1/28. Acute Charcot foot changes versus osteomyelitis: does Tc-99m HMPAO labeled leukocytes scan differentiate?osteomyelitis often complicates a diabetic neuropathic foot, leading to amputation, decreased function, and quality of life. Therefore, early detection and treatment are paramount. Furthermore, neuroarthropathic (Charcot) changes in the foot often resemble infection and must be differentiated. Currently, the Tc-99m HMPAO Labeled leukocytes Scan is considered to be the most reliable noninvasive imaging modality of choice in determining Charcot foot changes versus osteomyelitis. The purpose of this article is to alert the clinician that although the Tc-99m HMPAO Labeled leukocytes Scan may be the second most reliable test next to bone biopsy for determining osteomyelitis, false positives do occur.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
2/28. Avascular necrosis not Charcot's.BACKGROUND: A case of avascular necrosis (AN) of the navicular bone, in a 24-year-old woman with Type 1 diabetes with peripheral neuropathy, in the absence of any history of direct trauma is presented. The clinical and radiological features at presentation suggested an evolving Charcot arthropathy (CA), but subsequent serial x-rays clearly confirmed AN. CONCLUSIONS: Swelling and foot deformity in association with long-standing diabetic peripheral neuropathy is suggestive of CA, although AN, a less common condition, may show the same clinical features. It is therefore important to undertake further confirmatory radiological investigations if there is any doubt about the diagnosis.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
3/28. Evaluation and treatment of stage 0 Charcot's neuroarthropathy of the foot and ankle.Charcot's neuroarthropathy is a relatively common disease in patients with diabetic neuropathy. If unrecognized or left untreated, Charcot's neuroarthropathy can result in a severely misshapen and unstable foot and ankle. Ulceration, soft-tissue infection, and osteomyelitis frequently ensue, and partial or complete amputation of the foot is not uncommon. A high index of suspicion and proper interpretation of clinical and diagnostic findings are essential to establish a timely and accurate diagnosis and to institute appropriate treatment. The pathogenesis of neuroarthropathy is reviewed and diagnosis and treatment of the stage 0 diabetic Charcot foot are presented.- - - - - - - - - - ranking = 2keywords = diabetic (Clic here for more details about this article) |
4/28. Neuropathic osteoarthropathy in the diabetic foot.OBJECTIVE: To discuss a case involving a 55-year-old diabetic woman with neuropathic osteoarthropathy initiated by a fall. CLINICAL FEATURES: The patient fell into a hole, injuring her left foot. Because of the anesthesia associated with her diabetic peripheral neuropathy, she did not notice the ensuing plantar puncture wound. The patient assumed that her swelling was a result of a sprain. Mild dislocation and osseous fragmentation was noted within the midfoot on radiographs. The neuropathic osteoarthropathy progressed until the patient was later casted. Plain films taken at the time of cast removal demonstrated resorption and consolidation of fragmentation, but the dislocation was unaltered. INTERVENTION AND OUTCOME: The patient was scheduled for surgery and wound debridement. However, before surgery, complications of a burn sustained on the contralateral foot required fifth ray amputation. Surgery of the left foot has been postponed until adequate postsurgical healing has occurred at the right foot amputation site. CONCLUSION: This article provides tools for the timely diagnosis and treatment of neuropathic osteoarthropathy. An increased understanding of this entity will help lead to a reduction in the incidence of delayed treatment resulting from misdiagnosis.- - - - - - - - - - ranking = 6keywords = diabetic (Clic here for more details about this article) |
5/28. Application of external fixators for management of Charcot deformities of the foot and ankle.external fixators have been used effectively for a variety of traumatic, congenital, and neuromuscular conditions of the lower extremity for many decades. The transition to management of Charcot foot and ankle deformities in the diabetic neuropathic patient is a logical application. External fixation can address the unique challenges in the Charcot foot, including osteoporosis, osteomyelitis, wound healing, and compliance issues. The author's experience has lead to abandoning other methods of fixation in favor of external fixation for most infected and noninfected Charcot deformities of the foot and ankle.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
6/28. Charcot's joint: an overlooked diagnosis.Charcot's joint, also known as neuropathic osteoarthropathy, is a common complication of diabetes that often is unrecognized and misdiagnosed. It may be present in up to 35% of patients with diabetic neuropathy. This disorder causes progressive destruction of weight bearing joints leading to dislocations, fractures, and deformities. We report a case of Charcot's joint in a 55-year-old man with type two diabetes. He presented with unilateral foot and ankle swelling, foot pain, warmth, and erythema. A magnetic resonance image of his foot revealed changes consistent with a Charcot's joint. Treatment consisted of joint immobilization in a total contact cast and then an ankle foot orthosis with custom footware. Charcot's joint should be considered in patients with a unilateral, warm, erythematous, swollen foot without other systemic symptoms. Early recognition of a Charcot's joint is important in ultimate outcome. immobilization of the joint, patient education, and proper footcare and footware are essential in preventing further complications including ulceration and amputation.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
7/28. Neuropathic arthropathy of the digit: a case report.We present the case of a 60-year-old diabetic man who developed neuropathic arthropathy in the distal interphalangeal joint of the small finger. Neuropathic arthropathy is uncommon in the upper extremity, and only 2 cases of this condition occurring in the joints of the hand have been reported. The clinical presentation, diagnosis, and treatment options are discussed.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
8/28. Diabetic neuroarthropathy (Charcot joints): the importance of recognizing chronic sensory deficits in the treatment of acute foot and ankle fractures in diabetic patients.patients with diabetic neuropathy are at a higher risk of developing complications, especially Charcot arthropathy. early diagnosis and intervention is the key to optimizing outcome. Therefore, diabetic patients with a lower extremity injury should be screened with sensory testing using a 5.07 monofilament.- - - - - - - - - - ranking = 6keywords = diabetic (Clic here for more details about this article) |
9/28. Talectomy for diabetic Charcot foot. An alternative to amputation.A talectomy was performed because of Charcot degeneration during recovery from a hallux amputation. The patient was treated conservatively but Charcot degeneration continued, resulting in ulceration and dorsomedial dislocation of the talar head. The patient was hospitalized, and the talectomy was performed. The patient returned to normal activities.- - - - - - - - - - ranking = 4keywords = diabetic (Clic here for more details about this article) |
10/28. The utilization of autologous growth factors for the facilitation of fusion in complex neuropathic fractures in the diabetic population.A review of current knowledge of autologous growth factors as used in foot and ankle surgery is presented. This knowledge is clinically correlated with 50 Charcot's foot reconstruction patients who had diabetes and who were randomized to a platelet-rich plasma (PRP) concentration system (Symphony, DePuy, Warsaw, indiana) or a hollow-fiber hemoconcentration system (Interpore Cross AGF, Interpore Cross, Irvine, california) trial. Although the literature supports the notion that Symphony produces a higher yield of intact platelets more consistently, clinically, a statistically significantly higher number of patients treated with Interpore Cross AGF went on to solid fusion. The findings may indicate that one type of PRP may be indicated for a particular clinical circumstance based on the patient's medical history and resultant local wound environment.- - - - - - - - - - ranking = 4keywords = diabetic (Clic here for more details about this article) |
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