Cases reported "Diabetic Neuropathies"

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1/9. 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.
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ranking = 1
keywords = osteoarthropathy
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2/9. Erythromelia, or Mitchell's syndrome--new names for unexplained signs of inflammation in distal symmetrical neuropathy in diabetes.

    BACKGROUND: Two cases are described in which distal symmetrical sensorimotor neuropathy complicating diabetes was associated with episodes of subacute vasodilation of one or other lower limb, and which were otherwise unexplained. The vasodilation was associated with swelling and stiffness, but was painless and self-limiting. INTERPRETATION: It is suggested that this phenomenon results from disordered vasoregulation in diabetic neuropathy, and is linked to the processes which underlie diabetic neuropathic osteoarthropathy (Charcot foot), as well as disorders such as complex regional pain syndrome-1 (CRPS-1, reflex sympathetic dystrophy) and erythromelalgia. CONCLUSIONS: As self-limiting vasodilation may be not uncommon in distal symmetrical neuropathies, but unrecognized because the phenomenon has not been named, the terms 'neuropathic erythromelia' or 'Mitchell's syndrome' are proposed. The adoption of either of these names may lead to earlier diagnosis and prevent inappropriate investigation and treatment.
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ranking = 0.14285714285714
keywords = osteoarthropathy
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3/9. 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.
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ranking = 0.57142857142857
keywords = osteoarthropathy
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4/9. 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.
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ranking = 0.14285714285714
keywords = osteoarthropathy
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5/9. 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.
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ranking = 0.85714285714286
keywords = osteoarthropathy
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6/9. 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.
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ranking = 0.71428571428571
keywords = osteoarthropathy
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7/9. Neuro-osteoarthropathy (Charcot's joint) in diabetes mellitus following revascularization surgery. Three case reports and a review of the literature.

    The initial primary defect in the development of neuro-osteoarthropathy is neuropathy. Our case reports and a review of the literature strongly implicate a neurally initiated vascular reflex leading to increased blood flow. This may play a pivotal role in the development of Charcot's joint in the neuropathic limb. Mechanical trauma in an insensitive foot is contributory, but it is probably a secondary mechanism.
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ranking = 0.71428571428571
keywords = osteoarthropathy
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8/9. Radiologic case study. Neuropathic osteoarthropathy.

    Diabetic osteoarthropathy is the most common neuropathic condition seen clinically in the foot. It can develop rapidly with a time course of weeks to months. Soft tissue swelling and erythema with deformity are noted clinically, usually with decreased pain sensation. However, it is important to realize that these patients frequently do have pain; it may only be disproportionate to the degree of injury. Radiographic diagnosis can predate clinical suspicion and is based on recognizing the resorptive and the productive patterns of the osteoarthropathy. Often, the first clue is recognizing the radiographic features of joint instability. Remembering that overt trauma may precipitate neuropathic osteoarthropathy will also help its recognition in the follow up of fractures.
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ranking = 1
keywords = osteoarthropathy
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9/9. Subtalar and talonavicular joint dislocation as a presentation of diabetic neuropathic arthropathy with salvage by triple arthrodesis.

    Ligamentous laxity is a common component of diabetic neuropathic osteoarthropathy. In some cases soft tissue instability leads to spontaneous dislocations or subluxations without any bone destruction. This leads to marked instability in gait and chronic ulcerations. A case report is presented in which talonavicular and subtalar joint dislocation occurred with Charcot osteoarthropathy. The conservative and surgical management including salvage by triple arthrodesis is discussed with follow-up care.
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ranking = 0.28571428571429
keywords = osteoarthropathy
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