Charcot Joint (Degenerative Neuropathic Osteoarthropathy)

There are several old and new terms of this associated conditions. Charcot’s joint is a progressive disease with a degenerative arthritis in combination with a decreased pain perception or position sense. More commonly this term is called Neuropathic Osteoarthropathy, or when associated with diabetes, is called Diabetic Neuropathic Osteoarthropathy (DNOAP).

Symptoms of neuropathic osteoarthropathy are varied but most always associated with partial or total loss of sensation. Likewise, there is sometimes seen swelling, redness, dislocations of bones, fractures, or ulcers. This can involve the entire foot or ankle, or a very specific joint. If both feet are put next to each other and compared there usually is a different look between the two. Neuropathic arthropathy goes through progressive stages each with differing symptoms. It is most important to know if you have decreased feeling in you feet, make sure a podiatrist has examined them and re-evaluates them with regular check-ups.

Causes of neuropathic osteoarthropathy are complex, and not completely understood. Some theories are more popular than others. With a mixed neuropathy or when nerves are not working properly, the vascular tone is decreased, meaning the blood vessels lose there firmness. Vasodilation is the termed used when the blood vessels open wider. Blood is then allowed to pool more in areas such as the foot since gravitation forces allow the blood to flow down easier. The increased blood flow tends to “wash out” or demineralize the bone more, producing a weaker than normal bone. With trauma, or in some cases simple excessive weight placed on a bone, the bone has a tendancy to break. With the decreased sensation, or neuropathy, one may not even detect pain if there is a fracture or break in the bone. Muscles can also be affected and weakened to produce structural deformities leading to ulcer formation or bone breakdown.

Diagnosis is first by clinical suspicion of symptoms. X-rays are usually needed to detect fractures, or dislocations of the bones. A bone scan may aid in the diagnosis, although a positive bone scan is not necessarily neuropathic arthropathy. Sometimes this condition is very difficult to distinguish between an infection

Podiatric Care can be from simply resting the foot with no weight, sometimes as long as 8-12 weeks or longer. Wound care is completed if there is an open ulcer. Biomechanical deformities are usually supported with appropriate bracing, orthotics, or other supports. Sometimes custom molded shoes can be made if you are at risk.

Surgery is sometimes indicated for a neuropathic osteoarthropathy condition. This type of surgery is usually an attempt at stabilization and reconstruction, and by no means is to make the foot “normal”. The goal is usually to prevent further damage or injury. The procedures vary from fixating fractures, reduction of dislocations, muscle lengthening and transfers, and arthrodesis procedures.