot
• Structurally deformed foot
• Rocker bottom deformity
• Collapsed medial arc

10. • Stage 0: Joint oedema. Negative radiographs
• Stage 1: Fragmentation. Joint oedema. Bone resorption.
Dislocations. Fractures
Stage

11. Stage conti…..
• Stage 2: Decreased local oedema , Sclerosis , Fracture healing
Debris resorption , Decreased joint mobility.
• Stage 3: Reconstruction. No joint oedema ,Consolidation and
remodelling of fracture fragments. Ulcers may develop.

12. Investigation
• X-ray : considerable disruption of the joint. early disease, the picture
will resemble osteoarthritis.
• CT scan
• MRI: differentiate between abscess and soft tissue swelling
• Radionucleotide imaging : To differentiate soft tissue infection from
osteomyelitis.
• Indium WBC scan : Negative in Charcot. Positive in
osteomyelitis
• CBC,RBS,CRP
• HbA1C
• Biopsy: to guide antibiotic therapy
• Histology: Synovial hypertrophy and detritic synovitis

13. MANAGEMENT
General measures
 Counselling about disease
 Improve nutrition
 Optimize co-morbidity
 Rest
 Immobilization by cast
 Care of ulcer.
Non-Surgical:
 Protective splint
 walking brace
 orthosis or cast
Pharmacological :
 Bisphosphonates may be help to heal the bones.

14. Conti….
Surgical:
 Early stages may be treated with open reduction and internal fixation
and fusion.
 In the later stages, surgical options may include :
 Realignment osteotomy and fusion (correction of deformity) or
ostectomy (removal of bony prominence that could cause an ulcer)
 arthrodesis +/- osteotomy
• Severe deformity that is not braceable
 Amputation
• Failed surgery. Unstable arthrodesis. Recurrent infection.

15. Complications
 Fractures
 Collapse of the midfoot arch (called rocker bottom
foot)
 Deformities of the foot and ankle
 Ulcers
 Non-union
 “floppy foot”( gross instability )
 Infection
 Soft tissue infection or osteomyelitis may occur.

16. THANK YOU