Learning objectives
To review the etiology,
course of disease and treatment of the Charcot foot
To recapitulate the classifications of this disease and discuss the need for a new one
To demonstrate the important role of imaging,
especially MR-Imaging in early diagnosis,
monitoring and evaluation of complications in Charcot foot
Background
Introduction
The Charcot foot or Charcot neuropathic osteoarthropathy (CN) has been first described 1868 by Jean-Martin Charcot,
a French pathologist and neurologist,
in patients with tabes dorsalis,
a syphilitic myelopathy [1].
Nowadays,
the detailed pathomechanisms of this disease remain unclear,
but there is consensus that polyneuropathy is the underlying basic condition of this disease.
In industrialized countries diabetes mellitus is the main cause of neuropathy in the lower limb [2].
The prevalence of CN in a general diabetic population is estimated between 0.1% and 7.5%,...
Imaging findings OR Procedure Details
Classifications
The Charcot neuropathic osteoarthropathy has been classified in various systems using anatomical landmarks on x-rays and clinical symptoms.
Sanders and Frykberg Classification
Sanders and Frykberg identified 5 zones of disease distribution according to their anatomical location,
as demonstrated in Fig.
9.
Zone I: metatarsophalangeal and interphalangeal joints (Fig.
10),
Zone II: tarsometatarsal joints (Fig.
11),
Zone III: tarsal joints (Fig.
12),
Zone IV: ankle and subtalar joints (Fig.
13),
Zone V: calcaneus (Fig.
14).
Most commonly involved are zone II (tarsometatarsal articulations) in about...
Conclusion
The Charcot foot is a rare disease,
associated with polyneuropathy,
in industrialized countries most commonly seen in the long-term diabetic population.
The Radiologist plays an important role in the management of this disease.
Therefore,
it is vital to be familiar with the typical imaging characteristics of the Charcot foot and to consider this diagnosis in a proper clinical setting.
Recognizing this disease in early stages prevents a delayed onset of an appropriate therapy (generally off-loading therapy) and helps minimizing the disability of these patients.
Commonly...
References
1. La Fontaine J,
Lavery L,
Jude E.
Current concepts of Charcot foot in diabetic patients.
Foot (Edinb).
2016;26:7–14.
doi:10.1016/j.foot.2015.11.001.
2. Ergen FB,
Sanverdi SE,
Oznur A.
Charcot foot in diabetes and an update on imaging.
Diabet Foot Ankle 2013.
doi:10.3402/dfa.v4i0.21884.
3. Schoots IG,
Slim FJ,
Busch-Westbroek TE,
Maas M.
Neuro-osteoarthropathy of the foot-radiologist: Friend or foe? Semin Musculoskelet Radiol.
2010;14:365–76.
doi:10.1055/s-0030-1254525.
4. van Netten JJ,
Prijs M,
van Baal JG,
Liu C,
van der Heijden F,
Bus SA.
Diagnostic values for skin temperature assessment...
Personal Information
C.
Loupatatzis
Department of Radiology,
Spital Maennedorf,
Asylstr.
10,
8708 Maennedorf,
Switzerland,
[email protected]
M.C.
Berli
Department of Orthopedic Surgery,Balgrist University Hospital,
Forchstrasse 340,
8008 Zurich,
Switzerland
C.W.A.
Pfirrmann,
A.B.
Rosskopf
Department of Radiology,
Balgrist University Hospital,
Forchstrasse 340,
8008 Zurich,
Switzerland