Charcot Neuroarthropathy of the Foot and Ankle

J Am Acad Orthop Surg, Vol 17, No 9, September 2009 Alexander van der Ven, MD, MBA, Cary B. Chapman, MD and John H. Bowker, MD

Charcot neuroarthropathy is a common cause of morbidity in persons with diabetes mellitus and sensory neuropathy. Although Charcot neuroarthropathy is rare, it likely will become more prevalent in conjunction with increased incidence of diabetes mellitus. Prevention of disease progression remains the mainstay of treatment, with surgical intervention usually reserved for refractory cases. Late deformities are often complicated by chronic ulceration, infection, and osteomyelitis. The clinical presentation is best summarized with the Eichenholtz classification, and progression often follows a predictable pattern. Although Charcot neuroarthropathy is a clinical diagnosis, recent advances in diagnostic imaging have eased the clinical challenge of deciphering infection from Charcot changes. Advances in surgical treatment have demonstrated new options for limb salvage. Pharmacologic therapies directed toward decreasing bone resorption have also shown promise for treatment, but clinical application remains theoretical.