11/28. [Charcot foot treated by correction and arthrodesis of the hindfoot]THE PROBLEM: First patient: neuropathic osteoarthropathy with severely deformed foot, plantar ulceration and recurrent purulent infections. Second patient: diabetic osteoarthropathy with pathologic fracture. CLINICAL FINDINGS: First patient: 50-year-old man with hereditary sensory and motor neuropathy, plantar ulceration, equinus of the hindfoot, and extensive destruction of all bones of the foot. Recurrent infections necessitated repeated surgical interventions during the last 7 years. At the time of admission purulent infection of the foot. Healing after debridement including a resection of metatarsal bones and part of sequestrated bones of the foot. Patient was left with a severe equinus of the hindfoot. TREATMENT OPTIONS: Orthopedic shoes with or without below-knee orthesis. Lengthening of the achilles tendon and plantar alignment of the calcaneus. arthrodesis of the hindfoot. Below-knee amputation, if necessary as a primary procedure to combat infection. THE SOLUTION: arthrodesis of the hindfoot after realignment; an amputation of the foot was refused. SURGICAL TECHNIQUE: Two-stage procedure: treatment of infection followed by astragalectomy and tibiocalcaneal arthrodesis achieved with cancellous lag screws. Bridging of the area of resection with a segment of the fibula. RESULT: Bony fusion and full load bearing in an orthopedic shoe after 3 months. recurrence of ulcerations after 20 and 27 months due to wear of ill-fitting shoes. The accompanying purulent process forced the authors to resort to a below-knee amputation and fitting of a prosthesis. Second patient: of this patient only radiographs with a retrograde introduced intramedullary nail are shown.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
12/28. Charcot foot osteoarthropathy in diabetes mellitus.Charcot joint, a destructive bone and joint disorder of the foot, is becoming more common in long-term diabetic patients. The combination of diabetic neuropathy and painless trauma causes dislocation and collapse of the tarsal joints. The resulting soft tissue and osseous pathology easily mimics an infective episode. This report presents a review of the clinical identification, diagnosis, and treatment of this unusual diabetic complication, plus a review of three cases. Also, the pathogenesis of Charcot joint is explained in describing why surgery can be a viable treatment alternative in these patients, after careful evaluation. It is also necessary that physicians inspect the feet of their diabetic patients to rule out quiescent beginnings of Charcot joints. Referral to a podiatrist is recommended for long-term management of the Charcot foot.- - - - - - - - - - ranking = 4keywords = diabetic (Clic here for more details about this article) |
13/28. Rapidly progressive Charcot arthropathy following minor joint trauma in patients with diabetic neuropathy.Neuropathic (Charcot) arthropathy is a slowly progressive, chronic, destructive form of joint degeneration seen in patients with a neurosensory deficit. Attempts to produce neuropathic joint disease experimentally with a variety of deafferentation procedures have generally been unsuccessful. However, if the knee is rendered unstable by anterior cruciate ligament transection (ACLT), breakdown of the joint occurs rapidly in dogs that have previously undergone dorsal root ganglionectomy (DRG) for deafferentation of the ipsilateral limb. In contrast, ACLT in neurologically intact dogs produces not only nonprogressive changes that are characteristic of mild osteoarthritis. This report describes 3 patients with longstanding insulin-dependent diabetes mellitus in whom neuropathic arthropathy developed within weeks after minor trauma to the foot or ankle. In these patients, diabetic neuropathy served as the functional equivalent of dorsal root ganglionectomy, and the minor trauma served as the functional equivalent of ACLT. Together, they illustrate the phenomenon of neurogenic acceleration of joint degeneration in humans.- - - - - - - - - - ranking = 5keywords = diabetic (Clic here for more details about this article) |
14/28. The diabetic foot with synovial cyst.Diabetic lower extremity infections, frequently polymicrobial, are at times fascinating though frustrating for the practitioner to treat. The classical triad of neuropathy, infection, and angiopathy is the hallmark of diabetic foot pathology. One of the main forms demonstrating the severe long-term neuropathic disease is called osteoarthropathy or Charcot joint. This is usually relatively painless, always progressive, and frequently destructive. It generally attacks the midtarsal joint and eventually changes the entire architecture of the foot, causing the so-called "rocker bottom" foot type. We present a case of a severely destructive Charcot foot that caused a large synovial cyst because of its vast underlying osseous pathology. The morbidity and mortality of these infections can be minimized by understanding the unique challenges these individuals offer the practitioner.- - - - - - - - - - ranking = 5keywords = diabetic (Clic here for more details about this article) |
15/28. Combined leukocyte and bone imaging used to evaluate diabetic osteoarthropathy and osteomyelitis.Six diabetic patients with roentgenographic finding of osteomyelitis, osteoarthropathy, or both, had combined leukocyte and bone imaging. Bone images demonstrated increased activity in all cases, including three without osteomyelitis. Leukocyte images, however, showed increased activity in only the three cases of osteomyelitis. There was minimal or no activity in the other three cases where osteoarthropathy was ultimately believed to be the basis of the roentgenographic and bone imaging changes.- - - - - - - - - - ranking = 5keywords = diabetic (Clic here for more details about this article) |
16/28. The neuropathic joint in diabetes mellitus.This article discusses the development and treatment of Charcot's joints in patients with diabetic peripheral neuropathy. Historical and clinical reviews are presented, as are case illustrations. This article provides the practitioner with a comprehensive review of diagnosis and treatment of this clinical entity.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
17/28. Imaging for infection: caution required with the Charcot joint.Scintigraphic techniques for detecting bone infection can be misleading in neuroarthropathy (Charcot joint). Three patients showed strongly positive three phase bone and 67Ga imaging despite absence of osteitis. indium labelled white cell imaging provided the correct information on each patient. The findings have important implications for the investigation of diabetic patients with suspected bone infection.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
18/28. Diabetic neuro-osteoarthropathy. rehabilitation of a patient with both ankle joints involved and associated skin problems.Neuro-osteoarthropathy in diabetes mellitus is not rare. The case of a 53-year-old diabetic with involvement of both ankle joints and multiple associated skin problems complicating rehabilitation management is discussed. By applying a team approach, closely monitoring the patient's skin and joint problems, and treating them at an early stage by adaptive shoes and orthoses, we found that function could be sustained at an optimal level for a prolonged period. In addition to prevention of ulceration, modifying the weight bearing or temporarily non-weight bearing is the treatment of choice. amputation is to be considered only as a last resort.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
19/28. Diabetic arthropathy of the first metatarsal cuneiform joint. Introduction of a new surgical fusion technique.This paper describes the surgical treatment of advanced arthropathy of the first metatarsal cuneiform joint in the diabetic patient. A new surgical procedure is described as performed on a 59-year-old black diabetic woman with advanced arthropathy of the first metatarsal cuneiform joint. A brief review of diabetic arthropathy is presented, with special emphasis on the first metatarsal cuneiform joint involvement. The authors believe that with early diagnosis and surgical fusion, the process of rapid tarsal disintegration can be prevented.- - - - - - - - - - ranking = 3keywords = diabetic (Clic here for more details about this article) |
20/28. Diabetic Charcot spine as cauda equina syndrome: an unusual presentation.Some 6% to 21% of Charcot joints occur in the spine. The underlying disease is usually tabes dorsalis, but diabetes mellitus is another etiology. Degeneration of spinal elements is accelerated and lumbar spinal stenosis with weakness may occur, as has been reported in tabetic arthropathy. The case presented is unusual in two respects: first, the Charcot spine was secondary to diabetic complications, which resulted in a compressive cauda equina syndrome; second, the patient presented with progressive paraparesis and bowel and bladder dysfunction but physical examination by several examiners revealed no clinically evident sensory abnormality. The patient had vague and inconsistent sensory complaints for several years preceding definitive workup, but the overall picture of his disease process only could be made following multiple laboratory, electrodiagnostic, microbiologic, and radiologic testing. The patient presented with subacute paraparesis, providing a wide differential diagnosis ranging from guillain-barre syndrome to spinal neoplasm. The physical, radiologic, laboratory, electrophysiologic, histologic/pathologic findings, treatment, and recovery status are included in this report.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
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