Neuropathic arthropathy

Neuropathic arthropathy (also known as Charcot neuroarthropathy or diabetic arthropathy) refers to a progressive fragmentation of bones and joints in the presence of neuropathy. It can occur in any joint where denervation is present, although it most frequently presents in the foot and ankle. It follows an episodic pattern of early inflammation followed by periarticular destruction, bony coalescence, and finally bony remodeling.  This can lead to considerable deformity and morbidity, including limb instability, ulceration, infection, and amputation.

The diagnosis of Charcot neuroarthropathy is made clinically and should be considered whenever a patient presents with warmth and swelling around a joint in the presence of neuropathy. Although counterintuitive, pain is present in many cases despite the neuropathy. Some sort of trauma or microtrauma is thought to initiate the cycle but often patients will not remember because of numbness. Misdiagnosis is common.

The goal of treatment is to avoid ulceration, create joint stability, and to maintain a plantigrade foot. Early recognition, patient education, and protection of joints through various offloading methods is important in treating this disorder. Surgery can be considered in cases of advanced joint destruction.