Questions and Answers
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?
Charcot arthropathies
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?
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Diabetes is the only condition that can lead to charcot joint changes.
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If an individual with Charcot has an ulcer, their life expectancy is ____________.
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DNOAP (diabetic neuro-osteopathy) is more commonly bilateral in what patients?
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What are the 2 theories of how an individual develops Charcot?
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What is the modern theory that was not previously theorized to cause charcot?
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When proinflammatory cytokines are released, what does it do to the bone?
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What is the name of the signaling system that regulates the osteoclastic activation and survival in normal bone remodeling?
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What is the name of the factor that protects the skeleton from excessive bone resorption?
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RANKL-mediated osteoclastic resorption is the modus operandi in infection mediated resorption.
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When the OPG/RANKL signaling pathway causes an increased expression of bone matrix proteins in vascular smooth muscle cells, what does this cause?
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Pain is the common complaint that brings individuals in that are suffering from charcot changes.
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If an individual has a severely painful charcot foot what is this suggestive of?
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What are the clinical symptoms of a charcot foot?
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When looking at the Sanders-Frykeberg classification where is the most common pedal target of the charcot joint?
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According to Sanders-Frykberg classification, what is the anatomic pattern type 1?
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When looking at the IP joints in an individual with Sanders-Frykberg classification type 1 pattern, what are you most likely to see?
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In the Sanders-Frykeberg classification pattern 1, radiographically we will see ___________ changes.
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What is the Sanders-Frykberg classification type 2?
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What are some frequent findings of an individual with a Sanders-Frykberg classification type 2 anatomic pattern?
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What is Sanders-Frykberg classification type III?
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What is Sanders-Frykberg classification type IV?
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What is Sanders-Frykberg classification type V?
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What is type 1 of the Brodsky classification?
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What is the most common type joint deformity that is seen with the Brodsky classification?
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Type 1 of the Brodsky classification rarely results in chronic instability.
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Brodsky classification type 2 has what joints involved?
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Type 2 of the Brodsky classification rarely results in chronic instability.
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What joints are involved in type 3a Brodsky classification?
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Type 3a of the Brodsky classification requires the longest time for bony healing.
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What portion of the foot is involved in an individual with a type 3b Brodsky classification?
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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?
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What are the 5 Ds of the charcot foot?
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What are the major differences between post traumatic OA and Charcot?
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Any patient with diabetes that presents with a hot swollen foot, what should you think?
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When looking at the Eichenholtz classification, what are the progressive radiographic stages that are seen?
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What is the primary radiographic finding of the Eichenholtz classification stage 1 'development' classification?
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In the developmental stage I of Eichenholtz classification the ROM is ____________.
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Clinically, an individual in stage 1 of the Eichenholtz classification will present with what?
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Subchondral osteopenia is an acute phase finding.
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Stage 2 of the Eichenholtz Classification is what?
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What occurs in the coalescence stage, stage 2 of Eichenholtz Classification?
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In what stage of Eichenholtz Classification do we see an increase in sclerosis?
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In Eichenholtz Classification stage 2, there is a loss of vascularity from fragmentation and disorganization which results in what?
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What is the radiographic hallmark of Stage 2 Coalescence stage Eichenholtz Classification?
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What is stage 3 of the Eichenholtz Classification?
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In which stage of Eichenholtz Classification would you find a decreased ROM of the foot?
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What do we see occurring in stage 3 of Eichenholtz Classification?
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What are the signs of healing?
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What is stage zero Charcot also known as?
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What are the radiographic findings of an individual with stage 0 Charcot?
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Individuals that are termed to be at stage zero are said to be an _____________ patient.
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When is it critically important to make the diagnosis of Charcot before the destruction and collapse occurs?
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How are we able to adequately image the extent of damage, fragmentation and lysis in an individual at stage 0 Charcot?
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What is the most reliable specialized test during the earliest stage of Charcot?
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What are the major neuropathic differential diagnoses of Charcot with a predilection site of the foot/ankle?
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Who are some non-neuropathic mimickers of Charcot?
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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.