Diabetic Charcot Neuropathy - Foot & Ankle

Summary
- Diabetic Charcot Neuropathy is a chronic and progressive disease that occurs as a result of loss of protective sensation which leads to the destruction of foot and ankle joints and surrounding bony structures.
- Diagnosis can be made clinically with a warm and erythematous foot with erythema that decreases with foot elevation. Radiographs often reveal obliteration of joint space and fragmentation of both articular surfaces of a joint leading to subluxation or dislocation.
- Treatment is a trial of total contact casting for acute charcot deformities without skin breakdown. Operative management is indicated for recurrent infections, deformities, and severe skin breakdown.

Classification

Brodsky Classification
Type 1	Involves tarsometatarsal and naviculocuneiform joints Collapse leads to fixed rocker-bottom foot with valgus angulation	60%
Type 2	Involves subtalar, talonavicular or calcaneocuboid joints Unstable, requires long periods of immobilization (up to 2 years)	10%
Type 3A	Involves tibiotalar joint Late varus or valgus deformity produces ulceration and osteomyelitis of malleoli	20%
Type 3B	Follows fracture of calcaneal tuberosity Late deformity results in distal foot changes or proximal migration of the tuberosity	< 10%
Type 4	Involves a combination of areas	< 10%
Type 5	Occurs solely within forefoot	< 10%

Eichenholtz Classification
Stage 0		Joint edema Radiographs are negative Bone scan may be positive in all stages
Stage 1	Fragmentation	Joint edema Radiographs show osseous fragmentation with joint dislocation
Stage 2	Coalescence	Decreased local edema Radiographs show coalescence of fragments and absorption of fine bone debris
Stage 3	Reconstruction	No local edema Radiographs show consolidation and remodeling of fracture fragments

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