Podcast
Questions and Answers
What is the role of the pro-inflammatory cells in patients with DNOAP (diabetic charcot foot)?
What is the role of the pro-inflammatory cells in patients with DNOAP (diabetic charcot foot)?
Mediator of osteoclastic resorption
What is the slow to rapidly progressive, non-infectious destruction of one or more bones and/or joints that is associated with neuropathy?
What is the slow to rapidly progressive, non-infectious destruction of one or more bones and/or joints that is associated with neuropathy?
Charcot arthropathies
Early charcot joint will have a __________ ROM while over time, after about 8 weeks a charcot joint will have a ________ ROM.
Early charcot joint will have a __________ ROM while over time, after about 8 weeks a charcot joint will have a ________ ROM.
Increased; Decreased
What are the two types of charcot arthropathies?
What are the two types of charcot arthropathies?
Diabetes is the only condition that can lead to charcot joint changes.
Diabetes is the only condition that can lead to charcot joint changes.
If an individual with Charcot has an ulcer, their life expectancy is ____________.
If an individual with Charcot has an ulcer, their life expectancy is ____________.
DNOAP (diabetic neuro-osteopathy) is more commonly bilateral in what patients?
DNOAP (diabetic neuro-osteopathy) is more commonly bilateral in what patients?
What are the 2 theories of how an individual develops Charcot?
What are the 2 theories of how an individual develops Charcot?
What is the modern theory that was not previously theorized to cause charcot?
What is the modern theory that was not previously theorized to cause charcot?
When proinflammatory cytokines are released, what does it do to the bone?
When proinflammatory cytokines are released, what does it do to the bone?
What is the name of the signaling system that regulates the osteoclastic activation and survival in normal bone remodeling?
What is the name of the signaling system that regulates the osteoclastic activation and survival in normal bone remodeling?
What is the name of the factor that protects the skeleton from excessive bone resorption?
What is the name of the factor that protects the skeleton from excessive bone resorption?
RANKL-mediated osteoclastic resorption is the modus operandi in infection mediated resorption.
RANKL-mediated osteoclastic resorption is the modus operandi in infection mediated resorption.
When the OPG/RANKL signaling pathway causes an increased expression of bone matrix proteins in vascular smooth muscle cells, what does this cause?
When the OPG/RANKL signaling pathway causes an increased expression of bone matrix proteins in vascular smooth muscle cells, what does this cause?
Pain is the common complaint that brings individuals in that are suffering from charcot changes.
Pain is the common complaint that brings individuals in that are suffering from charcot changes.
If an individual has a severely painful charcot foot what is this suggestive of?
If an individual has a severely painful charcot foot what is this suggestive of?
What are the clinical symptoms of a charcot foot?
What are the clinical symptoms of a charcot foot?
When looking at the Sanders-Frykeberg classification where is the most common pedal target of the charcot joint?
When looking at the Sanders-Frykeberg classification where is the most common pedal target of the charcot joint?
According to Sanders-Frykberg classification, what is the anatomic pattern type 1?
According to Sanders-Frykberg classification, what is the anatomic pattern type 1?
When looking at the IP joints in an individual with Sanders-Frykberg classification type 1 pattern, what are you most likely to see?
When looking at the IP joints in an individual with Sanders-Frykberg classification type 1 pattern, what are you most likely to see?
In the Sanders-Frykeberg classification pattern 1, radiographically we will see ___________ changes.
In the Sanders-Frykeberg classification pattern 1, radiographically we will see ___________ changes.
What is the Sanders-Frykberg classification type 2?
What is the Sanders-Frykberg classification type 2?
What are some frequent findings of an individual with a Sanders-Frykberg classification type 2 anatomic pattern?
What are some frequent findings of an individual with a Sanders-Frykberg classification type 2 anatomic pattern?
What is Sanders-Frykberg classification type III?
What is Sanders-Frykberg classification type III?
What is Sanders-Frykberg classification type IV?
What is Sanders-Frykberg classification type IV?
What is Sanders-Frykberg classification type V?
What is Sanders-Frykberg classification type V?
What is type 1 of the Brodsky classification?
What is type 1 of the Brodsky classification?
What is the most common type joint deformity that is seen with the Brodsky classification?
What is the most common type joint deformity that is seen with the Brodsky classification?
Type 1 of the Brodsky classification rarely results in chronic instability.
Type 1 of the Brodsky classification rarely results in chronic instability.
Brodsky classification type 2 has what joints involved?
Brodsky classification type 2 has what joints involved?
Type 2 of the Brodsky classification rarely results in chronic instability.
Type 2 of the Brodsky classification rarely results in chronic instability.
What joints are involved in type 3a Brodsky classification?
What joints are involved in type 3a Brodsky classification?
Type 3a of the Brodsky classification requires the longest time for bony healing.
Type 3a of the Brodsky classification requires the longest time for bony healing.
What portion of the foot is involved in an individual with a type 3b Brodsky classification?
What portion of the foot is involved in an individual with a type 3b Brodsky classification?
When there is inflammatory soft tissue swelling and severe subluxation with marked new bone formation in the midfoot on an x-ray, what condition might this indicate?
When there is inflammatory soft tissue swelling and severe subluxation with marked new bone formation in the midfoot on an x-ray, what condition might this indicate?
What are the 5 Ds of the charcot foot?
What are the 5 Ds of the charcot foot?
What are the major differences between post traumatic OA and Charcot?
What are the major differences between post traumatic OA and Charcot?
Any patient with diabetes that presents with a hot swollen foot, what should you think?
Any patient with diabetes that presents with a hot swollen foot, what should you think?
When looking at the Eichenholtz classification, what are the progressive radiographic stages that are seen?
When looking at the Eichenholtz classification, what are the progressive radiographic stages that are seen?
What is the primary radiographic finding of the Eichenholtz classification stage 1 'development' classification?
What is the primary radiographic finding of the Eichenholtz classification stage 1 'development' classification?
In the developmental stage I of Eichenholtz classification the ROM is ____________.
In the developmental stage I of Eichenholtz classification the ROM is ____________.
Clinically, an individual in stage 1 of the Eichenholtz classification will present with what?
Clinically, an individual in stage 1 of the Eichenholtz classification will present with what?
Subchondral osteopenia is an acute phase finding.
Subchondral osteopenia is an acute phase finding.
Stage 2 of the Eichenholtz Classification is what?
Stage 2 of the Eichenholtz Classification is what?
What occurs in the coalescence stage, stage 2 of Eichenholtz Classification?
What occurs in the coalescence stage, stage 2 of Eichenholtz Classification?
In what stage of Eichenholtz Classification do we see an increase in sclerosis?
In what stage of Eichenholtz Classification do we see an increase in sclerosis?
In Eichenholtz Classification stage 2, there is a loss of vascularity from fragmentation and disorganization which results in what?
In Eichenholtz Classification stage 2, there is a loss of vascularity from fragmentation and disorganization which results in what?
What is the radiographic hallmark of Stage 2 Coalescence stage Eichenholtz Classification?
What is the radiographic hallmark of Stage 2 Coalescence stage Eichenholtz Classification?
What is stage 3 of the Eichenholtz Classification?
What is stage 3 of the Eichenholtz Classification?
In which stage of Eichenholtz Classification would you find a decreased ROM of the foot?
In which stage of Eichenholtz Classification would you find a decreased ROM of the foot?
What do we see occurring in stage 3 of Eichenholtz Classification?
What do we see occurring in stage 3 of Eichenholtz Classification?
What are the signs of healing?
What are the signs of healing?
What is stage zero Charcot also known as?
What is stage zero Charcot also known as?
What are the radiographic findings of an individual with stage 0 Charcot?
What are the radiographic findings of an individual with stage 0 Charcot?
Individuals that are termed to be at stage zero are said to be an _____________ patient.
Individuals that are termed to be at stage zero are said to be an _____________ patient.
When is it critically important to make the diagnosis of Charcot before the destruction and collapse occurs?
When is it critically important to make the diagnosis of Charcot before the destruction and collapse occurs?
How are we able to adequately image the extent of damage, fragmentation and lysis in an individual at stage 0 Charcot?
How are we able to adequately image the extent of damage, fragmentation and lysis in an individual at stage 0 Charcot?
What is the most reliable specialized test during the earliest stage of Charcot?
What is the most reliable specialized test during the earliest stage of Charcot?
What are the major neuropathic differential diagnoses of Charcot with a predilection site of the foot/ankle?
What are the major neuropathic differential diagnoses of Charcot with a predilection site of the foot/ankle?
Who are some non-neuropathic mimickers of Charcot?
Who are some non-neuropathic mimickers of Charcot?
Study Notes
Charcot Foot Overview
- Diabetic Neuro-Osteopathy (DNOAP) involves osteoclastic resorption mediated by pro-inflammatory cells.
- Charcot arthropathies result in rapid destruction of bones and joints associated with neuropathy.
- Early Charcot joint shows increased range of motion (ROM); however, after 8 weeks, the ROM decreases.
Types and Etiology of Charcot Arthropathies
- Two charcot arthropathy types: hypertrophic (charcot joints) and atrophic (diabetic osteolysis).
- Charcot can occur due to factors beyond diabetes, including juvenile-onset DM leading to bilateral DNOAP.
- Key theories of development: neurovascular damage affecting trophic centers and repetitive trauma to insensate feet.
- Modern understanding emphasizes the role of pro-inflammatory cytokines in Charcot development.
Radiographic Classification Systems
- Sanders-Frykberg classification identifies common targets: Lisfranc Joint is highly affected.
- Types within this system include:
- Type 1: Involves IPJs, phalanges, MPJs; characterized by atrophic changes and common plantar ulcers.
- Type 2: Lisfranc's joint; most prevalent with subluxations and notable deformations.
- Type 3: Includes Chopart + navicular calcaneus; hallmark is navicular osteolysis.
- Type 4: Ankle joint involvement; marked destruction and instability.
- Type 5: Calcaneus involvement; rare, linked to insufficiency fracture.
Brodsky Classification
- Type 1 involves tarsometatarsal joints and is commonly seen with "cube foot."
- Type 2 affects STJ, TN, CC joints, associated with chronic instability.
- Type 3a is linked to talocrural joint; characterized by prolonged healing times.
- Type 3b includes avulsions at the posterior calcaneal tuberosity; leads to secondary collapse of the foot.
Clinical Features of Charcot Foot
- Symptoms may include variable pain, swelling, deformity, and shoe fit issues; pain is less reported.
- Evidence of infection includes severe pain in an otherwise asymptomatic Charcot foot.
- The 5 Ds of Charcot foot: destruction, density, debris, disorganization, and dislocation.
Eichenholtz Classification Stages
- Stage 1 (Development): marked by fragmentation, increased ROM, and clinical signs like swelling and heat.
- Stage 2 (Coalescence): involves new bone formation, increased sclerosis, and absorption of fragments.
- Stage 3 (Reconstruction): involves bony consolidation and healing, decreased swelling, and reduced ROM.
- Stage 0 (Charcot in situ): presents no radiographic changes but marked by local warmth and potential instability.
Imaging and Diagnosis
- Importance of early diagnosis in Eichenholtz stage zero to prevent subsequent destruction.
- Specialized imaging such as CT, MRI, or triphasic bone scans aid in assessing damage at stage 0.
- Differential diagnoses include diabetic neuropathy, chronic alcohol use, and other conditions mimicking Charcot.
Key Points on Treatment and Management
- Analyze common presentations: hot swollen foot suggests Charcot until proven otherwise.
- Early identification and imaging are critical to manage and prevent complications associated with Charcot foot.
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Description
This quiz covers the key concepts related to Charcot Foot and its types, focusing on the pathophysiology of Diabetic Neuro-Osteopathy (DNOAP) and the classification systems used to identify various manifestations. Participants will explore the etiology, radiographic classification, and implications of this condition, enhancing their understanding of Charcot arthropathies.
