Neuropathic osteoarthropathy
| Neuropathic joint disease | |
|---|---|
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| A 68-year-old diabetic female on dialysis presented with a chronic right heel ulcer (3.4 cm X 3.1 cm) of greater than 3 months duration. Photograph of the wound after thorough wound bed preparation over the course of 2 weeks. | |
| Classification and external resources | |
| Specialty | rheumatology |
| ICD-10 | M14.6 |
| ICD-9-CM | 713.5 |
| DiseasesDB | 2344 |
| eMedicine | orthoped/381 radio/476, article/1234293 |
Neuropathic arthropathy (or neuropathic osteoarthropathy), also known as Charcot joint (often "Charcot foot"), refers to progressive degeneration of a weight bearing joint, a process marked by bony destruction, bone resorption, and eventual deformity. Onset is usually insidious.
If this pathological process continues unchecked, it can result in joint deformity, ulceration and/or superinfection, loss of function, and in the worst-case scenario, amputation or death. Early identification of joint changes is the best way to limit morbidity.
Any condition resulting in decreased peripheral sensation, proprioception, and fine motor control:
In reality, both of these mechanisms probably play a role in the development of a Charcot joint.
Diabetes is the foremost cause in America today for neuropathic joint disease, and the foot is the most affected region. In those with foot deformity, approximately 60% are in the tarsometatarsal joints (medial joints affected more than lateral), 30% Metatarsophalangeal joints and 10% have ankle disease. Over half of diabetic patients with neuropathic joints can recall some kind of precipitating trauma, usually minor.
Patients with neurosyphilis tend to have knee involvement, and patients with syringomyelia of the spinal cord may demonstrate shoulder deformity.
Hip joint destruction is also seen in neuropathic patients.
The clinical presentation varies depending on the stage of the disease from mild swelling to severe swelling and moderate deformity. Inflammation, erythema, pain and increased skin temperature (3–7 degrees Celsius) around the joint may be noticeable on examination. X-rays may reveal bone resorption and degenerative changes in the joint. These findings in the presence of intact skin and loss of protective sensation are pathognomonic of acute Charcot arthropathy.
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