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Arthritis und Rheuma 2008; 28(04): 223-230
DOI: 10.1055/s-0037-1620120
Diabetes und Rheuma
Schattauer GmbH

Diabetisch neuropathische Osteoarthropathie – Charcot-Fuß

Diabetic neuropathic osteoarthropathy – Charcot foot
O. Tajiyeva   *
1   Friedrich-Schiller-Universität Jena, Klinik für Innere Medizin III (Direktor: Prof. Dr. Gunter Wolf), Endokrinologie/Stoffwechselerkrankungen
,
T. Neumann   *
2   Rheumatologie/Osteologie (Leiter: Prof. Dr. Gert Hein)
› Author Affiliations
Further Information

Publication History

Publication Date:
24 December 2017 (online)

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Zusammenfassung

Die diabetisch neuropathische Osteoarthropathie (DNOAP, Charcot-Fuß) ist eine nichtinfektiöse Arthropathie, die sich in einem gut durchbluteten, insensitiven und biomechanisch alterierten Fuß entwickelt. Diabetes mellitus ist die häufigste Ursache der DNOAP, wobei die Veränderungen auch bei sensomotorischen Neuropathien anderer Genese auftreten. Die Pathogenese ist bisher nicht sicher aufgeklärt. Im Verlauf der Erkrankung tritt eine Knochen- und Gelenkdestruktion mit Fragmentation und anschließendem Remodelling der Gelenkstukturen auf. Charakteristischerweise präsentieren sich die Patienten mit einem warmen, geschwollenen und wenig schmerzhaften Fuß. Das Nativ-Röntgenbild ist diagnostisch wegweisend und wird in der differenzialdiagnostischen Abgrenzung gegenüber der Osteomyelitis durch die MR-Tomografie ergänzt. Die Therapie der DNOAP richtet sich nach dem Erkrankungsstadium. In der Frühphase der Erkrankung ist eine konsequente Druckentlastung von zentraler Bedeutung. Spätere Fußkomplikationen sind häufig, weshalb eine sorgfältige Verlaufskontrolle wichtig ist.

Summary

Diabetic neuropatic osteoarthropathy (DNOAP, Charcot joint disease) is a noninfective arthropathy in a well-perfused, insensitive and biomechanical altered foot. Although DNOAP occurs in various sensomotoric neuropathies, diabetes mellitus is the most common cause. The pathogenesis remains still uncertain. During the course of disease bone and joint destruction, fragmentation, and remodelling can develop. In patients presenting with a warm, swollen and only slightly painful foot, DNOAP should be concidered. Plain radiography is adequate to make the diagnosis, but magnetic resonance imaging can be helpful to exclude osteomyelitis. The treatment of DNOAP depends on the stage of the disease. Patients with a history of Charcot joint disease are at high risk of future foot problems, and careful follow- up is mandatory.

Schlüsselwörter

Diabetisch neuropathische Osteoarthropathie - Charcot-Fuß - Diabetes mellitus - Druckentlastung

Keywords

Diabetic neuropathic arthropathy - Charcot joint disease - diabetes mellitus - offloading

* Die Autoren haben einen gleichen Anteil an der Erstellung des Manuskripts


 

  • Literatur

  • 1 Jeffcoate WJ, Price P, Harding KG. Wound healing and treatments for people with diabetic foot ulcers. Diabetes/metabolism research and reviews 2004; 20 (Suppl. 01) Suppl S78-89.
    CrossrefPubMedGoogle Scholar
  • 2 Charcot JM. Sur quelques arthropathies qui paraissent dependre d'une lesion du cerveau ou de la moelle epiniere. Archivesde Physiologie normale et pathologique 1868; 1: 161-178.
    Google Scholar
  • 3 Nagarkatti DG, Banta JV, Thomson JD. Charcot arthropathyinspina bifida. J Pediatr Orthop 2000; 20: 82-87.
    PubMedGoogle Scholar
  • 4 McKay DJ, Sheehan P, De Lauro TM, Iannuzzi LN. Vincristine-induced neuroarthropathy (Char-cot'sjoint). Journal of the American Podiatric Medical Association 2000; 90: 478-480.
    CrossrefPubMedGoogle Scholar
  • 5 Jordan WR. Neuritic manifestations in diabetes mellitus. Arch Intern Med 1936; 57: 307-358.
    CrossrefGoogle Scholar
  • 6 Frykberg RG, Kozak GP. Neuropathic arthropathy in the diabetic foot. Am F am Physician 1978; 17: 105-113.
    Google Scholar
  • 7 Edmonds ME. Progress in care of the diabetic foot. Lancet 1999; 354: 270-272.
    CrossrefPubMedGoogle Scholar
  • 8 Wilson M. Charcot foot osteo arthropathy in diabetes mellitus. Mil Med 1991; 156: 563-569.
    CrossrefPubMedGoogle Scholar
  • 9 Edmonds ME, Watkins PJ. Plantar Neuropathic ulcers and charcot joints: risk factors, presentation, and management. In, Diabetic Neuropathy. Philadelphia: WB Saunders; 1999: 398-406.
    Google Scholar
  • 10 Sinha S, Munichoodappa CS, Kozak GP. Neuroarthropathy (Charcot joints) in diabetesmellitus (clinical study of 101 cases). Medicine (Balti-more) 1972. 51 191-210.
    Google Scholar
  • 11 Bailey CC, Root HP. Neuropathic foot lesions in diabetes mellitus. N Engl J Med 1947; 387: 401.
    Google Scholar
  • 12 Fabrin J, Larsen K, Holstein PE. Long-term follow-up in diabetic Charcot feet with spontaneous onset. Diabetes care 2000; 23: 796-800.
    CrossrefPubMedGoogle Scholar
  • 13 Klenerman L. The Charcot joint in diabetes. Diabet Med 1996; 13 (Suppl. 01) Suppl S52-S54.
    CrossrefPubMedGoogle Scholar
  • 14 Smith DG, Barnes BC, Sands AK. et al. Prevalence of radiographic foot abnormalities in patients with diabetes. Foot Ankle Int 1997; 18: 342-346.
    CrossrefPubMedGoogle Scholar
  • 15 Cofield RH, Morrison MJ, Beabout JW. Diabetic neuroarthropathy in the foot: patient characteristics and patterns of radiographic change. Foot Ankle 1983; 4: 15-22.
    CrossrefPubMedGoogle Scholar
  • 16 Clouse ME, Gramm HF, Legg M, Flood T. Diabetic osteoarthropathy. Clinical and roentgenographicobservations in 90 cases. Am J Roentgenol Radium Ther Nucl Med 1974; 121: 22-34.
    CrossrefPubMedGoogle Scholar
  • 17 Armstrong DG, Todd WF, Lavery LA. et al. The natural history of acute Charcot'sarthropathyinadiabetic foot specialty clinic. Journal of the American Podiatric Medical Association 1997; 87: 272-278.
    CrossrefPubMedGoogle Scholar
  • 18 Griffith J, Davies AM, Close CF, Nattrass M. Organized chaos? Computed tomographic evaluation of the neuropathic diabetic foot. Br J Radiol 1995; 68: 27-33.
    CrossrefPubMedGoogle Scholar
  • 19 Gazis A, Pound N, Macfarlane R. et al. Mortality in patients with diabetic neuropathic osteoarthropathy (Charcot foot). Diabet Med 2004; 21: 1243-1246.
    CrossrefPubMedGoogle Scholar
  • 20 Chammas NK, Hill RL, Foster AV, Edmonds ME. Is neuropathic ulceration the key tounder standing increased mortality due to is chaemic heart disease in diabetic foot ulcer patients? A population approach using a proportionate model. J Int Med Res 2002; 30: 553-559.
    CrossrefPubMedGoogle Scholar
  • 21 Rajbhandari SM, Jenkins RC, Davies C, Tesfaye S. Charcot neuroarthropathy in diabetes mellitus. Diabetologia 2002; 45: 1085-1096.
    CrossrefPubMedGoogle Scholar
  • 22 Boulton AJ. Lawrence lecture. The diabetic foot: neuropathic in aetiology?. Diabet Med 1990; 7: 852-858.
    CrossrefPubMedGoogle Scholar
  • 23 Flynn MD, Edmonds ME, Tooke JE, Watkins PJ. Direct measurement of capillary blood flow in the diabetic neuropathic foot. Diabetologia 1988; 31: 652-656.
    CrossrefPubMedGoogle Scholar
  • 24 Edmonds ME, Clarke MB, Newton S. et al. Increased up take of bone radio pharmaceutical indiabetic neuropathy. The Quarterlyjournal of medicine 1985; 57: 843-855.
    Google Scholar
  • 25 Collange C, Burde MA. Musculoskeletal problems of neurogenicorigin. Bailliere's best practice & research 2000; 14: 325-343.
    Google Scholar
  • 26 Gough A, Abraha H, Li F. et al. Measurement of markers of osteoclast and osteoblast activity in patients with acute and chronic diabetic Charcot neuroarthropathy. Diabet Med 1997; 14: 527-531.
    CrossrefPubMedGoogle Scholar
  • 27 Togari A. Adrenergic regulation of bone metabolism: possible involvement of sympathetic innervation of osteoblastic and osteoclastic cells. Microscopyresearch and technique 2002; 58: 77-84.
    Google Scholar
  • 28 Udagawa N. Mechanisms involved in bone resorption. Biogerontology 2002; 3: 79-83.
    CrossrefPubMedGoogle Scholar
  • 29 Chambers TJ. Regulation of the differentiation and function of osteoclasts. The Journal of pathology 2000; 192: 4-13.
    CrossrefPubMedGoogle Scholar
  • 30 Chantelau E, Onvlee GJ. Charcot foot in diabetes: farewell to the neurotrophic theory. Hormone and metabolic research Hormon-und Stoffwechselforschung 2006; 38: 361-367.
    PubMedGoogle Scholar
  • 31 Anonymous Bm G. In: Sitzung vom 17. November 1886; Berliner Klinische Wochenschrift 1886; 851: 855.
    Google Scholar
  • 32 O'Connor BL, Palmoski MJ, Brandt KD. Neurogenic acceleration of degenerative joint lesions. The Journal of bone and joint surgery 1985; 67: 562-572.
    CrossrefPubMedGoogle Scholar
  • 33 Brower AC, Allman RM. Pathogenesis of the neurotrophic joint: neurotraumatic vs. neurovascular. Radiology 1981; 139: 349-354.
    CrossrefPubMedGoogle Scholar
  • 34 Frykberg RG, Mendeszoon E. Management of the diabetic Charcot foot. Diabetes/metabolism research and reviews 2000; 16 01 Suppl S59-S65.
    CrossrefPubMedGoogle Scholar
  • 35 Boyko EJ, Ahroni JH, Stensel V. et al. A prospective study of risk factors for diabetic foot ulcer. The Seattle Diabetic Foot Study. Diabetes care 1999; 22: 1036-1042.
    CrossrefPubMedGoogle Scholar
  • 36 Hofbauer LC, Heufelder AE. Clinical review 114: hot topic. The role of receptor activator of nuclear factor-kappa B ligand and osteoprotegerin in the pathogenesis and treatment of metabolic bone diseases. The Journal of clinical endocrinology and metabolism 2000; 85: 2355-2363.
    PubMedGoogle Scholar
  • 37 Boyle WJ, Simonet WS, Lacey DL. Osteoclast differentiation and activation. Nature 2003; 423: 337-342.
    CrossrefPubMedGoogle Scholar
  • 38 Hofbauer LC, Schoppet M. Clinical implications of the osteoprotegerin/RANKL/RANK system for bone and vascular diseases. Jama 2004; 292: 490-495.
    CrossrefPubMedGoogle Scholar
  • 39 Jiang MZ, Tsukahara H, Ohshima Y. et al. Effects of antioxidants and nitric oxide on TNF-alpha-induced adhesion molecule expression and N Fkappa B activation in human dermal micro vascular endothelial cells. Life sciences 2004; 75: 1159-1170.
    CrossrefPubMedGoogle Scholar
  • 40 Tintut Y, Morony S, Demer LL. Hyperlipidemia promotes osteoclastic potential of bone marrow cells ex vivo. Arteriosclerosis, thrombosis, and vascular biology 2004; 24: e6-10.
    CrossrefPubMedGoogle Scholar
  • 41 Yerneni KK, Bai W, Khan BV. et al. Hyperglycemia-induced activation of nuclear transcription factor kappa B in vascular smooth muscle cells. Diabetes 1999; 48: 855-864.
    CrossrefPubMedGoogle Scholar
  • 42 Aljada A, Ghanim H, Saadeh R, Dandona P. Insulin inhibits N F kappa Band MCP-1 expression in human aortic endothelial cells. The Journal of clinical endocrinology and metabolism 2001; 86: 450-453.
    PubMedGoogle Scholar
  • 43 Jeffcoate W. Vascular calcification and osteolysis in diabetic neuropathy-is RANK-L the missing link?. Diabetologia 2004; 47: 1488-1492.
    CrossrefPubMedGoogle Scholar
  • 44 Gerstenfeld LC, Cho TJ, Kon T. et al. Impaired intra membranous bone formation during bone repair in the absence of tumor necrosis factor-alpha signaling. Cells, tissues, organs 2001; 169: 285-294.
    CrossrefPubMedGoogle Scholar
  • 45 Sugawara J, Hayashi K, Kaneko F. et al. Reductions in basal limb blood flow and lumen diameter after short-term leg casting. Medicine and science in sports and exercise 2004; 36: 1689-1694.
    CrossrefPubMedGoogle Scholar
  • 46 Yamaguchi M, Kojima T, Kanekawa M. et al. Neuropeptides stimulate production of interleukin-1 beta, interleukin-6, and tumor necrosis factor-alpha in human dental pulp cells. Inflamm Res 2004; 53: 199-204.
    CrossrefPubMedGoogle Scholar
  • 47 Schon LC, Easley ME, Weinfeld SB. Charcot neuroarthropathy of the foot and ankle. Clinical orthopaedics and related research 1998; 116: 131.
    Google Scholar
  • 48 Eichenholtz SN.. Charcot joints. In Springfield Ill: Thomas; ed 1966
  • 49 Sanders LJ, Frykberg RG. Diabetic neuropathic osteoarthropathy: the Charcot foot. In Frykberg RG.. Ed The high risk foot in diabetes mellitus. NewYork, NY: Churchill Livingstone; 1991: 297-338.
    Google Scholar
  • 50 Reike H. Diabetische Osteoarthopathie und Char-cot Fuß. In: Diabetisches Fußsyndrom. Berlin: de Gruyter 1999; 69: 80.
    Google Scholar
  • 51 Chantelau E, Poll LW. Evaluation of the diabetic charcot foot by MR imaging or plain radiography –an observational study. Exp Clin Endocrinol Diabetes 2006; 114: 428-431.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 52 Chantelau E. The perils of procrastination: effects of early vs. delayed detection and treatment of incipient Charcot fracture. Diabet Med 2005; 22: 1707-1712.
    CrossrefPubMedGoogle Scholar
  • 53 Chantelau E, Richter A, Ghassem-Zadeh N, Poll LW. Silent“ bonestress injuries in the feet of diabetic patients with polyneuropathy: areporton 12 cases. Archives of orthopaedic and trauma surgery 2007; 127: 171-177.
    CrossrefPubMedGoogle Scholar
  • 54 Pinzur MS. Current concepts review: Charcot arthropathy of the foot and ankle. Foot Ankle Int 2007; 28: 952-959.
    CrossrefPubMedGoogle Scholar
  • 55 Newman LG, Waller J, Palestro CJ. et al. Unsuspected osteomyelitis in diabetic foot ulcers. Diagnosis and monitoring byleukocyte scanning with indium in 111 oxyquinoline. Jama 1991; 266: 1246-1251.
    CrossrefPubMedGoogle Scholar
  • 56 Höpfner S, Krolak C, Kessler S. et al. Preoperative imaging of Charcot neuroarthropathy indiabetic patients: comparison of ring PET, hybrid PET, and magnetic resonance imaging. Foot Ankle Int 2004; 25: 890-895.
    CrossrefPubMedGoogle Scholar
  • 57 Keidar Z, Militianu D, Melamed E. et al. The diabetic foot: initial experience with 18F-FDG PET/ CT. J Nucl Med 2005; 46: 444-449.
    PubMedGoogle Scholar
  • 58 Larsen K, Holstein PE. Stress Fractures as a Cause of Charcot Feet. In: Proceedings of the First International Symposium on the Diabetic Foot. Bakker K.. ed Amsterdam: Excerpta Medica. 1991: 108-116.
    Google Scholar
  • 59 Young MJ, Marshall A, Adams JE. et al. Osteopenia, neurological dysfunction, and the development of Charcot neuroarthropathy. Diabetes care 1995; 18: 34-38.
    CrossrefPubMedGoogle Scholar
  • 60 Mittlmeier T, Klaue K, Haar P, Beck M. Charcot foot. Current situation and outlook. Unfallchirurg 2008; 111: 218-231.
    CrossrefPubMedGoogle Scholar
  • 61 Pitocco D, Ruotolo V, Caputo S. et al. Six-month treatment with alendronate in acute Charcot neuroarthropathy: a randomized controlled trial. Diabetes care 2005; 28: 1214-1215.
    CrossrefPubMedGoogle Scholar
  • 62 Jeffcoate WJ, Game FL, Armstrong DG, Cavanagh PR. Acute neuropathic joint disease: a medical emergency?. Diabetes care 2006; 29: 951-952. author reply 952.
    PubMedGoogle Scholar
  • 63 Pinzur M. Surgical versus accommodative treatment for Charcot arthropathy of the mid foot. Foot Ankle Int 2004; 25: 545-549.
    CrossrefPubMedGoogle Scholar
  • 64 Armstrong DG, Lavery LA, Harkless LB. Who is at risk for diabetic foot ulceration?. Clin Podiatr Med Surg 1998; 15: 11-19.
    PubMedGoogle Scholar
  • 65 Schon LC, Marks RM. The management of neuroarthropathic fracture-dislocations in the diabetic patient. Orthop Clin North Am 1995; 26: 375-392.
    PubMedGoogle Scholar
  • 66 Baravarian B, Van Gils CC. Arthrodesis of the Charcot foot and ankle. Clin Podiatr Med Surg 2004; 21: 271-289.
    CrossrefPubMedGoogle Scholar
  • 67 Garapati R, Weinfeld SB. Complex reconstruction of the diabetic foot and ankle. Am J Surg 2004; 187: 81S-86S.
    CrossrefPubMedGoogle Scholar
  • 68 Pakarinen TK, Laine HJ, Honkonen SE. et al. Charcot arthropathy of the diabetic foot. Current concepts and review of 36 cases. Scand J Surg 2002; 91: 195-201.
    CrossrefPubMedGoogle Scholar