الفهرس 
Charcot footOnly 14 pages are availabe for public view
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Abstract
Charcot neuropathic osteoarthropathy commonly referred to as the charcot foot. It is one of the longstanding complications of diabetes mellitus. It is a condition affecting bone joints and soft tissues of the foot and ankle characterized by inflammation in the earliest phase.
Peripheral neuropathy is the underlying cause of charcot foot, and the most common etiology of peripheral neuropathy is diabetes mellitus.
The interaction between several factors of diabetes mellitus named sensory neuropathy, motor neuropathy, autonomic neuropathy, trauma and metabolic abnormalities of bone results in acute localized inflammatory condition of bone and soft tissues of the foot that may lead to varying degrees of bone destruction, sub laxation, dislocation, deformity and ulceration.
Prevalence of charcot foot in specialized foot clinics ranges from 0.1% to as high as 13% while incidence of charcot disease in diabetic patients ranges from 0.15% to 2.5%. Bilateral disability has been observed in 39% of charcot patients. Incidence of undiagnosed charcot disease among diabetic patients ranges from 0.4% to 13%.
There is specific X- ray findings of charcot foot which are focal bone demineralization, debris formation at the articular margin, fragmentation of subchondral bone, capsular distension, subluxation, dislocation and particular fractures. Early detection of these findings plays an important role in early diagnosis of charcot disease and minimizing its serious complications especially major amputations.
In this study we included 50 patients with long standing diabetes mellitus (ten years or more) who are not diagnosed earlier with charcot foot. We excluded children below 18 years old, patients with any cause of peripheral neuropathy other than diabetes mellitus, patients currently have any type of foot ulcers or had pervious minor or major amputations and patients with peripheral arterial diseases.
All patients included in the study had bilateral plain foot X-ray in both antero-posterior and oblique views and these X-rays were assessed by radiology department in Sheikh Zayed specialized hospital to identify early signs of charcot foot in the plain foot x rays and the percentage of patients whose X-rays showed the early charcot changes to the overall patients of the sample was calculated.
Among the 50 patients of the study, 26 (52%) patients had positive findings for charcot disease while 24 (48%) patients showed negative results. In the positive group, the X-ray studies on both feet with oblique lateral and antero-posterior views showed focal bone demineralization only in eight patients, focal bone demineralization with fragmentation of subchondral bone and mild dislocation in three cases, debris formation at the articular margin with fragmentation of subchondral bone and mild sublaxation in eight cases, capsular distention with fragmentation of subchondral bone and mild sublaxation in two patients, and fragmentation of subchondral bone with debris formation at the articular margin in five patients.
Positive findings on X-ray were significantly found to be related with increasing age of the patients. There was statistically significant relation between finding positive changes on X-ray with increase of HbA1C (which reflects poor glycemic control) and DM duration. Also,
positive changes were significantly related to BMI increase. On the other hand, there was no statistically significant relation between finding positive changes on X-ray with gender or type of diabetic medication.
The 26 patients of the positive group were advised about weight reduction, proper glycemic control, avoiding minor trauma and were followed up by x ray studies of the affected foot to detect new charcot attacks and whether new skeleton regions were involved. All these patients remained asymptomatic throughout the duration of the study except the five patients who had new changes in their follow up X-rays at six months, when three of them showed mild foot swelling, and one patient showed moderate foot swelling, and they started immediately offloading in the form of total contact cast. While only one patient showed mild midfoot discomfort and he started immediately offloading in the form of airwalker.
Among the 20 positive patients who had mid-foot involvement, five (19.23%) patients showed new changes on X-ray in the previously affected foot at 6 months, to those patients MRI studies were performed to ensure a proper management protocol and they started immediately offloading in the form of total contact cast (in four patients) or airwalker (in one patient). While the follow up X-rays of the six patients who had forefoot involvement showed no new changes.
The patients whose x rays showed no changes were advised to follow the usual guidelines mentioned before to avoid having charcot foot or foot ulcers and deformities.
from the previous data we can conclude that patients with longstanding diabetes mellitus with no obvious deformity or foot ulcerations should be screened with bilateral foot X-rays to detect early
Charcot foot X-ray findings. These X-rays should be assessed by radiologists to detect the positive findings of early charcot foot, and positive cases should start offloading and proper foot wear as soon as possible, and they should be carefully followed up to avoid progression of the disease and its serious complications. So, it is more important to screen patients with longstanding diabetes mellitus and history of charcot foot or foot ulcerations or minor amputations with plain foot X- rays on their unaffected feet to detect the X-ray findings of early charcot foot, and patients with positive findings in their X-rays should start offloading as soon as possible to prevent progression of the disease and to avoid its serious complications.
Also, all patients with longstanding diabetes should be advised about proper glycemic control, avoiding minor trauma and seeking medical advice once early clinical signs of charcot foot appear (which are erythema and swelling and mild pain) to avoid misdiagnosis with similar conditions such as cellulitis, gout and superficial thrombophlebitis and to avoid progression of the disease and to avoid foot deformity.