Charcot osteoarthropathy is a progressive deterioration of weight-bearing joints caused by neuropathy. It most commonly affects the feet and ankles of diabetic patients. Treatment involves immobilization with casting in early stages to prevent fractures and deformity. Later stages may require surgical fusion of affected joints. Arthrodesis fuses bones to stabilize severe deformities and relieve pain, though it limits ankle motion and increases stress on other joints. Multiple techniques exist including internal fixation with screws or plates. Bone grafting aids fusion while bracing post-surgery protects new bone formation.
Ankle and Foot Injuries for Athletes - Dr. Andre Ross - Livingston Library, 9...Summit Health
SMG Podiatric Surgeon, Dr. Andre Ross, presented Ankle and Foot Injuries for Athletes at Livingston Public Library. Foot and Ankle injuries make up roughly 25% of sports related injuries. Dr. Ross recommends seeking fast medical attention for these injuries before they result in a more serious conditions. It can make the difference between an early return to sport with full function vs. long term disability.
SPORTS INJURIES OF ANKLE AND FOOT original.pptxMeghaPrakash9
sports injuries of ankle and foot is a seminar done by Ms. Megha ck on behalf of completing her master of physiotherapy program during the year 2020-2022
Ankle and Foot Injuries for Athletes - Dr. Andre Ross - Livingston Library, 9...Summit Health
SMG Podiatric Surgeon, Dr. Andre Ross, presented Ankle and Foot Injuries for Athletes at Livingston Public Library. Foot and Ankle injuries make up roughly 25% of sports related injuries. Dr. Ross recommends seeking fast medical attention for these injuries before they result in a more serious conditions. It can make the difference between an early return to sport with full function vs. long term disability.
SPORTS INJURIES OF ANKLE AND FOOT original.pptxMeghaPrakash9
sports injuries of ankle and foot is a seminar done by Ms. Megha ck on behalf of completing her master of physiotherapy program during the year 2020-2022
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
3. Interoduction
• Charcot neuropathy is a progressive deterioration of weight-
bearing joints, usually in the foot or ankle.
• Historically, neuropathy of the knee was most frequently
caused by syphilis, and neuropathy of the shoulder was usually
caused by syringomyelia.
4. • Today, the Charcot foot occurs most often in patients with
diabetic neuropathy; other predisposing conditions include
alcoholic neuropathy, cerebral palsy and congenital
insensitivity to pain.
• The first description of neuroarthropathy occurring with
diabetes mellitus was published in 1936.
6. Pathogenesis
• Two theories:
Neurotraumatic
• Attributes bony destruction to the loss of pain sensation and
proprioception combined with repetitive and mechanical
trauma to the foot.
Neurovascular
• suggests that joint destruction is secondary to an
autonomically stimulated vascular reflex that causes
hyperemia and periarticular osteopenia with contributory
trauma.
7. Pathogenesis
Intrinsic muscle imbalance can produce eccentric loading of
the foot, propagating microfractures, ligament laxity and
progression to bony destruction.
In DM, the cause is high concentrations of glucose with
altered osmolarity.
Micro vascular damage can also occur.
Associated with increased risk of ulceration.
Skin integrity becomes abnormal due to neuropathy.
8. Epidemiology
• Neuropathic arthropathy is prevalent in 0.8 to
7.5 percent of diabetic patients with
neuropathy.
• 9 to 35 percent of these affected patients
have bilateral involvement.
• Most of those patients have uncontrolled DM
for 15 to 20 years.
9. Epidemiology
• The (Lisfranc’s) joint is the most common site
for arthropathy.
• Initial involvement usually occure on the
medial column of the foot.
• Distribution:
– 70% at the midfoot.
– 15% at forefoot or rearfoot.
10. Learning Point
Charcot osteo-arthropathy must occur in the presence of
a neuropathy. It rarely occurs in the presence of arterial
insufficiency as high blood flow is required for osseous
resorbtion.
Charcot ankle is considered the worst among the other
Charcot because the difficulty to control the instability.
11. Classification
• Neuropathic arthropathy is
either atrophic or
hypertrophic.
• Atrophic:
localized to the forefoot
and causes osteolysis of
the distal metatarsals. The
metatarsal heads and
shafts have a radiographic
deformity that resembles
a pencil point or “sucked
candycane”.
12. • Hypertrophic:
usually occurs at the midfoot, rearfoot or ankle, and is
traditionally defined according to the Eichenholtz
classification system.
13. • STAGE 1
The first stage is the developmental, or fragmentation, stage (acute
Charcot)
• Associated with: periarticular fracture and joint dislocation
leading to an unstable, deformed foot
14. Charcot Foot: Stage I
[Fragmentation]
• Initial presentation = hot,
swollen, painless foot! Early
radiographs negative!
• No fever, malaise; normal
WBC!
• Patient usually walks into
clinic
• Hyperemia precedes bony
destruction
15. • STAGE 2 “coalescence stage “
Patients in the (subacute Charcot) present with
resorption of bone debris.
• STAGE 3 “consolidation stage”
Reparative, stage (chronic Charcot) is associated
with re-stabilization of the foot with fusion of the
involved fragments . This leads to the return of a
stable, although deformed, foot.
18. Diagnosis
• 50 percent of patients with Charcot foot remember a
precipitating, minor traumatic event.
• Diabetic patients with neuropathy, erythema, edema,
increased temperature of the foot and normal radiographs
most likely has an acute Charcot process.
• Role out INFECTION!!!
19. Diagnosis
• Brodsky method!
• Decreased sensation light touch or vibration
Semmes-Weinstein 10-g monofilament wire.
• Decreased or absent
sensation in 4 out of 10
is an abnormal test.
20.
21. • If a neuropathic ulcer is present, it is graded using
the Wagner classification:
• Grade Description
1 Superficial diabetic ulcer
2 Ulcer extension to ligament, tendon, joint capsule or
deep fascia without abscess or osteomyelitis
3 Deep ulcer with abscess or osteomyelitis
4 Gangrene to portion of forefoot
5 Extensive
22. Treatment
• Stage 1:
• Immediate weight
bearing
protection!
Severe/bilateral =
bed rest!
Wheelchair
mobility!
Crutch walking [if
good balance]!
Total Contact
Casting [TCC]
23. • Goal: Prevent multiple
fractures of foot/ankle!
• TCC changed q 1-2 wks
• Unweighting for 2-3
months, or until
symptoms resolve and
radiographs show bony
stability
24.
25. Charcot Foot: Stage II
[Coalescence]
• Maintain external foot
contours while bone
Reconstitutes.
• Controlled weight
bearing believed to
facilitate healing.
• Wean from TCC to AFO
• Custom shoe, if foot is
deformed
26. Charcot Foot: Stage III
• Consider surgical
intervention
• Arthrodesis for
severe deformities
• Exostectomy for
local prominences
with recurrent
ulceration
27. FURTHER TREATMENTS
• Alternative:
C.R.O.W or PTB
• Preferred when
control of coronal
plane ankle
instability is needed
• Usually after
erythema and
swelling subside
28. • TOTAL CONTACT CASTING:
– The gold standard of treatment when pt are picked
early.
– Most cases can be treated by pressure-relieving
methods.
– Serial x ray every 6 weeks
• conversion to a Charcot restraint
orthotic walker (CROW) after the
active phase of the condition
is complete
29. • PREFABRICATED PNEUMATIC WALKING BRACE:
• An alternative to TCC, which decrease forefoot and
midfoot plantar pressure in the treatment of
neuropathic plantar ulceration.
• Benefits include:
• easier wound surveillance, ease of application and the
ability to use several types of dressings.
Use of the PPWB is limited in patients who have
severe foot deformity or who are noncompliant.
31. • SURGICAL TREATMENT:
– Exostosectomy:
• Stable chronic charcot
– Arthrodesis:
• Unstable or joint with subluxation.
32. Arthrodesis
• AIM:
To provide a solid, painfree fusion of the ankle in
the optimum position.
Minimise risk of complications.
33. Pre Operative
• Vascular study.
• Previous scars.
• Medical history, diabetes, smoker.
• XRs
• ? arthritis of subtalar jts or midfoot
• Increased movement in remaining joints in foot
34. Results
• 80-90% fusion rates
• Most patients satisfied with pain relief
• Hindfoot motion limited – uneven ground difficult
• Most can wear normal shoes
• Rocker bottom shoe may help gait
• Gait velocity slowed 16%
• 3% increase oxygen consumption
• Shortened stride length
• Increase ER at hip
37. Optimum Position
• The foot should be externally rotated 20 to 30
degrees relative to the tibia, with the ankle
joint in neutral flexion (0 degrees)
• 5 to 10 degrees of external rotation, and slight
valgus (5 degrees).
• Neutral to slight posterior displacement of
talus under tibia (minimise midfoot loading)
• Match to normal side
38. Surgery
• General or regional
• supine
• Antibiotics
• Prep for bone graft, sandbag under buttock
• +/- tourniquet
• Drape above knee (for alignment)
39. Surgical Techniques
• As a general rule, External fixators are preferred
for patients undergoing arthrodesis for a
preexisting septic joint and for those with severe
osteopenia.
• Arthroscopic arthrodesis or the “miniopen”
arthrodesis should be used only for patients with
minimal deformity.
• Open arthrodesis is appropriate for patients with
significant ankle deformity and foot and ankle
malalignment.
40. Approaches to Ankle
• Anterior
• Transmalleolar (transfibular) +/- medial
”utilitarian” approach
• Posterior behind fibular, hinged
• calcaneal osteotomy or TA divided if done for
tibio-talar-calcaneal fusion
• Mini-incision (Myerson)
• Arthroscopic
43. TRANSMALLEOLAR
(Mann)
• Incision 10cm above the
tip of fibula to base 4th MT
• Full thickness skin flaps
• Subperiosteal dissection
fibula and and tibia
44. • Oblique fibula osteotomy
2cm above joint
• Fibula removed (+/- as
graft)
• Distal tibia and talar neck
exposed
• Distal tibia cut – 2mm
• Talar cut 3-4mm
• Avoid excess bone
removal – loss of height
45. • Resect articular surface
medial malleolus (may
require medial incision)
• Position, temporary
Kwires
• 2 screws – sinus tarsi to
medial tibia, lat talus to
medial tibia
• Transcortical screws
46. • Practically, most of the cases with Charcot
ankle have severely deformed talus.
• Most of them need Pan talar arthrodesis.
47. Post OP
• Routine closure
• POP slabs initially
• Below knee POP & NWB 6-8weeks
• Then WB in cast further 6-8weeks
48. Screw fixation
• 6.5 – 7mm cancellous
screws
• +/- cannulated
• 2 or 3 – ( 3 screws stronger
than 2 in testing)
• Anterior, medial and central
placement
• Posterior “home-run” screw
, (inside-out technique)
49. Tibiotalocalcaneal arthrodesis
• Angled blade-plate:
Posterior approach
Prone position.
Achilles tendon is osteotomized at its insertion
into the calcaneus.
Curetting and Bone grafting
95 degree blade plate placed posteriorly
Achilles tendon is reattached.
51. Tibiocalcaneal Arthrodesis with
Intramedullary Nailing
• Medial and lateral skin
incisions.
• Body of the talus removed,
and fixation of the head
and neck of the talus to
the anterior tibia
• Posterior approach used
for wide exposure.
52.
53. Calandruccio device
• I & II
• Triplanar – more
control
• 2 pins in talus, 2 in
tibia
• Series II more
versatile and allows
XR of arthrodesis
site
54. Arthroscopic
• Entire articular surfaces denuded using shavers, burrs,
currettes ,etc
• Cannulated screws placment
• Good results:
• ? quicker union time
• Less morbidity / recovery time
• Union rates comparable to open
• Takes longer
• More difficult
55. Bone graft
• Some reports
indicate faster and
higher union rates
• Adaptable to
different situations,
esp with bone loss
• Iliac crest or fibula/
tibia
56. Long term
• Coester et al –JBJS am 2001(mean 22 yr FU on
post traumatic OA arthrodesis)
Increased risk of arthritis in subtalar and midfoot
areas
No increased risk of knee OA
57. Foot Arthrodesis
• Mostly for Lisfranc’s
joint.
• Two dorsal insicion
medial and lateral.
• Fixation with screws or
LP plates.
• Most of the cases will
need BG.
• Long time needed till
complete healing
58. Summary
• Charcot osteo-arthropathy is a potentially
catastrophic complication of neuropathy.
• However it most commonly presents in the foot and
ankle in the diabetic population.
• Early recognition and prevention of deformity make a
lot of difference.
• Arthrodesis is meant for unstable severely deformed
and painful ankle.