New Concepts in the Management of Charcot Neuroarthropathy in Diabetes

• Published in: Advances in experimental medicine and biology Vol. 1307; p. 391
• Main Authors: Kavitha, Karakkattu Vijayan, Patil, Vrishali Swanand, Sanjeevi, Carani Balarman, Unnikrishnan, Ambika Gopalakrishnan
• Format: Journal Article
• Language: English
• Published: United States 01.01.2021
• Subjects: Arthropathy, Neurogenic - diagnosis; Arthropathy, Neurogenic - therapy; Diabetes Mellitus; Diabetic Foot - diagnosis; Diabetic Foot - therapy; Humans; Osteomyelitis; Quality of Life; Charcot Neuroarthropathy; Total contact cast; RANKL antibody; Charcot; Immobilization; Deformity; Diabetes; Neuropathy; Offloading; Bisphosphonates
• ISSN: 0065-2598
• DOI: 10.1007/5584_2020_498

Charcot Neuroarthropathy (CN) is an uncommon, debilitating and often underdiagnosed complication of chronic diabetes mellitus though, it can also occur in other medical conditions resulting from nerve injury. Till date, the etiology of CN remains unknown, but enhanced osteoclastogenesis is believed to play a central role in the pathogenesis of CN, in the presence of neuropathy. CN compromises the overall health and quality of life. Delayed diagnosis can result in a severe deformity that can act as a gateway to ulceration, infection and in the worst case, can lead to limb loss. In an early stage of CN, immobilization with offloading plays a key role to a successful treatment. Medical therapies seem to have limited role in the treatment of CN.In case of severe deformity, proper footwear or bracing may help prevent further deterioration and development of an ulcer. In individuals with a concomitant ulcer with osteomyelitis, soft tissue infection and severe deformity, where conservative measures fall short, surgical intervention becomes the only choice of treatment. Early diagnosis and proper management at an early stage can help prevent the occurrence of CN and amputation.