# Charcot Charcot Charcot is a condition in which patients develop a neuropathic destruction of the joints. It is often described as painless but - - - (b) Figure 41.12 Charcot foot: radiographs taken at the time of a trivial injury (a) and 6 weeks later (b) . Figure 41.13 Diabetic foot ulcer. world diabetes is the biggest cause but in the rest of the world leprosy is also important. However, any other neurological condition can cause this disease. Charcot often presents with a hot, swollen, red extremity . It is often misdiagnosed as cellulitis, gout, fracture or DVT , and many present late because of the di ffi culty in diagnosis. If there is no history of skin damage, infection is unlikely , but MRI and e ven biopsy can help di ff erentiate between infec tion and Charcot. From initiation through to bone consolida tion ma y take up to 18 months. The principle of treatment throughout is to maintain a foot-shaped foot to prevent late pressure ulcers. The acute Charcot foot requires appr opriate splintage in a Charcot retaining orthotic walker (CROW) or a total contact cast (TCC), but many surgeons o ff er an aggres sive early surgical approach if bony prominence/ulceration is thought to be inevitable. Surgical excision of a bony pr nence dramatically reduces ulceration and amputation risk and reconstruction in the early phases of Charcot is now becoming more mainstream, but surgical risks are high. Long-segment fixation with implants and intramedullary nailing is now r ularly undertaken. Failure of non-operative or operative treat ment results in ulceration and amputation. Summary box 41.9 Diabetes /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF Any nerve supplying the foot can become entrapped and result in pain, and treatment often requires surgical decom - pression. Tarsal tunnel syndrome is much rarer than carpal tunnel syndrome and is confirmed with nerve conduction. A high proportion of patients retain neurology and pain despite release. - - Patients with diabetes are prone to infection because of: Peripheral neuropathy Peripheral vascular disease Impaired resistance to infection A Charcot foot is often misdiagnosed but is a surgical emergency and requires urgent admission and management An ulcer in a diabetic foot is a surgical emergency and requires urgent admission and management Charcot Charcot is a condition in which patients develop a neuropathic destruction of the joints. It is often described as painless but - - - (b) Figure 41.12 Charcot foot: radiographs taken at the time of a trivial injury (a) and 6 weeks later (b) . Figure 41.13 Diabetic foot ulcer. world diabetes is the biggest cause but in the rest of the world leprosy is also important. However, any other neurological condition can cause this disease. Charcot often presents with a hot, swollen, red extremity . It is often misdiagnosed as cellulitis, gout, fracture or DVT , and many present late because of the di ffi culty in diagnosis. If there is no history of skin damage, infection is unlikely , but MRI and e ven biopsy can help di ff erentiate between infec tion and Charcot. From initiation through to bone consolida tion ma y take up to 18 months. The principle of treatment throughout is to maintain a foot-shaped foot to prevent late pressure ulcers. The acute Charcot foot requires appr opriate splintage in a Charcot retaining orthotic walker (CROW) or a total contact cast (TCC), but many surgeons o ff er an aggres sive early surgical approach if bony prominence/ulceration is thought to be inevitable. Surgical excision of a bony pr nence dramatically reduces ulceration and amputation risk and reconstruction in the early phases of Charcot is now becoming more mainstream, but surgical risks are high. Long-segment fixation with implants and intramedullary nailing is now r ularly undertaken. Failure of non-operative or operative treat ment results in ulceration and amputation. Summary box 41.9 Diabetes /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF Any nerve supplying the foot can become entrapped and result in pain, and treatment often requires surgical decom - pression. Tarsal tunnel syndrome is much rarer than carpal tunnel syndrome and is confirmed with nerve conduction. A high proportion of patients retain neurology and pain despite release. - - Patients with diabetes are prone to infection because of: Peripheral neuropathy Peripheral vascular disease Impaired resistance to infection A Charcot foot is often misdiagnosed but is a surgical emergency and requires urgent admission and management An ulcer in a diabetic foot is a surgical emergency and requires urgent admission and management Charcot Charcot is a condition in which patients develop a neuropathic destruction of the joints. It is often described as painless but - - - (b) Figure 41.12 Charcot foot: radiographs taken at the time of a trivial injury (a) and 6 weeks later (b) . Figure 41.13 Diabetic foot ulcer. world diabetes is the biggest cause but in the rest of the world leprosy is also important. However, any other neurological condition can cause this disease. Charcot often presents with a hot, swollen, red extremity . It is often misdiagnosed as cellulitis, gout, fracture or DVT , and many present late because of the di ffi culty in diagnosis. If there is no history of skin damage, infection is unlikely , but MRI and e ven biopsy can help di ff erentiate between infec tion and Charcot. From initiation through to bone consolida tion ma y take up to 18 months. The principle of treatment throughout is to maintain a foot-shaped foot to prevent late pressure ulcers. The acute Charcot foot requires appr opriate splintage in a Charcot retaining orthotic walker (CROW) or a total contact cast (TCC), but many surgeons o ff er an aggres sive early surgical approach if bony prominence/ulceration is thought to be inevitable. Surgical excision of a bony pr nence dramatically reduces ulceration and amputation risk and reconstruction in the early phases of Charcot is now becoming more mainstream, but surgical risks are high. Long-segment fixation with implants and intramedullary nailing is now r ularly undertaken. Failure of non-operative or operative treat ment results in ulceration and amputation. Summary box 41.9 Diabetes /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF Any nerve supplying the foot can become entrapped and result in pain, and treatment often requires surgical decom - pression. Tarsal tunnel syndrome is much rarer than carpal tunnel syndrome and is confirmed with nerve conduction. A high proportion of patients retain neurology and pain despite release. - - Patients with diabetes are prone to infection because of: Peripheral neuropathy Peripheral vascular disease Impaired resistance to infection A Charcot foot is often misdiagnosed but is a surgical emergency and requires urgent admission and management An ulcer in a diabetic foot is a surgical emergency and requires urgent admission and management