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Modification of shoe wear
9%
298/3189
Use of a total contact cast
78%
2493/3189
Ankle arthrodesis
301/3189
Spanning external fixation of the ankle and hindfoot
1%
42/3189
Below-knee amputation
44/3189
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Charcot arthropathy is a devastating bone and joint disease. While it most commonly occurs in those with diabetes and neuropathy, it has been known to occur with other non-diabetic neuropathies as well. Figures A and B show severe Charcot changes to the hindfoot, leading to the patient's reports of pain and instability. Initial treatment should include bracing and frequent skin checks to monitor for development of ulcerations or other skin lesions. Neuropathic osteoarthropathy, otherwise known as Charcot neuroarthropathy, is a chronic, degenerative arthropathy and is associated with decreased sensory innervation. Typical findings include joint destruction, disorganization, and effusion with osseous debris. Progression of Charcot neuroarthropathy often follows a predictable clinical and radiographic pattern and is described by the Eichenholtz classification found in Illustration A. Hatzis et al reviewed a case series of neuroarthropathy of the shoulder (radiograph shown in Illustration B), and found that syringomyelia is the most common etiology of this disorder in the shoulder. The referenced article by van der Ven is a review of the etiologies, pathogenesis, treatments, and outcomes of Charcot neuroarthropathy of the foot and ankle.
3.7
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