Neuroarthropathy (neurogenic arthropathy, Charcot joint) is a painless and constantly increasing degeneration of a single or multiple joints, most often feet, resulting from damage to the innervation. It most often develops after many years of diabetes. It can also be caused by diseases such as tertiary syphilis, leprosy, syringomyelia, Addison-Biermer anemia, multiple sclerosis and many others.

Neuroarthropathy(neurogenic arthropathy, Charcot joint, Charcot foot) is most often located unilaterally in the ankle, metatarsal and metatarsophalangeal joints. It occurs in 1 in 500 people with diabetes. It occurs regardless of age and affects both men and women equally.

Initial changes in the joints result from damage to the nerve fibers, which may be manifested by disturbances in the area of ​​pain sensation, deep sensation and sympathetic activity. For this reason, the range of motion in the joints becomes excessive and is not protected by feeling them. Additionally, external injuries can have a negative effect, causing the joint capsule and ligaments to stretch and degenerate. There are subluxations that the patient does not feel.

  • Arthropathies - types, causes, symptoms, treatment

Over time, improperly positioned articular surfaces transfer abnormal vectors of frictional forces, pressure and stress to the adjacent bone parts, which leads to articular cartilage fibrosis, their breakdown and osteolysis. Active hyperemia (aseptic inflammatory reaction) appears, which stimulates the resorption of damaged bone and previously normal bone. As a result, the development of osteoporosis and the associated complications - bone fractures, their infection and amputation.

Charcot's Pond: Symptoms

The initial period of the disease is the period of destruction, in which degenerative changes, subluxations, damage to the articular cartilages and the appearance of their debris in the joint cavity occur. The biopsy of the joint capsule in this period shows its fibrosis, thickening, and the fragments are embedded with small fragments of detached bones.

The second period is characterized by the resorption of small bone fragments and mergingpreviously formed larger bone fragments. The last period of the disease is the period of reconstruction - revascularization takes place and the healing process takes place along with the formation of a new, abnormal joint.

Common symptoms in diabetic neuropathy-related foot include:

  • maintaining a relatively good nutritional status of tissues
  • presence of pulses on the dorsal arteries of the foot and the posterior tibial artery
  • reduction or no sense of touch, temperature, pain, vibration
  • no tendon reflexes in the lower limbs
  • formation of hammer toes and high arch of the foot vault
  • calluses in the foot support points
  • joint deformity
  • drooping feet in severe cases
  • symptoms overlap with the symptoms of infection, ulceration and osteitis mentioned above

It is worth bearing in mind that in diabetic patients with neuroarthropathy, metatarsophalangeal joints are particularly affected.

Neuroarthropathy: diagnosis

The reason for the patient's visit to the doctor is usually a little painful swelling of the joint. It is possible that additional symptoms of infection may coexist, e.g. neuropathic ulceration of the sole of the feet.

Radiographic examination shows degenerative, destructive changes. Their type depends on the period of the disease development. Initially, there are signs of damage to the articular surfaces, subluxation, subperiosteal sclerosis and marginal eruptions. In the second period, radiographs show complete destruction, osteolysis and resorption of entire segments of bones and members of the fingers or metatarsus, aseptic necrophages, osteoporosis and osteosclerosis foci. In the last stage, the damaged bone is rebuilt.

Neurogenic arthropathy: differentiation

The disease is differentiated from generalized inflammatory diseases (rheumatoid arthritis, visceral lupus, scleroderma, mixed collagenoses), spondyloarthropathies, metabolic, degenerative, infectious arthropathies and articular rheumatic lesions.

Charcot's foot: prevention, treatment, prognosis

Early diagnosis of arthropathy protects the foot from injuries. Lying in bed to relieve the foot reduces bone destruction and facilitates its regeneration. In more severe lesions, where the bone has been damaged and broken, it is recommended to put on a light plaster cast to relieve the foot. This is possible after the swelling of the joint and any possible infection have healed.

It should be remembered that a plaster dressing in a patient with impaired sensation can easily causeulcers. The correct way to put it on, proper placement of the bandage and gauze under the plaster, as well as constant control prevent this undesirable effect. After improvement, the patient may start to walk on crutches - a plaster dressing adapted to walking is put on.

After the lesions have stabilized, it is recommended to use individually shaped leather, elastic shoes with an appropriate sponge insert.

The prognosis in Charcot's pond depends on the extent of the destructive changes that occurred in the first period. If the disease is diagnosed early enough, and the foot is relieved by bed rest and protected against other injuries, the chances of stable bone fusion and spontaneous reconstruction increase.

Category:

Spine, bones, joints