What is Neuroarthropathy?

Neuroarthropathy is a destructive arthritis facilitated by neurological (nerve) disease. It is also known as Charcot joint disease. It is named for Jean-Marie Charcot a French neurologist who observed a severe pattern of joint destruction in patients with advanced syphilis. This advanced (tertiary) syphilis commonly causes absence of normal sensation; especially in the lower extremities (foot and ankle). Charcot noted this in 1868. For the last seventy years this has also been observed in patients with diabetic peripheral neuropathy (nerve disease). This neuropathy also causes a loss of normal sensation. Feet can become totally insensate (without feeling). It’s common for these feet to have normal arterial circulation. The last predisposing factor to Neuroarthropathy is trauma. Trauma can be acute as an injury like a fracture or sprain; or it can be subtle like a repetitive stress injury. A person whose foot musculoskeletal structure is even slightly dysfunctional is at a much greater risk for this destructive arthritis.

Who develops Neuroarthropathy?

The vast majority of patients who develop this arthropathy have diabetes mellitus. Specifically these patients have diabetic peripheral neuropathy. The incidence in the diabetic population is about 8.5 per 1000 patients. There are approximately sixteen million diagnosed and undiagnosed diabetics in the United States population; and another approximately forty million people with impaired glucose tolerance making them predisposed to diabetes mellitus.

Why do they develop Neuroarthropathy?

Simply put trauma with out pain. In the sensate foot even minor trauma causes pain. In the insensate foot the pain is not perceived. Pain is important for telling us something is wrong. Without the pain the diabetic person doesn’t feel strain, sprains, arthritis, fractures, and minor and major injuries. Without the pain telling the person there is a problem the person aggravates the condition which can lead to joint and bone destruction. Multiple fractures and total joint destruction are not uncommon. Neuroarthropathy can become so bad the foot or ankle becomes totally destroyed necessitating special shoes, foot orthosis, bracing, surgical care and even possible amputation.

Are there other conditions that lead to Neuroarthropathy?

Any disease or disorder that leads to an insensate foot can cause Neuroarthropathy.

Spine trauma can be a cause. Infectious disease such as syphilis and leprosy can be causes. Neurological disorders such as Charcot-Marie-Tooth disease; and vitamin deficiency can also be causes. These represent a miniscule incidence of Neuroarthropathy. But the worse trend of all and the highest risk are probably in people who are both diabetic and alcoholic.

What are common symptoms of Neuroarthropathy?

Unexplained swelling of the foot and ankle usually unilateral (one side) usually without pain is a common presentation. Redness and heat maybe present. Common differential diagnosis includes gout, infection of soft tissues or bone and tendonitis.

How is Neuroarthropathy diagnosed?

Clinical examination with basic history are physical should lead a clinician to be highly suspicious of the disorder. An insensate diabetic patient who present with a unilateral warm, swollen, reddish foot with no history of significant should preliminarily treated as having Neuroarthropathy until proven otherwise. More advanced cases can have crepitating or grating noises between bone and joints when place through a range of motion.

Radiographs in early stages can often be inconclusive. In later stages they can be quite self evident with severe bone destruction, dislocations and fractures. Bone scans are helpful in making a diagnosis. Other testing such as MRI or CT scans can be helpful in diagnosing bone abscess and for surgical staging.

How is it treated?

Initial treatment consists of immobilization with a cast or cam-walker. Total non-weight bearing is mandatory. Use of crutches, walkers and knee walkers is a necessity also. Use of a wheelchair is not uncommon. After the condition becomes quiescent foot orthosis, special insoles, extra-depth shoes, custom shoes, braces and ankle foot orthosis may be needed to control the condition and stabilize deformity. Surgical care is sometimes needed.