The Charcot Foot. Brian J Burgess, DPM, AACFAS Hinsdale Orthopaedic Assoc. Midwest Podiatry Conference April 19, 2013

Size: px

Start display at page:

Download "The Charcot Foot. Brian J Burgess, DPM, AACFAS Hinsdale Orthopaedic Assoc. Midwest Podiatry Conference April 19, 2013"

Cecily Young
5 years ago
Views:

1 The Charcot Foot Brian J Burgess, DPM, AACFAS Hinsdale Orthopaedic Assoc. Midwest Podiatry Conference April 19, 2013

2 Brian J Burgess, DPM, AACFAS Associate of Hinsdale Orthopaedics. Doctor of Podiatric Medicine. Board Qualified by the American Board of Podiatric Surgeons (ABPS). Foot Surgery. Rearfoot Reconstruction and Ankle Surgery.

3 Topics Introduction Etiology Charcot Process Pathology Treatment Cases Take home points

4 Introduction Neuropathic form of arthropathy that leads to Bone destruction Fragmentation Dislocation Joint collapse. Foot deformity that is at high risk for ulceration and limb loss.

5 Etiology Anything that causes peripheral neuropathy. DIABETES Alcoholism Leprosy Syphilis Syringomyelia Spinal cord lesions Others

6 Charcot Process

7 53 yo DM female. Charcot Process initial presentation HgA1C was nd metatarsal stress fracture. NWB.

8 2 nd metatarsal stress fractures

9 Charcot Process

10 Charcot Process

11 Charcot Process

12 Charcot Process

13 Charcot Process

14 Midfoot Charcot. Most common site. 40% of cases. Can be triggered by minor trauma. Charcot Process

15 Charcot Process

21 Pathogenesis Neurovascular vs. Neurotraumatic Theories. Combination of sensorimotor deficits, microtrauma, osteopenia, hyperemia and joint instability that results in Charcot.

25 Charcot Process Destruction of afferent nerve fibers. Unrecognized trauma to joints. Severe degenerative changes, osteophyte formation, subchondral fractures, and calcification in surrounding tissues.

26 Common Findings DM duration 10+ years. Unilateral. No sex predilection. DM Type 1 and 2. Poor glycemic control. Peripheral neuropathy.

$Initiating Events Trauma (fractures) Minor$

27 Initiating Events Trauma (fractures) Minor trauma (sprains) Increased activity. Local surgery.

28 Diagnosis High index of suspicion. Neuropathic patient with a red, hot and swollen foot/ankle. Pain despite neuropathy. Rule out other possibilities (OM) Temperature measurements. 10 degrees higher than contralateral foot.

29 Differential Diagnosis Cellulitis Elevated CRP and ESR. Gout Elevated uric acid or positive fluid analysis. DVT Positive venous duplex. Osteomyelitis Presence of an ulcer. Bone biopsy.

30 Treatment Goal is to prevent joint collapse, amputation, maintain ambulation and keep/make the patient braceable. Immobilization and NWB. Total contact casting.

31 Conservative Treatment Immobilization Bracing (CAM, CROW, AFO) Total Contact Casting Jones Compression Custom Molded Shoes Wound Management

32 Surgical Treatment Exostectomies Rotational Skin Flaps Tendon Transfers Achilles Tendon Lengthening Arthrodesis: Internal vs. External Amputation

33 Case Presentation

34 72 yo DM/RA female. Internal Fixation initial presentation 2 year history of instability and pain. Neuropathic. Failed conservative treatment and bracing.

36 Tibio-talo-calcaneal (TTC) Arthrodesis.

37 Internal Fixation eight weeks post-op

38 Combined Internal and External Fixation

45 High Index of Suspicion A DM patient with neuropathic who presents with a warm, red and swollen foot is Charcot until proven otherwise.

46 Take Home Points Early diagnosis and treatment is key. Debilitating condition. Immobilization is generally effective. Surgical treatment is individualized to each patient. Importance of post-op expectations and glucose control.

47 References External fixation in the management of Charcot neuroarthropathy. G.P. Jolly DPM, T. Zgonis DPM, V. Polyzois MD. WBS Clinics in Podiatric Medicine and Surgery. Vol Midtarsal Arthrodesis in the Treatment of Charcot Midfoot Arthropathy. V.J. Sammarco, G.J. Sammarco, E.W. Walker, Jr., R.P. Guiao. The Journal of Bone and Joint Surgery. Vol Charcot foot reconstruction with combined internal and external fixation: case report. C.M. Ca[pbianco, C.L. Ramanujam, T. Zgonis. Journal of Orthopaedic Surgery and Research. 5: A Closer Look at Fixation Options for the Charcot Foot. J. Giurini DPM. Podiatry Today. Vool. 18, Issue 11. November Is External Fixation Overutilized in Managing Charcot in the Diabetic Foot? G. Liu DPM. Podiatry Today. Vol. 21, Issue 2. February 2008.

48 THANK YOU! Brian J Burgess, DPM, AACFAS brian.burgess@hoasc.com

Charcot Arthropathy of the Foot & Ankle. MTAPA Annual Meeting June 2018 Emily Harnden, MD

Charcot Arthropathy of the Foot & Ankle MTAPA Annual Meeting June 2018 Emily Harnden, MD Background Disclosures None Learning Objectives Define the disease Recognize presenting signs/symptoms for proper